Case# 13-000290

Ohio Board of Nursing

17 South High Street, Suite 400 March 22, 2013

www.nursing.ohio.gov

Columbus, Ohio 43215-7410 4, (614) 466-3947

NOTICE OF AUTOMATIC SUSPENSION AND OPPORTUNITY FOR HEARING

Tiffany Lynn Aubrey, L.P.N. 4436 McColloch Street Wheeling, West Virginia 26003 Dear Ms. Aubrey: You are hereby notified that, on or about September 21, 2012, you entered into a Consent Agreement (September 2012 Consent Agreement) with the Ohio Board of Nursing (Board), a copy of which is attached hereto and incorporated herein, in which you agreed with the Board that your license to practice nursing as a licensed practical nurse in the State of Ohio would be suspended indefinitely and that such suspension would be stayed subject to probationary terms, conditions, and limitations for a minimum period of three (3) years. A. Item 4. of the September 2012 Consent Agreement states, M.S. AUBREY shall abstain completely from the personal use or possession of drugs, except those prescribed, administered, or dispensed to her by another so authorized by law who has received a complete copy of this Consent Agreement prior to prescribing for MS. AUBREY. MS. AUBREY shall self-administer the prescribed drugs only in the manner prescribed." Item 6. of the September 2012 Consent Agreement states, "Within forty-five (45) days of the effective date of this Consent Agreement and continuing throughout the probationary period, MS. AUBREY shall submit, at her expense and on the day selected, blood, breath, hair, or urine specimens for drug and/or alcohol analysis at a collection site specified by the Board at such times as the Board may request. Upon and after MS. AUBREY's initiation of drug screening, refusal to submit such specimen, or failure to submit such specimen on the day she is selected, or in such a manner as the Board may request, shall constitute a violation of a restriction placed on a license for purposes of Section 4723.28(B), ORC. This screening shall require a daily call-in process. The specimens submitted by MS) AUBREY shall be negative, except for substances prescribed, administered, or dispensed to her by another so authorized by law who has received a complete copy of this Consent Agreement prior to prescribing for MS. AUBREY." Despite these provisions, on November 26, 2012, you provided a specimen for analysis to Firstiab, the Board's random drug/alcohol screen program administrator, that tested positive for Oxycodone (Percocet). Prior to. November

Tiffany Lynn. Aubrey, L.P.N. Page 2 26, 2012, your last prescription for Percocet according to the Medication Report you submitted to the Board was issued on September 26, 2012 and ended on October 5, 2012. Furthermore, on the dates set forth in Attachment A, attached hereto and incorporated herein, you failed to call Firstlab to determine if you had been selected to provide a specimen for analysis. In addition, on the following dates, you were selected to provide a specimen for analysis and failed to do so: January 15, 2013 and on February 13, 2013. Section 4723.28(B)(8), ORC, authorizes the Board to discipline a licensee for self-administering or otherwise taking into the body any dangerous drug, as defined in section 4729.01 of the Revised Code, in any way not in accordance with a legal, valid prescription issued for that individual, or self-administering or otherwise taking into the body any drug that is a schedule I controlled substance. Section 4723.28(B)(17), ORC, authorizes the Board to discipline a licensee for violation of any restrictions placed on a nursing license by the Board. B. Item 6. a. of the September 2012 Consent Agreement states, "Prior to MS. AUBREY initiating drug screening, MS. AUBREY shall provide a copy of this Consent Agreement to all treating practitioners and shall provide to the Board a list of all treating practitioners, including addresses and telephone numbers and cause all treating practitioners to complete a medication prescription report that is to be mailed by the practitioner directly to the Board. The medication report is to be completed for any and all substances prescribed, administered, or dispensed to MS. AUBREY." Item 6. b. of the September 2012 Consent Agreement states, "After initiating drug screening, MS. AUBREY shall be under a continuing duty to provide a copy of this Consent Agreement, prior to initiating treatment, to additional treating practitioners, and to update the list of treating practitioners with the Board within forty-eight (48) hours of being treated by another practitioner. Further, MS. AUBREY shall notify the Board of any and all medication(s) or prescription(s) received within twenty-four (24) hours of release from hospitalization or medical treatment." Despite these provisions, you were admitted to WVU Hospitals and University Health Associates (WVU) on or about September 22, 2012 and discharged on or about September 26, 2012. To date, the Board has not received medication prescription report(s) from treating practitioners for medications/prescriptions associated with your hospitalization. You also failed to notify the Board, within 24 hours, of a prescription you received on or about November 7, 2012 from WVU for "pain medication" or for Norco prescribed on or about December 5, 2012. In a December 7, 2012 e-mail to a Board Monitoring Agent, regarding some of the unreported prescriptions, you stated, "[I-if the medication was the same, even though the Rx was written new by the physician, I did not realize that I needed to do Form 5 every time."

Tiffany Lynn Aubrey, L.P.N. Page 3 Section 4723.28(B)(17), ORC, authorizes the Board to discipline a licensee for violation of any restrictions placed)on a nursing license by the Board. C. Item 7. of the September 2012 Consent Agreement states, "Within thirty (30) days of the effective date of this Consent Agreement and continuing throughout the probationary period MS. AUBREY shall attend a minimum of one (1) meeting per week of a support or peer group meeting approved in advance by the Board or its designee, or a Twelve Step program, and MS. AUBREY shall provide satisfactory documentation of such attendance to the Board beginning within sixty (60) days of the effective date of this Consent Agreement and every six (6) months thereafter." Despite this provision, you failed to provide documentation of attendance to the Board within the timeframe established by the September 2012 Consent Agreement In an e-mail you sent to the Board Monitoring Agent on or about December 7, 2012, you stated you were not aware of established timeframe. Section 4723.28(B)(17), ORC, authorizes the Board to discipline a licensee for violation of any restrictions placed on a nursing license by the Board. D. Item 8. of the September 2012 Consent Agreement states, "Within sixty (60) days following the effective date of this Consent Agreement, MS. AUBREY shall, at her expense, begin chemical dependency counseling at the Intensive Outpatient Level with a provider (IOP Provider) approved in advance by the Board or its designee. MS. AUBREY shall cause the IOP Provider to submit quarterly written reports to the Board regarding: (i) MS. AUBREY's current diagnosis; (ii) MS. AUBREY's compliance with treatment recomMendations/plans, including but not limited to appropriate use of prescribed medications; (iii) all dates MS. AUBREY was seen in the three month period prior to the date of the report; and (iv) any concerns regarding MS. AUBREY's ability to practice nursing in accordance with acceptable and prevailing standards of safe nursing care. Further, MS. AUBREY agrees that the Board may use the IOP Provider's recommendations during the course of treatment, and recommendations for continuing care, as a basis for additional terms, conditions, and limitations on MS. AUBREY's license and that the terms, conditions, and limitations may be incorporated in any addendum to this Consent Agreement." Despite this provision, as of March 6, 2013, you have failed to provide required information to the Board to permit the Board to grant approval for an Intensive Outpatient Level chemical dependency provider, failed to obtain prior approval for an Intensive Outpatient Level chemical dependency provider, and failed to begin counseling within the timeframe established by the September 2012 Consent Agreement.

Tiffany Lynn Aubrey, L.P.N. Page 4 Section 4723.28(B)(17), ORC, authorizes the Board to discipline a licensee for violation of any restrictions placed on a nursing license by the Board. E. Item 14. of the September 2012 Consent Agreement states "MS. AUBREY shall submit any and all information that the Board may request regarding her ability to practice according to acceptable and prevailing standards of safe nursing practice." Despite this provision, you did not provide a written statement regarding your November 26, 2012 positive drug screen, as requested by the Board Monitoring Agent in his e-mail to you dated December 14, 2012. You also failed to cause the RiteAid Pharmacy in Benwood, West Virginia, to submit a list to the Board showing all prescriptions you had filled there since the effective date of the September 2012 Consent Agreement, as requested by the Board Monitoring Agent in his e-mail to you dated December 14, 2012. You also failed to cause information to be sent to the Board regarding a prescription you received for pain medication on or about November 7, 2012, as requested by the Board Monitoring Agent in his e-mail to you dated December 14, 2012. Additionally, you failed to provide information to the Board regarding the level of care being provided to you by Northwood Health Systems, as requested by the Board Monitoring Agent in his e-mail to you dated December 14, 2012. Section 4723.28(B)(17), ORC, authorizes the Board to discipline a licensee for violation of any restrictions placed on a nursing license by the Board. In accordance with the paragraph under "FAILURE TO COMPLY" of the September 2012 Consent Agreement, you are hereby notified that it appears to the Board that you have violated Items 4., 6., 6.a., 6.b., 7., 8., and 14. of the September 2012 Consent Agreement. Y U ARE FURTHER NOTIFIED THAT YOUR LICENSE TO PRACTICE NURSING AS A LICENSED PRACTICAL NURSE, PN-112171, IS HEREBY AUTOMATICALLY SUSPENDED. Continued practice after receipt of this notice of suspension shall be considered engaging in the practice of nursing as a licensed practical nurse without a current, valid license, which is a violation of Section 4723.03(B), ORC. You are further notified that in accordance with Chapter 119, ORC, the Board proposes under authority of Section 4723.28, ORC, to deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500400) per violation for the following reasons: 1. On or about September 21, 2012, you entered into a Consent Agreement (September 2012 Consent Agreement) with the Ohio Board of Nursing (Board), a copy of which is attached hereto and incorporated herein, in which you agreed with the Board that your license to practice nursing as a licensed practical nurse in the State of Ohio would be suspended indefinitely and that

Tiffany Lynn Aubrey, L.P.N. Page 5 such suspension would be stayed subject to probationary terms, conditions, and limitations for a minimum period of three (3) years. 2. Item 4. of the September 2012 Consent Agreement states, MS. AUBREY shall abstain completely from the personal use or possession of drugs, except those prescribed, administered, or dispensed to her by another so authorized by law who has received a complete copy of this Consent Agreement prior to prescribing for MS. AUBREY. MS. AUBREY shall self-administer the prescribed drugs only in the manner prescribed." Item 6. of the September 2012 Consent Agreement states, "Within forty-five (45) days of the effective date of this Consent Agreement and continuing throughout the probationary period, MS. AUBREY shall submit, at her expense and on the day selected, blood, breath, hair, or urine specimens for drug and/or alcohol analysis at a collection site specified by the Board at such times as the Board may request. Upon and after MS. AUBREY's initiation of drug screening, refusal to submit such specimen, or failure to submit such specimen on the day she is selected, or in such a manner as the Board may request, shall constitute a violation of a restriction placed on a license for purposes of Section 4723.28(B), ORC. This screening shall require a daily call-in process. The specimens submitted by MS. AUBREY shall be negative, except for substances prescribed, administered, or dispensed to her by another so authorized by law who has received a complete copy of this Consent Agreement prior to prescribing for MS. AUBREY." Despite these provisions, on November 26, 2012, you provided a specimen for analysis to Firstlab, the Board's random drug/alcohol screen program administrator, that tested positive for Oxycodone (Percocet). Prior to November 26, 2012, your last prescription for Percocet according to the Medication Report you submitted to the Board was issued on September 26, 2012 and ended on October 5, 2012. Furthermore, on the dates set forth in Attachment A, attached hereto and incorporated herein, you failed to call Firstlab to determine if you had been selected to provide a specimen for analysis. In addition, on the following dates, you were selected to provide a specimen for analysis and failed to do so: January 15, 2013 and on February 13, 2013. Section 4723.28(B)(8), ORC, authorizes the Board to discipline a licensee for self-administering or otherwise taking into the )body any dangerous drug, as defined in section 4729.01 of the Revised Code, in any way not in accordance with a legal, valid prescription issued for that individual, or self-administering or otherwise taking into the body any drug that is a schedule I controlled substance. Section 4723.28(B)(17), ORC, authorizes the Board to discipline a licensee for violation of any restrictions placed on a nursing license by the Board. 3. Item 6. a. of the September 2012 Consent Agreement states, "Prior to MS. AUBREY initiating drug screening, MS. AUBREY shall provide a copy of

Tiffany Lynn Aubrey, L.P.N. Page 6 this Consent Agreement to all treating practitioners and shall provide to the Board a list of all treating practitioners, includitg addresses and telephone numbers and cause all treating practitioners to complete a medication prescription report that is to be mailed by the practitioner directly to the Board. The medication report is to be completed for any and all substances prescribed, administered, or dispensed to MS. AUBREY." Item 6. b. of the September 2012 Consent Agreement states, "After initiating drug screening, MS. AUBREY shall be under a continuing duty to provide a copy of this Consent Agreement, prior to initiating treatment, to additional treating practitioners, and to update the list of treating practitioners with the Board within forty-eight (48) hours of being treated by another practitioner. Further, MS. AUBREY shall notify the Board of any and all medication(s) or prescription(s) received within twenty-four (24) hours of release from hospitalization or medical treatment" Despite these provisions, you were admitted to WVU Hospitals and University Health Associates (WVU) on or about September 22, 2012 and discharged on or about September 26, 2012. To date, the Board has not received medication prescription report(s) from treating practitioners for medications/prescriptions associated with your hospitalization. You also failed to notify the Board, within 24 hours, of a prescription you received on or about November 7, 2012 from WVU for "pain medication" or for Norco prescribed on or about December 5, 2012. In a December 7, 2012 e-mail to a Board Monitoring Agent, regarding some of the unreported prescriptions, you stated, "[I]f the medication was the same, even though the Rx was written new by the physician, I did not realize that I needed to do Form 5 every time." Section 4723 .28(B)(17), ORC, authorizes the Board to discipline a licensee for violation of any restrictions placed on a nursing license by the Board. 4: Item 7. of the September 2012 Consent Agreement states, "Within thirty (30) days of the effective date of this Consent Agreement and continuing throughout the probationary period MS. AUBREY shall attend a minimum of one (1) meeting per week of a support or peer group meeting approved in advance by the Board or its designee, or a Twelve Step program, and MS. AUBREY shall provide satisfactory documentation of such attendance to the Board beginning within sixty (60) days of the effective date of this Consent Agreement and every six (6) months thereafter." Despite this provision, you failed to provide documentation of attendance to the Board within the tirneframe established by the September 2012 Consent Agreement. In an e-mail you sent to the Board Monitoring Agent on or about December 7, 2012, you stated you were not aware of established timeframe. Section 4723.28(B)(17), ORC, authorizes the Board to discipline a licensee for violation of any restrictions placed on a nursing license by the Board.

Tiffany Lynn Aubrey, L.P.N. Page 7

5. Item 8. of the September 2012 Consent Agreement states, "Within sixty (60) days following the effective date of this Consent Agreement, MS. AUBREY shall, at her expense, begin chemical dependency counseling at the Intensive Outpatient Level with a provider (IOP Provider) approved in advance by the Board or its designee. MS. AUBREY shall, cause the TOP Provider to submit quarterly written reports to the Board regarding: (i) MS. AUBREY's current diagnosis; (ii) MS. AUBREY's compliance with treatment recommendations/plans, including but not limited to appropriate use of prescribed medications; (iii) all dates MS. AUBREY was seen in the three month period prior to the date of the report; and (iv) any concerns regarding MS. AUBREY's ability to practice nursing in accordance with acceptable and prevailing standards of safe nursing care. Further, MS. AUBREY agrees that the Board may use the TOP Provider's recommendations during the course of treatment, and recommendations for continuing care, as a basis for additional terms, conditions, and limitations on MS. AUBREY's license and that the terms, conditions, and limitations may be incorporated in any addendum to this Consent Agreement." Despite this provision, as of March 6, 2013, you have failed to provide required information to the Board to permit the Board to grant approval for an Intensive Outpatient Level chemical dependency provider, failed to obtain prior approval for an Intensive Outpatient Level chemical dependency provider, and failed to begin counseling within the timeframe established by the September 2012 Consent Agreement. Section 4723.28(B)(17), ORC, authorizes the Board to discipline a licensee for violation of any restrictions placed on a nursing license by the Board. 6. Item 14. of the September 2012 Consent Agreement states "MS. AUBREY shall submit any and all information that the Board may request regarding her ability to practice according to acceptable and prevailing standards of safe nursing practice!' Despite this provision, you did not provide a written statement regarding your November 26, 2012 positive drug screen, as requested by the Board Monitoring Agent in his e-mail to you dated December 14, 2012. You also failed to cause the RiteAid Pharmacy in Benwood, West Virginia, to submit a list to the Board showing all prescriptions you had filled there since the effective date of the September 2012 Consent Agreement, as requested by the Board Monitoring Agent in his e-mail to you dated December 14, 2012. You also failed to cause information to be sent to the Board regarding a prescription you received for pain medication on or about November 7, 2012, as requested by the Board Monitoring Agent in his e-mail to you dated December 14, 2012. Additionally, you failed to provide information to the Board regarding the level of care being provided to

Tiffany Lynn Aubrey, L.P.N. Page 8 you by Northwood Health Systems, as requested by the Board Monitoring Agent in his e-mail to you dated December 14, 2012) Section 4723.28(B)(17), ORC, authorizes the Board to discipline a licensee for violation of any restrictions placed on a nursing license by the Board. Accordingly, the Board is authorized to impose one or more of the sanctions as cited in Section 4723.28, ORC. In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing in this matter. If you wish to request such hearing, the request must be made in writing and must be received in the Board office within thirty (30) days of the time of mailing of this notice. You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in writing. At the hearing you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to: Lisa Ferguson-Ramos, Compliance Unit Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, Ohio 432157410, or to the e-mail address, hearing*nursing.ohio.gov. If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Automatic Suspension and Opportunity for Hearing, deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely,

Rhonda S. Barkheimer, C.N.P. Supervising Board Member Ceftified Mail Receipt No. 7012 2210 0000 6272 3810 cc; Henry G. Appel, Senior Assistant Attorney General

Case # 11-002621

Ohio Board Of Nursing

www.nursing.ohio.gov
(614) 466-3947

17 South High Street. Suite 400 Columbus. Ohio. 432 I 5-7410

CONSENT AGREEMENT .. BETWEEN TIFFANY LYNN AUBREY, LPN. AND OHIO BOARD OF NURSING
This Consent Agreement is entered into by and between TIFFANY LYNN AMP EY, L.P.N. (MS. AUBREY) and the Ohio Board of Nursing (Board), the state agency charged with enforcing Chapter 4723. of the Ohio Revised Code (ORC), and all administrative rules promulgated thereunder. This Consent Agreement contains the entire agreement between the parties, there being no other agreement of any kind, verbal or otherwise, which varies the terms of this Consent Agreement. BASIS FOR ACTION This Consent Agreement is entered into on the basis of the following stipulations, admissions and understandings: A. The Board is empowered by Section 4723.28, ORC, to deny, permanently revoke, revoke, suspend, or place restrictions on any license issued by the Board; reprimand or otherwise discipline a licensee; or impose a fine of five hundred dollars ($500.00) or less per violation. Section 4723.28(G) of the Ohio Revised Code authorizes the Ohio Board of Nursing to compel a licensee to submit to a mental or physical examination, or both, as required by the Board and at the expense of the individual, if the Board finds reason to believe that the individual under investigation may have a physical or mental impairment that may affect the individual's ability to provide safe nursing care. Section 4723.28(B)(11), ORC, authorizes the Board to discipline a licensee for impairment of the ability to practice according to acceptable and prevailing standards of safe nursing care because of a physical or mental disability. Rule 4723-3-02, Ohio Administrative Code, defines impairment as an inability to practice according to acceptable and prevailing standards of safe nursing care without appropriate treatment, monitoring or supervision. B. MS. AUBREY was initially licensed to practice nursing as a licensed practical nurse in the State of Ohio, PN# I 12171, in February 2003. MS. AUBREY's license is currently active. C. MS. AUBREY knowingly and voluntarily states as follows:

Tiffany Lynn Aubrey, L.P.N. Page 2

1)On or about August 17, 2011 in Belmont County Court Case Number. 11 CR B 0620-01, MS. AUBREY was convicted of one (I) count of Child Endangering, being a misdemeanor of the first degree. Also on or about August 17, 2011 in Belmont County Court Case Number I I TRC 0850, MS. AUBREY was convicted of one (1) Count of Operating a Motor Vehicle while httoxicated, being a misdemeanor of the first degree. Also on or about August 17, 2011 in Belmont County Court Case Numbers It CR B 0298-01 and 11 CR B 0298-02 MS. AUBREY was convicted of two (2) counts of Child Endangering, being misdemeanors of the first degree. Each of these convictions arose out of the improper use of chemical substances. 2) On April 13, 2012, the Board ordered MS. AUBREY to an examination pursuant to Section 4723.28(G), ORC (April 2012 Exam Order). MS. AUBREY complied with the April 2012 Exam Order and was evaluated by Dr. Richard N. Whitney '(Examiner) on July 18, 2012, The Examiner provided a written report to the Board dated July 27, 2012 (July 2012 Exam Report) diagnosing MS. AUBREY with Alcohol Dependence. The Examiner recommended MS. AUBREY enter a qualified treatment program at the Intensive Outpatient level of care. 3) MS. AUBREY reported to the Examiner that she discontinued the use of alcohol after her arrest in the above listed cases, MS. AUBREY states that she attends AA meetings, and that she attends counseling at Crossroads Counseling Services twice monthly. The Examiner recommended MS. AUBREY obtain additional counseling intervention. MS. AUBREY is agreeable to obtaining treatment and monitoring in order to retain her license to practice nursing as a licensed practical nurse in accordance with acceptable and prevailing standards of safe nursing care, AGREED CONDITIONS Wherefore, in consideration of the foregoing and mutual promises hereinafter set forth, and ,in lieu of any formal proceedings at this time, MS. AUBREY knowingly and voluntarily agrees with the Board to the following terms, conditions, and litnitations: MS. AUBREY's license to practice nursing as a licensed practical nurse shall be suspended indefinitely. Such suspension shall be stayed, subject to the following PROBATIONARY terms, conditions, and [imitations for a minimum period of three (3) years: I. MS. AUBREY shall obey all federal, state, and local laws, and all laws and rules governing the practice of tuni.sing in Ohio. MS. AUBREY shall comply with all terms .and conditions imposed upon her by the Belmont County Court in Case Nos. 11 CR B 0620-01, 11 TRC 0850, 11 CR B 0298-01, and 11 CR B 0298-02.

Tiffany Lynn Aubrey, L.P.N. Page 3

2.

MS. AUBREY shall appear in person for interviews before the full Board or its designated representative as requested by the Board or its designee. MS. AUBREY agrees that she will submit a request to the Bureau of Criminal Identification and Investigation (BCII) to conduct a criminal records check of MS. AUBREY, including a check of Federal Bureau of Investigation (FBI) records, and shall request BCII to submit MS. AUBREY's criminal records check reports to the Board. MS. AUBREY's completed criminal records check, including the FBI check, must be received by the Board prior to release from these probationary terms.

3.

Monitoring 4. MS. AUBREY shall abstain completely from the personal use or possession of drugs, except those prescribed, administered, or dispensed to her by another so authorized by law who has received a,coinplete copy of this Consent Agreement prior to prescribing for MS. AUBREY. MS. AUBREY shall self-administer the prescribed drugs only in the manner prescribed. MS. AUBREY shall abstain completely from the use of alcohol or products containing alcohol. Within forty-five (45) days of the effective date of this Consent Agreement and continuing throughout the probationary period, MS. AUBREY shall submit, at her expense and on the day selected, blood, breath, hair, or urine specimens for drug and/or alcohol analysis at a collection site specified by the Board at such times as the Board may request. Upon and after MS. AUBREY's initiation of drug screening, refusal to submit such specimen, or failure to submit such specimen on the day she is selected, or in such a manner as the Board may request, shall constitute a violation of a restriction placed on a license for purposes of Section 4723.28(B), ORC. This screening shall require a daily call-in propess. The specimens submitted by MS. AUBREY shall be negative, except for substances prescribed, administered, or dispensed to her by another so authorized by law who has received a complete copy of this Consent Agreement prior to prescribing for MS. AUBREY. a. Prior to MS. AUBREY initiating drug screening, MS. AUBREY shall provide a copy of this Consent Agreement to all treating practitioners and shall provide to the Board a list of all treating practitioners, including addresses and telephone numbers and cause all treating practitioners to complete a medication prescription report that is to be mailed by the practitioner directly to the Board. The medication report is to be completed for any and all substances prescribed, administered, or dispensed to MS. AUBREY. b- After initiating drug screening, MS. AUBREY shMl be under a continuing duty to provide a , copy of this Consent Agreement, prior to initiating

5.

6.

Tiffany Lynn'Aubrey, Page 4

treatment, to additional treating practitioners, and to update the list of treating practitioners with the Board within forty-eight (48) hours of being treated by another practitioner. Further, MS. AUBREY shall notify the Board of any and all medication(s) or prescription(s) received within twenty-four (24) hours of release from hospitalization or medical treatment. 7. Within thirty (30) days of the effective date of this Consent Agreement and continuing throughout the probationary period MS. AUBREY shall attend a minimum of one (1) meeting per week of a support or peer group meeting approved in advance by the Board or its designee, or a Twelve Step program, and MS. AUBREY shall provide satisfactory documentation of such attendance to the Board beginning within sixty (60) days of the effective date of this Consent Agreement and every six (6) months thereafter.

Treatment 8. Within sixty (60) days following the effective date of this Consent Agreement, MS. AUBREY shall, at her expense, begin chemical dependency counseling at the Intensive Outpatient Level with a provider (TOP Provider) approved in advance by the Bdard or its designee. MS. AUBREY shall cause the lOP Provider to submit quarterly written reports to the Board regarding; (i) MS. AUBREY's current diagnosis; (ii) MS. AUBREY's compliance with treatment recommendations/plans, including but not limited to appropriate use of prescribed medications; (iii) all dates MS. AUBREY was seen in the three month period prior to the date of the report; and (iv) any concerns regarding MS. AUBREY's ability to practice nursing in accordance with acceptable and prevailing standards of safe nursing care. Further, MS. AUBREY agrees that the Board may use the TOP Provider's recommendations during the course of treatment, and recommendations for continuing care, as a basis for additional terms, conditions, and limitations on MS. AUBREY's license and that the terms, conditions, and limitations may be incorporated in any addendum to this Consent Agreement. At the first appointment following the effective date of this Consent Agreement, MS. AUBREY shall provide the lOP Provider with a copy of this Consent Agreement, the April 2012 Exam Order, and the Judy 2012 Exam Report from Dr. Whitney. In addition, MS. AUBREY shall execute releases to permit the program to obtain any information deemed appropriate and necessary for the treatment and evaluation of MS. AUBREY. Employment Conditions 10. MS. AUBREY shall notify the Board, in writing, of the name and address of any current employer within thirty (30) days %flowing the effective date of this Consent Agreement, or any new employer prior to accepting nursing employment.

Tiffany Lynn Aubrey, .P.N. Page 5

11.

MS. AUBREY, within fifteen (15) days of the effective date of the Consent Agreement, if working in a position in which a nursing license is required, shall provide her employer(s) with a copy of this Consent Agreement, Further, MS. AUBREY is under a continuing duty to provide a copy of this Consent Agreement to any new employer prior to accepting . nursing employment. MS. AUBREY shall have her employer(s), if working in a position where a nursing license is required, submit written reports regarding job performance on a quarterly basis beginning within thirty (30) days of the effective date of this Consent Agreement or beginning within thirty (30) days of working in a nursing position, MS. AUBREY shall, have her employer(s) send documentation to the Board, along with the first employer report, of receipt of a copy of this Consent Agreement, including the date Consent Agreement was received.

Reporting Requirements 12. MS. AUBREY shall report to the Board, in writing, any violation of this Consent Agreement within thirty (30) days of the occurrence of the violation. MS. AUBREY shall sign release of information forms allowing health professionals and other organizations to submit the requested documentation directly to the Board, MS. AUBREY shall submit any and all information that the Board may request regarding her ability to practice according to acceptable and prevailing standards of safe nursing practice. MS. AUBREY shall not submit or cause to be submitted any false, misleading, or deceptive statements, information, or documentation to the Board or to employers or potential employers. MS. AUBREY shall submit the reports and documentation required by this Consent Agreement on forms specified by the Board. All reporting and communications required by this Consent Agreement shall be made to the Compliance Unit of the Board, MS. AUBREY shall submit the reports and documentation required by this Consent Agreement or any other documents required by the Board to the attention of the Compliance Unit, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, OH 43215-7410. MS. AU REY shall verify that the reports and documentation required by this Consent Agreement are received in the Board office. MS. AUBREY shall inform the Board within five (5) business days, in writing, of any change in employment status or of any change in residential or home address or telephone number.

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19.

Tiffany Lynn Aubrey, L.F.N. Page 6

Temporary Practice Restrictions Unless otherwise approved in advance, in writing, by the Board or its designee, MS. AUBREY shall not practice nursing as a licensed practical nurse (I) for agencies providing home care in the patient's residence; (2) for hospice care programs providing hospice care in the patient's residence; (3) for staffing agencies orfpools; (4) as an independent provider where the nurse provides nursing care and is reimbursed for services by the State of Ohio through State agencies or agents of the State; or (5) for an individual or group of individuals who directly engage MS. AUBREY to provide nursing services for fees, compensation, or other consideration or who engage MS. AUBREY as a volunteer. Unless otherwise approved in advance, in writing, by the Board or its designee, MS. AUBREY shall not function in a position or employment where the job duties or requirements involve management of nursing and nursing responsibilities, or supervising and evaluating nursing practice. Such positions include, but are not limited to, the following: Director of Nursing, Assistant Director of Nursing, Nurse Manager, Vice President of Nursing. FAILURE TO COMPLY MS. AUBREY agrees that her license to practice nursing as a licensed practical nurse will be automatically suspended if it appears to the Board that MS. AUBREY has violated or breached any terms or conditions of the Consent Agreement, Following the automatic suspension, the Board shall notify MS. AUBREY via certified mail of the specific nature of the charges and automatic suspension of her license. MS. AUBREY may request a hearing regarding the charges. The above described terms and conditions shall constitute "restrictions placed on a license" for purposes of Section 4723.28(8), ORC. If, in the discretion of the Board, MS. AUBREY appears to have violated or breached any terms or conditions of this Consent Agreement, the Board reserves the right to institute formal disciplinary proceedings for any and all possible violations or breaches, including, but not limited to, alleged violations of the laws of Ohio occurring before the effective date of this Consent Agreement. DURATION/ MODIFICATION OF TERMS The terms, limitations, and conditions, of this Consent Agreement may be modified or terminated, in writing, at any time upon the agreement of both MS. AUBREY and the Board. The Board may only alter the probationary period imposed by this Consent Agreement if: (I) the Board determines that MS. AUBREY has complied with all aspects of this Consent Agreement; and (2) the, Board determines that MS. AUBREY is able to practice according to acceptable and prevailing standards of safe nursing care without BoArd monitoring, based upon an interview with MS. AUBREY and review of the reports as required herein, Any period during which MS. AUBREY does not work in a position for which a nursing license is required shall not count toward fulfilling the'probationary period imposed by this Consent Agreement. 4

Tiffany Lynn Aubrey, L.P,N. Page 7

ACKNOWLEDG1VIENTS/LIAMLITY RELEASE MS. AUBREY acknowledges that she has had an opportunity to ask questions concerning the terms of this Consent Agreement and that all questions asked have been answered in a satisfactory manner. MS. AUBREY waives all of her rights under Chapter 119, ORC, as they relate to matters that are the subject of this Consent Agreement. MS. AUBREY waives any and all claims or causes of action she may have against the Board, and its members, officers, employees and/or agents arising out of matters, which are the subject of this Consent Agreement. This Consent Agreement shall be considered a public record as that term is used in Section 149.43, ORC, The information contained herein may be reported to appropriate organizations, data banks and governmental bodies. This Consent Agreement is not an adjudication order as discussed in Chapter 119, ORC. Any action initiated by the Board based on alleged violations of this Consent Agreement shall comply with the Administrative Procedures Act, Chapter 119, ORC. EFFECTIVE DATE MS. AUBREY understands that this Consent Agreement is subject to ratification by the Board prior to signature by the Board President and shall become effective upon the last date of signature below.

BERTHA LOVELACE, President Ohio Board of Nursing

DATE

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ET03/90/E0 ETOZ/SO/E0 ETOZ/ .170/E0 ETOZ/E0/E0 T03/30/E0 ETOZ/TO/E0 ET03/83/30 ETOZ/a/Z0 ET03/93/30 ETOZ/S3/30 ET0343/30 ET03/E3/30 ET03/33/30 ETOZ/TZ/Z0 ET03/03/30 ET03/61/30 ET03/8T/ZO STK/LI/30 ETOZ/9T/Z0 ETOZ/ST/30 EI03/i7T/30 ETOZ/ET/30 ET03/31/30 ETOZ/TI/30 ET03/01/30 ET03/60/30 ET03/80/30

Case #12-001822

Ohio card.
17 South Fligh Street, Suite 400 March 22, 2013

Nursing :sing
Columbus, Ohio 43215-7410

sing.ohio.gov
(614) 466-3947

NOTICE OF OPPORTUNITY FOR HEARING

Lawrence J. Averbeck 15 Loreco Drive Walton, KY 41094 Dear Mr. Averbeck: On or about February 6, 2013, the Ohio Board of Nursing (Board) issued to you a Notice of Immediate Suspension and Opportunity for Hearing, a copy of which is attached hereto and incorporated herein. You are notified that in accordance with Chapter 119, ORC, the Board proposes under authority of Section 4723.28 of the Ohio Revised Code, ORC, to deny, permanently revoke, revoke, suspend or place restrictions on your licenses to practice nursing as a registered nurse and as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: 1. On or about December 11, 2012, in Hamilton County Court of Common Pleas Case Number B 1201553, you pled guilty to and were found guilty of one (1) count of Theft of Drugs, a felony of the fourth degree, in violation of Section 2913.02(A)(1), ORC; and one (I) count of Illegal Processing of Drug Documents, a felony of the fourth degree, in violation Section 2925.23(A), ORC. The acts underlying this case occurred on or about February 25, 2012, and involve you obtaining or exerting control over Oxycodone without the consent of the owner or person authorized to give consent. Further acts underlying this case involve you making a false statement in a prescription, order, report, or record involving Oxycodone. Section 4723 .28(B)(4) [as in effect prior to March 20, 2013], ORC, authorizes the Board to discipline a licensee for conviction of, a plea of guilty to, a judicial finding of guilt of, a judicial findini of guilt resulting from a plea of no contest to, or a judicial, finding of eligibility for intervention in lieu of conviction for, any felony. Section 4723 .28(B)(5) [as in effect prior to March 20, 2013], ORC, authorizes the Board to discipline a licensee for conviction of, a plea of guilty to, a judicial finding of guilt of, a judicial finding of guilt resulting from a plea of no contest to, or a judicial finding of eligibility for intervention in lieu of conviction for, violating any municipal, state, county, or federal drug law..

Lawrence J. Averbeck Page 2

2.

In regard to your nursing practict while employed at Harrison Pavilion, Cincinnati, Ohio, you provided a written statement to the Board, dated May 4, 2012, in which you admit that you "took a Resident's percocet 1 tab for my personal use."

Section 4723.28(B)(8) [as in effect prior to June 8, 2012], ORC authorizes the Board to discipline a licensee for self-administering or otherwise taking into the body any dangerous drug, as defined in Section 4729.01, ORC, in any way not in accordance with a legal, valid prescription issued for that individual. Section 4723.28(B)(13) [as in effect prior to March 20, 2013], ORC, authorizes the Baud to discipline a licensee for obtaining or attempting to obtain money or anything of value by intentional misrepresentation or material deception in the course of practice. 3. A co-worker at Harrison Pavilion, where you worked as a nurse, provided a written statement that, on or about February 26, 2012, you: "informed me that he'd took percocet from a resident [and] replaced them [with] tylenol. He also stated that he had done so on different occasions." The Harrison Pavilion Employee Termination Report shows that your employment as a registered nurse was terminated due to drug diversion.

Section 4723.28(B)(19), ORC, authorizes the Board to discipline a licensee for failure to practice in accordance with acceptable and prevailing standards of safe nursing care. Section 4723.28(B)(16), ORC, authorizes the Board to discipline a licensee for violation of Chapter 4723, ORC, or any rules adopted under it. Specifically, Rule 4723-4-06(H), Ohio Administrative Code, states that a licensed nurse shall implement measures to promote a safe environment for each client. Accordingly, the Board is authorized to impose one or more of the sanctions as cited in Section 4723.28, ORC. In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing in this matter. If you wish to request such hearing, the request must be made in writing and must be received in the Board office within thirty (30) days of the time of mailing of this notice. You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by suchl other representative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in writing: At the hearing you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to: Lisa Ferguson-Ramos, Compliance Unit

Lawrence J. Averbeck Page 3

Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus OH 43215-7410, or to the email address, hearingAnursing,ohio.gov. If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Opportunity for Hearing, deny, permanently revoke, revoke, suspend or place restrictions on your licenses to practice nursing as a registered nurse and as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely,

Rhonda S. Barkheimer, C.N.P. Supervising Board Member Certified Mail Receipt No. 7012 2210 0000 6272 3865 cc: Henry G. Appel, Senior Assistant Attorney General

Case #12-001822

Ohio Board of -Nursing

February 6, 2013

www.nursing ohiio.gov
(614) 466-3947 -

17 South High Street, Suite 400 "t Columbus, Ohio 43215-7410 )

NOTICE OF IMMEDIATE SUSPENSION AND OPPORTUNITY FOR HEARING

Lawrence J. Averbeck, R.N., L.P.N. 15 Loreco Drive Walton, KY 41094 Dear Mr. Averbeck: In accordance with Sections 2929.42 and/or 3719.12 of the Ohio Revised Code (ORC), the. Ohio Board of Nursing (Board) has been notified that, on or about December 11,.2012, in Hamilton County Court of Common Pleas Case Number B 1201553, you pled guilty to and were found guilty of one (1) count of Theft of Drugs, a felony of the fourth degree, in violation of Section 2913 .02(A)(1), ORC; and one (1) count of Illegal Processing of Drug Documents, a felony of the fourth degree, in violation Section 2925.23(A), ORC. Section 3719.121(C), ORC, states in pertinent part as follows: On receiving notification pursuant to Section 2929.42 or 3719.12 of the Revised Code, the board under which a person has been issued a license, certificate or evidence of registration immediately shall suspend the license, certificate, or registration of that person on a plea of guilty to, a finding by a jury or court of the person's guilt of, or conviction of a felony drug abuse offense; a finding by a court of the person's eligibility for intervention in lieu of conviction; a plea of guilty to, or a finding by a jury or court of the person's guilt of, or the person's conviction of an offense in another jurisdiction that is essentially the same as a felony drug abuse offense; or a finding by a court of the person's eligibility for treatment or intervention in lieu of conviction in another jurisdiction. Theft of Drugs, a felony of the fourth degree, in violation of Section 2913.02(A)(1), ORC; and Illegal Processing of Drug Documents, a felony of the fourth degree, in violation Section 292523(A), ORC, constitute "felony drug abuse offenses" a defined in Section 2925.01, ORC. WHEREFORE, PURSUANT TO SECTION 3719.121(C), ORC, YOU ARE HEREBY NOTIFIED THAT YOUR LICENSE TO PRACTICE NURSING AS A 'REGISTERED NURSE, RN-218236, AND LICENSE TO PRACTICE NURSING AS A LICENSED PRACTICAL NURSE, PN-074551, ARE HEREBY SUSPENDED. Continued practice after receipt of this notice of suspension shall be considered engaging in the practice of

Lawrence J. Averbeck, R.N., L.P.N. Page 2 nursing without a current, valid license, which is a violation of Section 4723.03(A) and/or (B), ORC. In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing in this matter. If you wish to request such hearing, the request must be made in t writing and must be received in the Board office within thirty (30) days of the time of mailing of this notice. As required by Section 3719.121(C), ORC, the suspension ordered herein shall remain in effect until this hearing is held. You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in writing. At the hearing you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to: Lisa Ferguson-Ramos, Compliance Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, Ohio 43215-7410, or to the e-mail address, hearingAnursing.ohio.gov. If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Immediate Suspension and Opportunity for Hearing, deny, permanently revoke, revoke, suspend or place restrictions on your licenses to practice nursing as a registered nurse and as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely,

Rhonda S. Barkheimer, R.N., C.N.P. Supervising Board Member

Certified Mail Receipt No. 7012 2210 0000 6272 15.19 cc: i Henry G. Appel, Senior Assistant Attorney General

Case #2013-000181

Ohio Board of Nursing

www.nursing.ohio.gov

17 South High Street, Suite 400 d, Columbus, Ohio 43215-7410 (614) 466-3947

March 22, 2013

NOTICE OF OPPO TUNITY FOR HEARING

Neeka Barrow, R.N. 2407 Azalea Garden Drive Dunwoody, Georgia 30338 Dear Ms. Barrow: In accordance with Chapter 119, Ohio Revised Code (ORC), you are hereby notified that the Ohio Board of Nursing (Board) proposes under authority of Section 4723.28, ORC, to deny, revoke, permanently revoke, suspend or place restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of riot more than five hundred dollars ($500.00) per violation for the following reasons: On or about January 14, 2013, the Commonwealth of Virginia, Department of Health Professions issued an Order (Virginia Board 2013 Order) in which your license to practice nursing as a registered nurse in Virginia was suspended. A certified copy of the Virginia Board 2013 Order, along with Attachments are attached hereto and incorporated herein. Section 4723.28(B)(1) has in effect prior to March 20, 2013], ORC, authorizes the Board to discipline a license for denial, revocation, suspension, or restriction of authority to practice a health care occupation, including nursing, for any reason other than a failure to renew, in Ohio or another state or jurisdiction. Accordingly, the Board is authorized to impose one or more of the sanctions as cited in Section 4723.28 ORC. You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in writing. At the hearing you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to: Lisa Ferguson-Ramos, Compliance Unit Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, OF! 432157410, or to the email address, hearing@nursing,ohio,gov. If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal

Neeka Barrow, R.N. Page 2

allegations set forth in this Notice of Opportunity forMearing, to deny, revoke, permanently revoke, suspend or place restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation.
4

Sincerely,

Rhonda S. Barkheimer, C.N.P. Supervising Board Member Certified Mail Receipt No. 7012 2210 0000 6272 3148 cc: Henry G. Appel, Senior Assistant Attorney General

m M.D. Dianne L, Reynolds-Can Director

COMMONWEALTH of VIRGINIA VA Department of Health Professions

Perimeter Center 8060 Mayland Drive, Suite 300 riendoo, Virginia 23233-1463

PD Oc

4.V

www,dhp.yirginia,gov Tar. (804) 367. 4400 FAX (804) 527-4475

January 14, 2013 Neeka Den= Barrow 2407 Azalea Garden Drive Dunwoody, GA 30338 RE: License No.: 0001-223470 Dear Ms. Barrow: Pursuant to Section 54.1-2409 of the Code of Virginia (1950), as amended, (Code"), you are hereby given notice that your license to practice nursing in the Commonwealth of Virginia has been mandatoxily suspended by the enclosed Order entered January 14, 2013. You are hereby advised that, pursuant to Section 54.1-2409.1 of the Code, any person who practices a Profession or occupation after having their license or certificate to do so suspended shall be guilty of a felony. Please return your license to Say P. Douglas, Executive Director of the Virginia Board of Nursing, at the above address, immediately upon receipt of this letter. Section 54.1-2409 of the Code further provides that you may apply to the Board of Nursing ("Board") for reinstatement of your license, and shall be entitled to a beating not later than the next regular meeting of the Board after the expiration of sixty days from the receipt of such reinstatement application. You have the following rights, among others: to be represented by legal counsel, to have witnesses subpoenaed on your behalf, to present documentary evidence and to cross-examine adverse witnesses. The reinstatement of your license shall require the affirmative vote of three-fourths of the members present of the Board of Nursing Should you wish to petition the Board of Nursing for reinstatement of your license, contact Jay P, Douglas, Executive Director, at the above address or (804) 367-4599. Sincerely, CERTIFIED MAIL

DUPLICATE COPY
VIA FIRST CLASS MAIL DATE

di/e k ; 4) 4(46ee
Enclosures Casef 148490

Arne W. Owens, Chief Deputy Director Department of Health Professions

Board of Audiology & Speech-Language Pathology - Board of Counseling-. Board of Dentistry - Board of Funeral Dtrootors & Embalmers Board of Long-Term Care Administrators - Board of Medicine - Board of Nursing -. Board.of Optometry. Board of Pharmacy Board of Phystcd Therapy - Board of Psychology - Board of Social Work - Board of Veterinary Medicine Board of Health Professions

BEFORE 'THE DEPARTMENT OF HEALTH PROFESSIONS IN RE: NEM& DENEEN BARROW, R.N. License No.:. 0001423470 ORDER In accordance with Section 54.1-2409 of the Code of Virginia (1950), as amended, ("Code), I, Arne W, Owens, Chief Deputy Director of the Virginia Department of Health Professions, received and acted upon evidence that the North Carolina Board of Nursing accepted the voluntary surrender, in lieu of further disciplinary action, from Neeka Deneen Barrow, RN., of her license to practice nursing in the State of North Carolina by a Consent to Surrender License/Privilege to Practice dated January 2, 2013. A certified copy of the Consent to Surrender License/Privilege to Practice is attached to this Order and is marked as Commonwealth's Exhibit No. 1. WHEREFORE, by the authority vested in the Director of the Department of Health Professions pursuant to Section 54.1-2409 of the Code, it is hereby ORDERED that the license of Neeka Deneen Barrow, R,N., to practice nursing in the Commonwealth of Virginia be, and hereby is, SUSPENDED. Upon entry of this Order, the license of Neeka .Deneen Barrow, RN., will be recorded as suspended. Should Ms. Barrow seek reinstatement of her license pursuant to Section 54.1-2409 of the Code, she shall be responsible for any fees that may be required for the reinstatement and renewal of her license prior to issuance of her license to resume practice. Pursuant to Sections 2.2-4023 and 54J-2400.2 of the Code, the signed original of this Order

Mandatory Suspension Order-Neeka Deneen Barrow, R.N.

page 2 of 2

}shall

remain in the custody of the Department of Health Professions as a public record and shall be

made available for public inspection and copying upon request.

Arne W. Owens, Chief Deputy Director Department of Health Professions ENTERED:

(:(

C MMONWEALTH of VIRGINIA.
Dianne L. Roynoids-Cane, M.D. Director

Department offfealth Professions

Perimeter Center 8960 Mayiend Drive, Suite 300 Hendee, Virginia 23233-1463

www.dhp.virginla.goy TEL (804) 367-4400 FAX (804) 527- 4475

CERTIFICATION OF DUPLICATE RECORDS I, Arne W. Owens, Chief Deputy Director., Director of the Department of Health Professions, hereby certify that the attached Consent to Surrender License/Privilege to Practice dated January 2, 2013, regarding Neeka Deneen Barrow, R.N., is a true copy of the records received from the North Carolina Board of Musing.

,A14) (4t)e--e( Arne W. Owens

Date: I /e tge9 /

Board of Audiology & Bp000tt,Language Pathology Board of Counseling Beard of Dentistry Board of Funeral Directors & Enrittaimers Board of Long-Term Caro Administrators Board of Medicine Board of Nursing Board of Optometry Board of Pharmacy Board of Physical Therapy Board of PsychologY Board of Boole! Work Board of Veterinary Medicine Board of Health Professions

12/81/2012 08:25

757-547-4202

PEDEN OFF/CE

0928

PAGE 01

NORTH CAROLINA BOARD OF NURSING CONSENT TO SURRONDBR LICENSP.ipiwiLein TO PRACTICE 1. firitstta Donee) liairraW, Registered NUM, %IMGate #23$001, front the state of NOM Carolina, having been advised by a Representative of the North Carolina Board of Nursing rhereafter known as the Board} of pending charges against me and abe my waiver of the foikAing (8s shown by my tratthais):

v.v
L-4-A

My right to receive a leiter of charges that tootles the following allegations: Drug Diversion - controlled substances My right tO an Administrative Hewing under G.S. 0O-'171.31 and G.S. 9171.37A where I am afforded notice and an opportunity to confront witnesses against me; In exchange for ending this matter and no further investigation Win be fidendaded. juial review of the Soares Decision because of my Sdic My ht to ght t+ urrender, Volun ri

This surrender shall constitute my consent to an donations as explained to me by Kertbfeert RN, IVISN Scud Representative, for the Board on December ik 202, -Ns surrender of my !prase will be considered by the Board to be a disciplinary eaten and will be reported to the appropriate entWes as outlined by SOntd Polloytand as required by state and/or federal guidelines. Those entitles Include, but may not be firnftd, to; NURSYS, National prwitIoner gate sank (NPD8), the Milos aft Inspector General (OM Health Care Integrity and Precntioner Data Bank (HMOS) end any other etattquriscliction in which the licensee Is or hes been licensed. Mile I may deny these allegetIonts, 3 ant voluntarily surrendering my licensaiprivilege to (442Z practice. Based on my violater of These rights, I hereby surrender, to the eostrd, my license/privilege to Foolice as a Registered Name/Licensed Proollool Nuree for a minimum et one (1) year. I fully underatond and agree, that I snail not practice nursing or use any card, title or abbreviation to represent my statue as a licensed nurse during the lime my limes Is held by the Board: and, In turn, the Board agrees to madder my petition for nsVieW Of my stelae at scree port in the future. ger to requesting reinst atement of my license, I agree to =tact the Beard la Order te deerralne what typo of evklence wilt be needed, In order that ray petition for rem Win be conekterad. Such requested evidence shall be submitted with the request fs tairRitaternerrt and all fees required by law I understand at time or reinstatement, the kenos may nave sancidons or letatictions imposed.

rsoccans.cbsa4ines-asse-rxwnourcar
I

I COMMONWEAL ITS EXHIBIT .4 g

I1

CERTIFIED TRUE COPY

Case# 13-000141 & 13-001157

Ohio Board of Nursing

vvww.nurs ng ohio.gov

17 South High Street, Suite 400 6. Columbus, Ohio 43215-7410 W (614) 466-3947

March 22, 2013

NOTICE OF AUTOMATIC SUSPEISION AND OPPORTUNITY FOR HEARING

rAdriann Marie Brierley, R.N., L.P.N. P.O. BOX 1845 Buckeye Lake, Ohio 43008 Dear Ms. Brierley: You are hereby notified that, on or about May 18, 2012, you entered into a Consent Agreement (May 2012 Consent Agreement) with the Ohio Board of Nursing (Board), a copy of which is attached hereto and incorporated herein, in which you agreed with the Board that your license to practice nursing as a registered nurse in the State of Ohio would be suspended indefinitely, and that such suspension would be stayed subject to probationary terms, conditions, and limitations for a minimum period of two (2) years. A. Item 1. of the May 2012 Consent Agreement states, "MS. BRIERLEY shall obey all federal, state, and local laws, and all laws and rules governing the practice of nursing in Ohio." Section 4723 .28(B)(4) [as in effect prior to March 20, 2013] ORC, authorizes the Board to discipline a licensee for conviction of, a plea of guilty to, a judicial finding of guilt of, a judicial finding of guilt resulting from a plea of no contest to, or a judicial finding of eligibility for intervention in lieu of conviction for, any felony or of any crime involving gross immorality or moral turpitude. Despite this provision, in the United States District Court, Southern District of Ohio, Case No. CR2-12-203, you pled guilty to and on or about February 28, 2013, were convicted of, one (1) count of Intentionally Accessing a Computer without Authorization and Obtaining Information From a Protected Computer in Furtherance of any Criminal or Tortious Act, a Felony, in violation of 18 U.S.C. 1030 (a)(2)(C) & (c)(2)(B)(ii). The events underlying your conviction occurred from on or moot September 26, 2008 through on or about October 10, 2008, and involve you intentionally accessing a computer without authorization and obtaining protected personal information of another to commit an invasion of privacy, slander, and intentional infliction of emotional distress. Section 4723.28(B)(4) [as in effect prior to March 20, 2013] ORC, authorizes the Board to discipline a licensee for conviction of, a plea of guilty to, a judicial finding of guilt of, a judicial finding of guilt resulting from a plea of no contest to, or a judicial finding of eligibility for

Adriann Marie Brierley, R.N., L.P.N. Page 2 intervention in lieu of conviction for, any felony or of any crime involving gross immorality or moral turpitude. Section 4723.28(B)(17), ORC, authorizes the Board to discipline a licensee for violation of any restrictions placed on a nursing license by the Board. B. Item 8. of the May 2012 Consent Agreement states, "MS. BRIERLEY shall abstain completely from the use of alcohol or products containing alcohol." Item 9. of the May 2012 Consent Agreement states, "Within forty-five (45) days following the effective date of this Consent Agreement MS. BRIERLEY shall begin submitting, at her expense and on the day selected, blood or urine specimens for drug and/or alcohol analysis at a collection site specified by the Board at such times as the Board may request. Refusal to submit such specimen, or failure to submit such specimen on the day she is selected, or in such a manner as the Board may request, shall constitute a violation of a restriction placed on a license for purposes of Section 472328(B), ORC. This screening shall require a daily call-in process. The specimens submitted by MS. BRIERLEY shall be negative, except for substances prescribed, administered, or dispensed to her by another so authorized by law who has full knowledge of MS. BRIERLEY's history of chemical dependency." Despite this provision, on the dates set forth in Attachment A, attached hereto and incorporated herein, you failed to call Firstlab, the Board's random drug/alcohol screen program administrator, to determine if you had been selected to provide a specimen for analysis. Additionally, on the following dates, you were selected to provide a specimen for analysis and failed to do so: December 26, 2012; January 8, 2013; January 10, 2013; and February 27, 2013. Furtheti lore, on October 10, 2010, you submitted a specimen to Firstlab that tested positive for Ethyl Glucuronide (Alcohol). In a statement received by the Board on November 16, 2012, you explain that you were " . . . recently ill for several weeks and had been taking generic night time liquid cough, cold and flu medication . . ." Section 4723 .28(B)(17), Ohio Revised Code, CRC, authorizes the Board to discipline a licensee for violation of any restrictions placed on a nursing license by the Board. In accordance with the paragraph under "FAILURE TO COMPLY" of the May 2012 Consent Agreement, you are hereby notified that it appears to the Board that you have violated Items 1., 8. and 9. of the May 2012 Consent Agreement. YOU ARE FURTHER NOTIFIED THAT YOUR LICENSE TO PRACTICE NU *SING AS A REGISTERED NURSE, RN-303648, IS HEREBY AUTOMATICALLY SUSPENDED. Continued practice after receipt of this notice of suspension shall be considered engaging in the practice of nursing as a registered nurse without a current, valid license, which is a violation of Section 4723.03(A), ORC.

Adriann Marie Brierley, R.N., L.P.N. Page 3 You are further notified that in accordance with Chapter 119, ORC, the Board proposes under authority of Section 4723.28, ORC, to Ileny, permanently revoke, revoke, suspend or place restrictions on your licenses to practice nursing as a registered nurse and as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: I. On or about May 18, 2012, you entered into a Consent Agreement (May 2012 Consent Agreement) with the Ohio Board of Nursing (Board), a copy of which is attached hereto and incorporated herein, in which you agreed with the Board that your license to practice nursing as a registered nurse in the State of Ohio would be suspended indefinitely, and that such suspension would be stayed subject to probationary terms, conditions, and limitations for a inimum period of two (2) years. 2. Item 1. of the May 2012 Consent Agreement states, "MS. BRIERLEY shall obey all federal, state, and local laws, and all laws and rules governing the practice of nursing in Ohio." Section 4723.28(B)(4) [as in effect prior to March 20, 2013] ORC, authorizes the Board to discipline a licensee for conviction of, a plea of guilty to, a judicial finding of guilt of, a judicial finding of guilt resulting from a plea of no contest to, or a judicial finding of eligibility for intervention in lieu of conviction for, any felony or of any crime involving gross immorality or moral turpitude." Despite this provision, in the United States District Court, Southern District of Ohio, Case No. CR2-12-203, you pled guilty to and on or about February 28, 2013, were convicted of, one (1) count of Intentionally Accessing a Computer without Authorization and Obtaining Information From a Protected Computer in Furtherance of any Criminal or Tot/ions Act, a Felony, in violation of 18 U.S.C. 1030 (a).(2)(C) & (c)(2)(B)(ii). The events underlying your conviction occurred from on or about September 26, 2008 through on or about October 10, 2008, and involve you intentionally accessing a computer without authorization and obtaining protected personal information of another to commit an invasion of privacy, slander, and intentional infliction of emotional distress. Regarding your licenses to practice nursing as a registered nurse and licensed practical nurse, Section 4723.28(B)(4) [as in effect prior to March 20, 2013] ORC, authorizes the Board to discipline a licensee for conviction of, a plea of guilty to, a jidicial finding of guilt of, a judicial finding of guilt resulting from a plea of no contest to, or a judicial finding of eligibility for intervention in lieu of conviction for, any felony or of any crime involving gross immorality or moral turpitude. Regarding your license to practice as a registered nurse, Section 4723.28(B)(17), CRC, authorizes the Board to discipline a licensee for violation of any restrictions placed on a nursing license by the Board.

Adriann Marie Brierley, R.N., L.P.N. Page 4

3. Item 8. of the May 2012 Consent Agreement states, "MS. BRIERLEY shall abstain completely from the use of alcohol or products containing alcohol." Item 9. of the May 2012 Consent Agreement states, "Within forty-five (45) days following the effective date of this Consent Agreement MS. BRIERLEY shall begin submitting, at her expense and on the day selected, blood or urine specimens for drug and/or alcohol analysis at a collection site specified by the Board at such times as the Board may. request. Refusal to submit such specimen, or failure to submit such specimen on the day she is selected, or in such a manner as the Board may request, shall constitute a violation of a restriction placed on a license for purposes of Section 4723.28(B), ORC. This screening shall require a daily call-in process. The specimens submitted by MS. BRIERLEY shall be negative, except for substances prescribed, administered, or dispensed to her by another so authorized by law who has full knowledge of MS. BRIERLEY's history of chemical dependency." Despite this provision, on the dates set forth in Attachment A, attached hereto and incorporated herein, you failed to call Firstiab, the Board's random drug/alcohol screen program administrator, to determine if you had been selected to provide a specimen for analysis. Additionally, on the following dates, you were selected to provide a specimen for analysis and failed to do so: December 26, 2012; January 8, 2013; January 10, 2013; and February 27, 2013. Furthermore, on October 10, 2010, you submitted a specimen to Firstlab that tested positive for Ethyl Glucuronide (Alcohol). In a statement received by the Board on November 16, 2012, you explain that you were " . . . recently ill for several weeks and had been taking generic night time liquid cough, cold and flu medication . . ." Regarding your license to practice nursing as a registered nurse, Section 4723.28(B)(17), Ohio Revised Code, ORC, authorizes the Board to discipline a licensee for violation of any restrictions placed on a nursing license by the Board. Accordingly, the Board is authorized to impose one or more of the sanctions as cited in Section 4723 .28, ORC. In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing in)this matter. If you wish to request such hearing, the request must be made in writing and must be received in the Board office within thirty (30) days of the time of mailing of this notice. You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in writing. At the hearing you may also present evidence and examine witnesses appearing for and against you.

Adriann Marie Brierley, RN., L.P.N. Page 5

Should you choose to request a 'hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to: Lisa Ferguson-Ramos, Compliance Unit Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, Ohio 432157410, or to the e-mail address, hearing*nursing.ohio.gov. If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Automatic Suspension and Opportunity for Hearing, deny, permanently revoke, revoke, suspend or place restrictions on your licenses to practice nursing as a registered nurse and as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely,

Rhonda S. Barkheimer, R.N., G.N.P. Supervising Board Member Certified Mail Receipt No. 7012 2210 0000 6272 3841 cc: Henry G. Appel, Senior Assistant Attorney General

OhioBoard of Nursing
17 South 1-ligh Street, Suite 400

wWw.nursing.o.shiecgoV

Columbus, Ohio. 3215-741.0 0-(G'14) 466-3947

CONSENT AGREEMENT BETWEEN ADRIANN MARIE BRIERLEY, R.N. AND OHIO BOARD OF NURSING
This. Consent Agreement is entered into by and between ADRIANN MARIE BRIERLEY, R.N., EMS. BRIERLEY) and the Ohio Board of 'Nursing (Board) the state agency charged with ,enforcing Chapter 4723. of the Ohio Revised Code (ORC), and all administrative rules promulgated thereunder. MS. BRIERLEY voluntarily enters into this Consent. Agreement being fully informed of her tights Under Chapter 119, Q.Rc; ikluding the right to representation by legal counsel and the right to a formal adjudicative hearing on the issue's Considered herein. This Consent Agreement contains the entire agreement betWeeil the parties, there being no other agreethent of any kind, verbal or otherwise, which varies the terms of this CeriSent Agreement: BASIS FOR ACTION This Consent Agreement is entered into On the basis of the following s :adthisSionsand.understandings: A. :ations,

The B.oard is empowered by Section 4723.28, RC., to deny, :permanently revoke, 'revoke., suspend, or place restrictions on any license issued by the Board; 'reprimand ,or otherwise discipline :a licensee; QT itilp(0 a fine of five hundred dallars:($500.00) or less'per violation, Section 4723.28(G)'of the MO Revised Code authorize the Ohio Board of Nursing to compel :a licensee to submit to a mental or physical examination., or both, as required by the Board ,and at the expense of the individual, if the Board finds reason to believe that the individual under investigation may have a physical or mental impairment that May affect. the itidiVidnal' ability to provide safe nursing care. Section 4723;280(14 On, authorizes the Board to discipline a licensee for impairment of the ability to practice aCeording to acceptable and prevailing standards of safe nursing 'pare because of habitual or excessive use of drOgs, aloohol, or other chernical substances that impair the ability to practice. S. BRItkLEY has, been licensed to practice musing as <i registered nurse, RN-303648 in the State of Ohio since 'November 2002: MS. f

ADRIANN MARIE BRIERLEY, R.N. Page 2 BRIERELY has also been licensed as a licensed practical nurse, PN098482, since June 1996; this license lapsed September 1, 2006, C. MS. BRIERLEY knowingly and voluntarily admits to the following: MS. ARIERLEY was terminated from employment at Ohio Health (Riverside Methodist Hospital) effective October 31, 2008 due to issues related to her conduct. Following her termination, MS. BRIERELY was ordered by the Franklin County Common Pleas Court (Case No. 08CVC11-16040) to pay damages to her former supervisor and enjoined from invading the person's privacy. ii. MS. BRIERLEY has a November 9, 2010 OVI conviction (Franklin County Municipal Court Case No, 2010 TRC 177259) and January 6, 2009 Disorderly Conduct conviction (Licking County Municipal Court Case No. 08CRB02687-A). On December 16, 2011, the Board ordered MS. BRIERLEY 'to a Psychiatric examination, specifically addresSing MS. BRIERLEY's ability to function in a clinical nursing capacity (Exam Order). MS. BRIERLEY was examined by Dr. Howard Soklov, OSU Harding Hospital, Dr. Soklov submitted a written report to the Board dated January 28, 2012; diagnosing MS. BRIERLEY with Adult Situational Disorder, with noted history of Alcohol Abuse, and some Personality Disorder Features. Dr. Sokolov recommends that the Board monitor MS. BRIERLEY's nursing practice, by requiring MS. BRIERLEY to attend mental health counseling for a period of at least two (2) years, on a basis of at least twice per month, with a skilled mental health counselor. MS. BRIERELY reported to Dr. Soklov that as of the examination date, she had not worked as a nurse since October 2008. MS. BRIERLEY states that she would like to continue her nursing career, and is willing to do what it takes to treat her condition and enable her to practice safely as a registered nurse. AGREED CONDITIONS Wherefore, in consideration of the foregoing and mutual promises hereinafter set forth, and in lieu of any formal proceedings at this time, MS. BRIERLEY knowingly and voluntarily agrees with the Board to the following terms, conditions, and limitations: MS. BRIERLEY's license to practice nursing as a registered nurse is hereby suspended indefinitely. Such suspension is hereby stayed, subject to. the following PROBATIONARY terms, conditions, and limitations for a MilliMUM period of two (2) years:

Hi,

iv.

ADRIANN MARIE BRIERLEY, R.N. Page 3

MS. BRIERLEY shall obey all federal, state, and local laws, and all laws and rules governing the practice of nursing in Ohio. 2. MS. BRIERLEY shall appear in person for interviews before the full Board or its designee as requested by the Board or its designee. MS. BRIERLEY agrees that she will submit a request to the Bureau of Criminal Identification and Investigation (BCH) to conduct a criminal records check of MS. BRIERLEY, including a check of Federal Bureau of Investigation (FBI) records, and shall cause BCII to submit MS. BRIERLEY's criminal records check reports to the Board. MS. BRIERLEY's completed criminal records check, including the FBI check, must be received by the Board within six (6) months following the effective date of the Consent Agreement. Within six (6) months of the effective date of this Consent Agreement, MS. BRIERLEY shall, in addition to the requirements of iieensure renewal, successfully complete and submit satisfactory documentation of successful completion of the following continuing nursing education, or another comparable course approved in advance by the Board or its designee, taken subsequent to the effective date of two (2) hours of Chemical this Consent Agreement: Dependency/Substance Abuse,, and one (1) hour of the Ohio Law and Rules.

3,

4.

Chemical Dependency Assessment 5. Upon request of the Board or its designee, and within sixty (60) days of the request, MS. BRIERLEY shall, at her expense, obtain another chemical dependency evaluation by Dr. Richard Whitney (Shepherd Hill), or another Board approved chemical dependency professional and shall provide the Board with complete documentation of this evaluation. Prior to the evaluation, MS. BRIERLEY shall provide the chemical dependency professional with a copy of this Consent Agreement and Dr. Sokolov's January 28, 2012 report. Further, MS. BRIERLEY shall execute releases to permit the chemical dependency professional to obtain any information deemed appropriate and necessary for the evaluation. The professional shall submit a written opinion to the Board that includes diagnoses, recommendations for treatment and monitoring, any additional restrictions that should be placed on MS. BRIERLEY's license to practice, and stating whether MS. BRIERLEY is capable of practicing nursing according to acceptable and prevailing standards of safe nursing care.

ADRIANN MARIE BRIERLEY, R.N. Page 4

6.

MS. BRIERLEY shall provide the Board with satisfactory documentation of compliance with all aspects of the treatment plan developed by the chemical dependency professional described above until released. Further, MS. BRIERLEY agrees that . the Board may utilize the professional's recommendations and conclusions from the s a basis for additional terms, conditions, and limitations on evaluation ad MS. BRIERLEY's license and that the . terms, conditions, and limitations may be incorporated in an addendum to this Consent Agreern. .ent.

Monitoring of Alcohol/Chemical Use 7. MS. BRIERLEY shall abstain completely from the personal use or possession of drugs, except those prescribed, administered, or dispensed to her by another so authorized by law who has full knowledge of MS. BRIERLEY's history of alcohol abuse. MS. BRIERLEY shall self-administer prescribed drugs only in the manner prescribed. MS. BRIERLEY shall abstain completely from the use of alcohol or products containing alcohol. Within forty-five (4S) days following the effective date of this Consent Agreement MS. BRIERLEY shall begin submitting, at her expense and on the day selected, blood or urine specimens for drug and/or alcohol analysis at a collection site specified by the Board at such times as the Board may request. Refusal to submit such specimen, or failure to submit such specimen on the clay she is selected, or in such a manner as the Board may request, shall constitute a violation of a restriction placed on a license for purposes of Section 4723.28(B), ORC. This screening shall require a daily call-in process. The specimens submitted by MS. BRIERLEY shall be negative, except for substances prescribed, administered, or dispensed to her by another so authorized by law who has full knowledge of MS. BRIERLEY's history of chemical dependency,

8.

9.

Mental Health Treatment and Monitoring 10. MS. BRIERLEY shall, at her own expense, begin individual counseling sessions with a licensed therapist approved in advance by the Board or its designee. On a quarterly basis, or as otherwise requested by the Board or its designee, beginning August 1, 2012 until released, MS. BRIERLEY shall cause the therapist to submit written reports to the Board

11.

ADRIANN MARIE BRIERLEY, Page 5 regarding: (i) All medications prescribed to MS. BRIERLEY; (ii) compliance with treatment recommendationsfplans, including but Rot limited to medications; (iii) all dates MS. BRIERLEY was seen in the three (3) month period. prior to the date of the report; and (iv) any concerns regarding MS. BRIERLEY's ability to practice nursing in accordance with acceptable and prevailing standards of safe nursing care. Further, MS. BRIERLEY agrees that the Board may utilize the therapist's recommendations during the course of treatment as a basis for additional terms, conditions, limitations on MS. BRIERLEY's license and that the terms, conditions, and limitations may be incorporated in an addendum to this Consent Agreement. 12, At the first appointment following the effective date of thiS Consent Agreement, MS. BRIERLEY shall provide the therapist with a copy of this Consent Agreement, the Board's December 16, 2011 Exam Order; and Dr. Sokolov's January 28, 2012 report to the Board. In addition, MS. BRIERLEY shall execute releases to permit the therapist to obtain any information deemed appropriate and necessary for their treatment and evaluation of MS. BRIERLEY. MS. BRIERLEY shall continue in treatment with the therapist at least two (2) times per month, until released, but for a period of not less than two (2) years from the effective date of this Consent Agreement,

13.

Treating Practitioners and Reporting 14. Within forty-five (45) days of the effective date of this Consent Agreement, MS. BRIERLEY shall provide a copy of this Consent Agreement to all treating practitioners and shall provide to the Board a list of all treating practitioners, including addresses and telephone numbers. Further, MS. BRIERLEY shall be under a continuing duty to provide a copy of this Consent Agreement, prior to initiating treatment, to additional treating practitioners, and to update the list of treating practitioners with the Board within forty-eight (48) hours of being treated by another.practitioner. Within forty-five (45) days of the effective date of this Consent Agreement, MS. BRIERLEY shall cause all treating practitioners to complete a medication prescription report that is to be mailed by the practitioner directly to the Board. The medication report is to be completed for any and all substances prescribed, administered, or dispensed to MS. BRIERLEY throughout the duration of this Consent Agreement.

15.

ADRIANN MARIE BRIERLE)% R.N. Page 6 Within twenty-four (24) hours of release from hospitalization or medical treatment, MS. BRIERLEY shall notify the Board of any and all medication(s) or prescription(S) received.

16.

Employment Conditions 17. MS. BRIERLEY shall notify the Board, in writing, of the name and address of any current employer within thirty (30) days following the effective date of this Consent Agreement, or any new employer prior to accepting employment. MS. BRIERLEY, within fifteen (1.5) days of the effective date of the Consent Agreement, if working in a position in which a nursing license is required, shall provide her employer(s) with a copy of this Consent Agreement. Further, MS, BRIERLEY is under a continuing duty to provide a copy of this Consent Agreement to any new employer prior to accepting employment. MS. BRIERLEY shall have her employer(s), if working in a position where . a nursing license is required, submit written reports regarding job performance on a quarterly basis beginning within thirty (30) days of 'accepting employment or being employed in a position in which a nursing license is required. MS. BRIERLEY shall have her employer(s) send documentation to the Board, along with the first.employer report, of receipt of a copy of this Consent Agreement, including the date the Consent Agreement was received.

18.

Reporting Requirements of Licensee 19. MS. BRIERLEY shall report to the Board, in writing, any violation of this Consent Agreement within thirty (30) days of the occurrence of the violation. MS. BRIERLEY shall sign release of information forms allowing health professionals and other organizations to submit the requested documentation directly to the Board. MS. BRIERLEY shall submit any and all information that the Board may request regarding her ability to practice according to acceptable and prevailing standards of safe nursing practice. MS. BRIERLEY shall not submit or cause to be submitted any false, misleading, or deceptive stoements, information, or documentation to the Board or to employers or potential employers.

20.

21.

22.

ADRIANN MARIE BRIERLEY, R.N. Page 7

23..

MS. BRIERLEY shall submit the reports and documentation required by this Consent Agreement on forms specified by the Board. All reporting and communications required by this Consent Agreement shall be made to the CoMpliance Unit of the Board, MS. BRIERLEY shall submit the reports and documentation required by this Consent Agreement or any other documents required by the Board to the attention of the Compliance Unit, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, OH 43215-7410. MS. BRIERLEY shall verify that the reports and documentation required by this Consent Agreement are received in the Board office, MS. BRIERLEY shall inform the Board within five (5) business days, in writing, of any change in employment status or of any change in residential or home address or telephone number. 4

24.

25,

26.

Nursing Refresher Course Upon request of the Board or its designee, MS. BRIERLEY shall complete and submit satisfactory documentation of completion of a nursing refresher course or an extensive orientation approve in advance by the Board or its designee. Temporary Practice Restrictions MS. BRIERLEY further knowingly and voluntarily agrees with the Board to the following TEMPORARY LICENSURE RESTRICTIONS: Unless otherwise approved by the Board or its designee, MS. BRIERLEY shall not practice nursing as a registered nurse: (1) for agencies providing home care in the patient's residence; (2) for hospice care programs providing hospice care in the patient's residence; (3) for staffing agencies or pools; (4) as an independent provider where the nurse provides nursing care and is reimbursed for services by the State of Ohio through State agencies or agents of the State.; or (5) for an individual or group of individuals who directly engage MS. BRIERLEY to provide nursing services for fees, compensation, or other consideration or as a volunteer. Unless otherwise approved by the Board or its designee, MS. BRIERLEY shall not function in a position or employment where the job duties or requirements involve management of nursing and nursing responsibilities, or supervising and evaluating nursing practice. Such positions include but -are not limited to the following: Director of Nursing, Assistant Director of Nursing, Nurse Manager, Vice President of Nursing.

ADRIANN MARIE BRIERLEY, R.N. Page 8 FAILURE TO COMPLY MS. BRIERLEY agrees that her license to practice nursing as a registered nurse will be automatically suspended if it appears to the Board that MS. BRIERLEY has violated or breached any terms or conditions of the Consent Agreement. Following the automatic suspension, the Board shall notify MS. BRIEeLEY via certified mail of the specific nature of the charges and automatic suspension of her license. Upon receipt of this notice, MS. BRIERLEY may request a hearing regarding the charges. The above described terms and conditions shall constitute "restrictions placed on a license" for purposes of Section 4723,28(B), ORC. If, in the discretion of the Board, MS. BRIERLEY appears to have violated or breached any terms or conditions of this Consent Agreement, the Board reserves the right to institute formal disciplinary proceedings for any and all possible violations or breaches, including, but not limited to, alleged violations of the laws of Ohio occurring before the effective date of this Consent Agreement. DURATION/ MODIFICATION OF TERMS The terms, limitations and conditions of this Consent Agreement, may be modified or terminated, in writing, at any time upon the agreement of both MS. BRIERLEY and the Board. The Board may only alter the probationary period imposed by this Consent Agreement if: (1) the Board determines that MS. BRIERLEY has complied with all aspects of this Consent Agreement; and (2) the Board determines that MS. BRIERLEY is able to practice according to acceptable and prevailing standards of safe nursing care without Board monitoring, based upon an interview with MS. BRIERLEY and review of the reports as required herein. Any period during which MS. BRIERLEY does not work in a position for which a nursing license is required shall not count toward fulfilling the probationary period imposed by this Consent Agreement. ACKNOWLEDGMENTS/LIABILITY RELEASE MS. BRIERLEY acknowledges that she has had an opportunity to ask questions concerning the terms of this Consent Agreement and that all questions asked have been answered in a satisfactory manner. MS. BRIERLEY waives all of her rights under Chapter 119, ORC, as they relate to matters that are the subject of this Consent Agreement. MS. BRIERLEY waives any and all claims or causes tof action she may have against the Board, and its members, officers, employees and/or agents arising out of matters that are the subject of this Consent Agreement.

ADRIANN MARIE BRIERLBY, Page 9

This Consent Agreement shall be considered a public record as that term is used in Section 149.43, ORC. The information contained herein may be reported to appropriate organizations, data banks and governmental bodies. This Consent Agreement is not an adjudication order as discussed in Chapter 119, ORC. Any action initiated by the Board based on alleged violations of this Consent Agreement shall comply with the Administrative Procedures Act, Chapter 119, ORC. EFFECTIVE DATE S. BRIERLEY understands that this Consent Agreement is subject to ratification by the Board prior to signature by the Board President and shall become effective upon the last date of signature below.

ADRIANN MARIE BRIERLEY, R.N.

DATE

daaRkm-,RAJ
BERTHA LOVELACE, President Ohio Board of Nursing

5 i, re_
DATE

ATTACHMENT A
Adriann Brierley Missed Call History: Date 09/26/2012 01/05/2013 01/08/2013 01/07/2013 01/08/2013 01/09/2013 01/10/2013 01/11/2013 01/12/2013
L

retails Missed Call Missed Call Missed Call Missed. Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call

01/13/2013 01/14/2013 01/15/2013 01/16/2013 01/17/2013 01/18/2013 01/19/2013 01/20/2013 01/21/2013 01/22/2013 01/23/2013 01/24/2013 01/25/2013 01/26/2013 01/27/2013 01/28/2013 01/29/2013 01/30/2013 01/31/2013 02/01/2013 02102/2013

02/03/2013 , 02/04/2013 02/05/2013 02/06/2013 02/07/2013 02/08/2013 02/09/2013 02/10/2013 02/11/2013 02/12/2013 02/13/2013 02/14/2013 02/15/2013 02/16/2013 02/17/2013 02/18/2013 02/19/2013 02/20/2013 02/21/2013 02/22/2013 02/23/2013 02/24/2013 02/25/2013 02/26/2013 02/27/2013 02/28/2013 03/01/2013

Missed Call Missed Cali Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Cali Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call

Row Count 57

Case # 12-001726

Ohio Board of Nursing

17 South High Street, Suite 400 March 22, 2013

wwwinursing.ohi9.gov
e

Columbus, Ohio 43215-741.0

(614) 466-3947

NOTICE OF OPPORTUNITY FOR HEARING

Jessica Ann Burd, L.P.N. 613 Oil Street St. Marys, Ohio 45885 Dear Ms. Burd: In accordance with Chapter 119 Ohio Revised Code (ORC), you are hereby notified that the Ohio Board of Nursing (Board) proposes under authority of Section 4723.28, ORC, to deny; permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: 1. You entered into a Consent Agreethent with the Board on November 21, 2008 (November 2008 Consent Agreement) that placed your license to practice nursing as a licensed practical nurse on probation subject to probationary terms, conditions, and limitations. On March 19, 2010, you were released from the terms of the November 2008 Consent Agreement, with the exception of the temporary practice restrictions. While working as a nurse, for Briarwood Village, in Coldwater, Ohio, (Briarwood), in or about March 2011, you falsely documented that Patient #1 had on a heel lift boot when in fact the patient had refused treatment. You initially failed to document that the patient refused a prescribed treatment. You were counseled by Briarwood about this conduct on or about March 23, 2011 and signed the conference form. [See Attached Patient Key to Remain Confidential and Not Subject to Public Disclosure.]

2.

Section 4723.28(B)(19), ORC, authorizes the Board to discipline a licensee for failure to practice in accordance with acceptable and prevailing standards of safe nursing care. Section 4723.28(B)(16), ORC, authorizes the Board to discipline a licensee for violation of Chapter 4723, ORC, or any rules adopted under it. Specifically, Rule 4723-406(E), Ohio Administrative Code (OAC), states that a licensed nurse shall, in a complete, accurate, and timely manner, report and document nursing assessments or observations, the care provided by the nurse for the client, and the client's response to that care. Rule 4723-4-06(G), OAC, states that a licensed nurse shall

Jessica Arm Third, L.P.N. Page 2 not falsify any client record or any other document prepared or utilized in the course of, or in conjunction with) nursing practice. This includes, but is not limited to, case management documents or reports or time records, reports, and other documents related to billing for nursing services. 3. While working ps a nurse for Briarwood on or about May 2, 2011, you failed to notify a physician that Patient #2 had an open wound, failed to get a physician's order to treat the wound and place the order on. the Treatment Administration Record, and failed to document an assessment of the wound in Nurse's Notes or a facility Wound documentation checklist.

Section 4723.28(B)(19), ORC, authorizes the Board to discipline a licensee for failure to practice in accordance with acceptable and prevailing standards of safe nursing care. Section 4723.28(B)(16), ORC, authorizes the Board to discipline a licensee for violation of Chapter 4723, ORC, or any rules adopted under it. Specifically, Rule 4723-4-06(E), OAC, states that a licensed nurse shall, in a complete, accurate, and timely manner, report and document nursing assessments or observations, the care provided by the nurse for the client, and the client's response to that care. Rule 4723-4-04(C), OAC, states that a licensed practical nurse shall demonstrate Competence and accountability in all areas of practice in which the nurse is engaged which includes, but is not limited to, the following: (1) Consistent performance of all aspects of nursing care; and (2) Appropriate recognition, referral or consultation, and intervention, when a complication arises. Rule 4723-4-04(G), OAC, states that a licensed practical nurse shall, in a timely manner report to and consult as necessary with other nurses or other members of the health care team and make referrals as appropriate. 4. While working as a nurse for Briarwood on or about May 27, 2011, you inaccurately transcribed a physician's order onto Patient #3's PRN (or "as needed") Medication Administration Record rather than transcribing the order onto the patient's routine Medication Administration Record.

Section 4723.28(B)(19), ORC, authorizes the Board to discipline a licensee for failure to practice in accordance with acceptable and prevailing standards of safe nursing care. Section 4723.28(B)(16), ORC, authorizes the Board to discipline a licensee for violation of Chapter 4723, ORC, or any rules adopted under it. Specifically, Rule 4723-4-04(C), OAC, states that a licensed practical nurse shall demonstrate competence and accountability in all areas of practice in which the nurse is engaged which includes, but is not limited to, the following: (1) Consistent performance of all aspects of nursing care. Rule 4723-4-06(H), OAC, states that a licensed nurse shall implement measures to promote p safe environment for each client. 5. While working as a nurse for Briarwood on or about June 9, 2011, you mixed liquid medications together to administer to Patient # 4 without first consulting the Medication Administration Record. You acknowledged to a witness present that day that your conduct was not acceptable practice.

Jessica Ann Burd, L.P.N. Page 3 Section 4723.28(B)(19), ORC, authorizes the Board to discipline a licensee for failure to practice in accordance with acceptable and prevailing standards of safe nursing care. Section 4723.28(B)(16), ORC, authorizes the Board to discipline a licensee for violation of Chapter 4723, ORC, or any rules adopted under it. Specifically, Rule 4723-4-04(C), OAC, states that a licensed practical nurse shall demonstrate competence and accountability in all areas of practice in which the nurse is engaged which includes, but is not limited to, the following: (1) Consistent performance of all aspects of nursing care. Accordingly, the Board is authorized to impose one or more of the sanctions as cited in Section 4723.28 ORC. In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing on this matter. If you wish to request such hearing, the request must be made in writing and must be received in the Board office within thirty (30) days of the time of mailing this notice. You are hereby further informed that if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present you position, argument, or contentions in writing. At the hearing you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter to: Lisa Ferguson-Ramos, Compliance Unit Manager, 17 South High Street, Suite 400, Columbus, OH 43215-7410, or to the email address, hearing@nursialg.phio,gov.. If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in the Notice of Opportunity for Hearing, to deny; permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely, e_A/..75" Rhonda S. Barkheimer, C.N.P. Supervising Board Member Certified Mail Receipt No. 7012 2210 0000 6272 3339 cc: Henry G. Appel, Senior Assistant Attorney General

Case # 12-000684

Ohio Boar of Nursing

17 South High Street, Suite 400

www.nursing.ohio.gov
(614) 466-3947

Columbus, Ohio 43215-7410

March 22, 2013

NOTICE OF OPPORTUNITY FO '1? HEARING

Thomas Lawrence Butkovic, L.P.N. 5360 E. 134th St. Garfield Heights, Ohio 44125 Dear Mr. Butkovic: In accordance with Chapter 119, Ohio Revised Code (ORC), you are hereby notified that the Ohio Board Of Nursing (Board) proposes under authority of Section 472328 ORC, to deny, revoke, permanently revoke, suspend or place restrictions on your license to practice nursing as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: 1. On or about November 13, 2011, you admitted that while working as a nurse for Buckeye Homecare Services, Inc. in South Euclid, Ohio (Buckeye), you diverted Patient #11 5 [See attached Patient Key to remain confidential and not subject to public disclosure] prescription medications. Section 4723.28(B)(13) [as in effect prior to March 20, 2013], ORC, authorizes the Board to discipline a licensee for obtaining or attempting to obtain money or anything of value by intentional misrepresentation or material deception in the course of practice. 2. On or about November 13, 2011, you admitted that you ingested Oxycodone (Percocet) and Ativan (Lorazeparn) that was prescribed to Patient #1. Section 4723.28(B)(8) [as in effect prior to June 8, 2012], ORC, authorizes the Board to discipline a licensee for self-administcring or otherwise taking into the body any dangerous drug, as defined in Section 4729.01, ORC, in any way not in accordance with a legal, valid prescription issued for that individual. Accordingly, the Board is authorized to impose one or more of the sanctions cited in Section 4723.28, ORC. In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing in this matter. If you wish to request such hearing, the request must be made in writing and must be received in the Board office within thirty (30) days of the time of mailing of this notice. You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to

Thomas Lawrence Butkovic, Page 2 practice before the Board, or you may present your position, arguments, or contentions in writing. At the hearing, you may) also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter) to Lisa Ferguson-Ramos, Compliance Unit Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, Ohio 432157410 or to the email address, heari.ng@nursing.ohio.aov. If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Opportunity for Hearing, deny, revoke, permanently revoke, suspend, or place restrictions on your license to practice nursing as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely, A74/ Rhonda S. Barkheirner, R.N., C.N.P. Supervising Board Member Certified Mail Receipt No. 7012 2210 0000 6272 3278 Attorney Certified Mail Receipt No. 7012 2210 0000 6272 3919 cc: Henry G. Appel, Senior Assistant Attorney General Steven A. Sindeli, Esq.

Case # 10-5350

Ohio Board of Nursing

www.nursing.ohio.gov

17 South High Street, Suite 400 '6 Columbus, Ohio 43215-7410 . (614) 466-3947

March 22, 2013

NOTICE OF OPPORTUNITY FOR HEARING

Timothy Jerome Carlin, R.N. 5216 Riverwalk Dr. Kings Mills, Ohio 45034 Dear Mr. Carlin: In accordance with Chapter 119, Ohio Revised Code (ORC), you are hereby notified that the Ohio Board of Nursing (Board) proposes under authority of Section 4723.28 ORC, to deny, revoke, permanently revoke, suspend or place restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: 1. On or about November 11, 2010, while working as a nurse at Mercy Hospital Anderson in Cincinnati, Ohio, you were assigned to Patient #1 [key confidential, not subject to public disclosure]. You instructed a Clinical Nurse Administrator to re-start Diprivan for Patient #1 without a physician's order. Section 4723.28(B)(16), ORC, authorizes the Board to discipline a licensee for violation of Chapter 4723, ORC, or any rules adopted under it. Specifically, Rule 4723-4-03(J), Ohio Administrative Code, states that a registered nurse shall use acceptable standards of safe nursing care as a basis for any observation, advice, instruction, teaching, or evaluation and shall communicate information which is consistent with acceptable standards of safe nursing care with respect to the nursing care. Rule 4723-4-06(H), OAC, states that a licensed nurse shall implement measures to promote a safe environment for each client. Accordingly, the Board is authorized to impose one or more of the sanctions cited in Section 4723.28, ORC. In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing in this matter. If you wish to request such hearing, the request must be made in writing and must be received in the Board office within thirty (30) days of the time of mailing of this notice. You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in writing. At the hearing, you may also present evidence and examine witnesses appearing for and against you.

Timothy Jerome Carlin, R.N. Page 2 Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to Lisa Ferguson-Ramos, Compliance Unit Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, Ohio 432157410 or to the email address, hearing@nursing.ohio.gov. If the Board fails to receive a request for a hearing withintthirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and, legal allegations set forth in this Notice of Opportunity for Hearing, deny, revoke, permanently revoke, suspend, or place restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely,

;./c/ sc-7.26t,,
Rhonda S. Barkheimer, R.N., C.N.P. Supervising Board Member Certified Mail Receipt No. 7012 2210 0000 6272 3506 Attorney Certified Mail Receipt No. 7012 2210 0000 6272 3513 cc: Henry G. Appel, Senior Assistant Attorney General LaTonia Denise Wright, Esq.

Case It 12-000538; 12-003434 & 12-005028

Ohio Board of Nursing

www.nursing.ohio.gov

17 South High Street, Suite 400 .0 Columbus, Ohio 43215-74W 0 (614) 466-3947

March 22, 2013

NOTICE OF OPPORTUNITY FOR. HEARING

Samantha Lee Carter, L.P.N. 1310 Wilhelmina Drive Vandalia, Ohio 45377 Dear Ms. Carter: In accordance with Chapter 119, Ohio Revised Code (ORC), you are hereby notified that the Ohio Board of Nursing (Board) proposes under authority of Section 4723.28, ORC, to deny or permanently deny reinstatement of your license to practice nursing as a licensed practical nurse; permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a, licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: 1. On or about March 18, 2011, you entered into a Consent Agreement (March 2011 Consent Agreement) with the Ohio Board of Nursing (Board), a copy of which is attached hereto and incorporated herein, in which you agreed with the Board that your license to practice nursing as a licensed practical nurse in the State of Ohio would be suspended indefinitely, with conditions for reinstatement. Attached to and incorporated within the March 2011 Consent Agreement is a July 30, 2010 Notice of Opportunity for Hearing. Documents are redacted in accordance with Section(s) 2953 32 and/or 2953.52, O.C. a. On February 7, 2012, you provided a specimen for analysis to Firstlab, the Board's random drug/alcohol screen program administrator, that tested positive for Tramadol. You did not have a legal, valid prescription for Tramiadol. In a statement you provided the Board on March 7, 2012, you indicated that you took medication provided to you by a friend. b. On April 20,, 2012, you provided a specimen for analysis to Firstlab that tested positive for Propoxyphene. You did not have a legal, valid prescription for Propoxyphene. In a statement provided to the Board on August 2, 2012, you indicated that: "In April of 2012 I tested positive for

Samantha Lee Carter Page 2 Darvocet due to the fact that I had found some pills in my house and I took them on impulse."

Section 4723 28(B)(8) [as in effect prior to June 8, 2012], ORC authorizes the Board to discipline a licensee for self-administering or otherwise taking intp the body any dangerous drug, as defined in Section 4729.01, ORC, in any way not in accordance with a legal, valid prescription issued for that individual. c. Oa August 27, 2012, you provided a specimen for analysis to Firstlab that tested positive for Oxycodone. You did not have a legal, valid prescription for Oxycodone. d. On September 6, 2012, you provided a specimen for analysis to Firstlab that tested positive for Tramadol. You did not have a legal, valid prescription for Tramadol. Section 4723.28 (B)(8), ORC, authorizes the Board to discipline a licensee for self-administering or otherwise taking into the body any dangerous drug, as defined in Section 4729.01, ORC, in any way not in accordance with a legal, valid prescription issued for that individual, or selfadministering or otherwise taking into the body any drug that is a schedule I controlled substance. Accordingly, the Board is authorized to impose one or more of the sanctions cited in Section 4723.28, ORC. In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing in this matter. If you wish to request such hearing, the request must be made in writing and must be received in the Board office within thirty (30) days of the time of mailing of this notice. You, are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in writing. At the hearing, you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to Lisa Ferguson-Ramos, Compliance Unit Manager, Ohio Board of Nursing, 17 South High Street, Suite 400,rolumbus, Ohio 432157410 or to the email address, bearipgROgr.sina.obio,gpv. If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Opportunity for Hearing, deny or permanently deny reinstatement of your license to practice nursing as a licensed practical nurse; permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a licensed

Samantha Lee Carter Page 3 practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely,

Rhonda S. Barkheimer, R.N., C.N.P. Supervising Board Member Certified Mail Receipt No. 7012 2210 0000 6272 3162 Attorney Certified Mail Receipt No. 7012 2210 0000 6272 3179 cc: Henry G. Appel, Senior Assistant Attorney General LaTonia Denise Wright, Esq.

Ohio Board S f Nursing

17 South High Street. Suite 400

1VWW.I1UrSing.ohio.gov

Columbus, Ohio 43215-7410 <, (614) 466-3947

To Whom It May Concern:,.

You recently requested records regarding Samantha L. Carter, . PN # 125164. Enclosed are records in response to your request. Information has been redacted, per Section(s) 2953.32 and/or 2953.52 of the Ohio Revised Code. .1f you have any further questions or concerns, please contact the .Compliance Unit Manager or a Supervising Attorney.

Thank you. Compliance Unit Ohio Board of Nursing

Case #09-6217

Ohio Board of Nursing

17 South High Street, Suite 400

www.nursing.ohio.gov

Columbus, Ohio 43215-7410 s (614) 466.3947

CONSENT AGREEMENT BETWEEN SAMANTHA L, CARTER, L.PA, AND OHIO BOARD OF NURSING
This Consent Agreement is entered into by and between SAMANTHA L. CARTER, L.P,N. (MS. CARTER) and the Ohio Board of Nursing (Board), the state agency charged with enforcing Chapter 4723. of the Ohio Revised Code (ORC), and all administrative rules promulgated thereunder. MS. CARTER voluntarily enters into this Consent Agreement being fully informed of her rights under Chapter 119, ORC, including the right to representatiOn by legal counsel and the right to a formal adjudicative bearing on the issues considered herein. This Consent Agreement contains the entire agreement between the parties, there being no other agreement of any kind, verbal or otherwise, which varies the terms of this Consent Agreement. BASIS FOR ACTION This Consent Agreement is entered into on the basis of the following stipulations, admissions and understandings: A. The Board is empowered by Section 4723,28, Ohio Revised Code (ORC), to deny, 'permanently revoke, revoke, suspend, or place restrictions on any license issued by the Board; reprimand or otherwise discipline a licensee; or impose a fine of five hundred dollars ($500.00) or less per violation. Section 4723.28(B)(8), ORC, authorizes the Board to discipline a licensee for self-administering or otherwise taking into the body any dangerous drug, as defined in Section 4729.01, ORC, in any way not in accordance with a legal, valid prescription issued of that individual; Section 4723.28(B)(13), ORC, authorizes the Board to discipline a licensee for obtaining or attempting to obtain money or anything of value by intentional misrepresentation or material deception in the course of practice: Section 4723.28(B)(16), ORC, authorizes the Board to discipline a licensee for violation of Chapter 4723, ORC, or any rules adopted under it. Specifically, Rule 4723.4-06(0), Ohio Administrative Code l(OAC), states that a licensed nurse shall not falsify any client record or any other document prepared or utilized in the course of, or in .conjunction with, nursing practice, This includes, but is not limited to, case management

Samantha L. Carter, L.P.N. Page 2

documents or reports or time records, reports, and other documents related to billing for nursing services. Rule 4723-4-06(H), OAC, states that a licensed nurse shall implement measures to promote a safe environment for each client. B. MS. CARTER has been licensed to practice nursing as a licensed practical 'nurse in the State of Ohio, PN-125164, since January 2007. MS. CARTER requested that her license be placed on inactive status on January 4, 2010. MS. .CARTER knowingly and voluntarily admits to the legal and factual allegations set forth in the Notice of Opportunity for Hearing (July 2010 Notice) issued to her by the Board on July 30, 2010, a copy of which is attached hereto and incorporated herein. MS. CARTER knowingly and voluntarily admits to the following:

C.

D.

AGREED CONDITIONS Wherefore, in consideration of the foregoing and mutual promises hereinafter set forth, and in lieu of any formal proceedings at this time, S. CARTER knowingly and voluntarily agrees with the Board to the following terms, conditions, and limitations:

Samantha L. Carter, L.P.N. Page 3

SUSPENSION OF LICENSE 1. MS. CARTER'S license to practice as a licensed practical nurse is hereby suspended for an indefinite period of time, but not less than TWENTY-FOUR (24) months from the date that MS. CARTER placed her license on inactive status. MS. CARTER may submit a written request for reinstatement after December 1, 2011, if the conditions for reinstatement have bden satisfied,

CONDITIONS FOR REINSTATEMENT 2, MS. CARTER shall obey all federal, state, and local laws, and all laws and rules governing the practice of nursing in Ohio. MS. CARTER shall appear in person for interviews before the full Board or its designated representative as requested by the Board. Within six (6) months prior to requesting reinstatement, MS. CARTER agrees that she will submit a request to the Bureau of Criminal Identification and Investigation (BCII) to conduct a criminal records check of MS. CARTER, including a check of Federal Bureau of Investigation (FBI) records, and shall cause BCII to submit MS. CARTER'S criminal records check reports to the Board. MS. CARTER agrees that a request for reinstatement will not be considered by the Board until the completed criminal records check, including the FBI check, has been received by the Board. Prior to requesting reinstatement, MS. CARTER shall, in addition to the requirements of licensure renewal, successfully complete and submit satisfactory documentation of successful completion of the following continuing education taken subsequent to the effective date of this Consent Agreement: ten (10) hours of Chemical Dependency/Substance Abuse and two (2) hours in the Law and Rules Governing the Practice of Nursing in the State of Ohio. Prior to reinstatement, MS. CARTER shall enter into a Consent Agreement with the Board for probationary terms, conditions and limitations determined by the Board for a.minimum period of three (3) years following reinstatement,

3.

4.

5.

6.

Psychiatric Evaluation 7. Upon the request of the Board or its designee and vtrithin sixty (60) days of that request, MS. CARTER shall, at her expense, obtain a comprehensive evaluation by a psychiatrist who is approved in advance by the Board, . MS. CARTER shall provide the Board with complete documentation of this evaluation. Prior to the evaluation, MS. CARTER shall provide the evalitating psychiatrist with a copy of this Consent Agreement, the July 2010 Notice, and any psychiatric/psychological evaluation and treatment records for MS. CARTER for

Samantha L. Carter, L.P.N. Page 4

the past two years from Turning Point, Further, MS. CARTER shall execute releases to permit the evaluating psychiatrist to obtain any information deemed appropriate and necessary for the evaluation. The psychiatrist shall submit a written opinion to' the Board that includes diagnoses, recommendations for treatment and monitoring, and any additional restrictions to be placed on MS. CARTER'S license to practice, and stating whether MS. CARTER is capable of practicing nursing as a licensed practical nurse according to acceptable and prevailing standards of safe nursing care. If a psychiatric evaluation is requested, MS. CARTER shall prOvide the Board with satisfactory documentation of compliance with all aspects of the treatment plan developed by the psychiatrist described above until released. Further, MS. CARTER agrees that the Board may utilize the psychiatrist's recommendations, and conclusions from the evaluation as a basis for additional terms, eonditfons, and limitations on MS. CARTER'S license and that the terms, conditions, and limitations shall be incorporated in an addendum. to this Consent Agreement. Monitoring of Rehabilitation and Treatment 9. MS. CARTER shall abstain completely from the personal use or possession of drugs, except those prescribed, administered, or dispensed to her by another so authorized by law who has full knowledge of MS. CARTER'S history of chemical dependency and recovery status. MS. CARTER shall self-administer the prescribed drugs only in the manner prescribed. MS. CARTER shall abstain completely from the use of Alcohol. Within three (3) months immediately prior to requesting reinstatement, MS. CARTER shall, at her expense, obtain a chemical dependency evaluation by a Board approved chemical dependency professional and shall provide the Board with complete documentation of this evaluation. Prior to the evaluation, MS. CARTER shall provide the chemical dependency professional with a copy of this Consent Agreement, the July 2010 Notice, and copies of MS. CARTER'S psychiatric/psychological evaluation and treatment records for the past two (2) years from Turning Point. Further, MS. CARTER shall execute releases to permit the chemical dependency professional to obtain any information deemed appropriate and necessary for the evaluation. The chemical dependency professional shall submit a written opinion to the Board that includes diagnoses, recommendations for treatment and monitoring, any additional restrictions to be placed on MS. CARTER'S license to practice nursing as a licensed practical nurse, and stating whether MS. CARTER is capable of practicing nursing according to afceptable and prevailing standards of safe nursing care. MS. CARTER shall provide the Board with satisfactory documentation of compliance with all aspects of the treatment plan developed by the chemical

10. 11.

12.

Samantha L. Carter, L.P.N. Page 5

dependency professional described "above until released. Further, MS. CARTER agrees that the Board may utilize the professional's recommendations and conclusions from the evaluation as a basis for additional terms, conditions, and limitations on MS. CARTER'S' license and that the terms, conditions and limitations shall be incorporated in an addendum to the Consent Agreement. 13. For a minimum, continuous period of nine (9) months immediately prior to requesting reinstatement, MS. CARTER shall attend a minimum of one (1) meeting per week of a support or peer group meeting approved in advance by the Board, or a twelve-step program, and MS. CARTER shall provide satisfactory documentation of such attendance to the Board prior to requesting reinstatement. For a minimum, continuous period. of nine (9) months immediately prior to requesting reinstatement, MS. CARTER shall submit, at her expense and on the day selected, blood, breath, hair, or urine specimens for drug and/or alcohol analysis at a collection site specified by the Board at such times as the Board may request. Refusal to submit such specimen, or failure to submit such specimen on the day she is selected, or in such a manner as the Board may request, shall constitute a violation of a restriction placed on a license for purposes of Section 4723.28(B), ORC. This screening shall require a daily call-in process. The specimens submitted by MS. CARTER shall be negative, except for substances prescribed, administered, or dispensed to her by another so authorized by law who has full knowledge of MS. CARTER'S history of chemical dependency and recovery status. a, Within thirty (30) days prior to MS. CARTER initiating drug screening, MS. CARTER shall provide a copy of this Consent Agreement and the July 2010 Notice to all treating practitioners and shall provide to the Board a list of all treating practitioners, including addresses and telephone numbers and cause all treating practitioners to complete a medication prescription report that is to be mailed by the practitioner directly to the Board. The medication report is to be completed for any and all substances prescribed, administered, or dispensed to MS. CARTER. b. After_ initiating drug screening, MS. CARTER shall be under a continuing duty to provide a copy of this Consent Agreement and the July 2010 Notice prior to initiating treatment to additional treating practitioners and to update the list of treating practitioners with the Board within fortyeight (48) hours of being treated by another practitioner. Further, MS. CARTER shall notify the Board of any and all medications(s)t or prescription(s) received within twenty-four (24) hours of release from hospitalization or medical treatment. 4

14.

Samantha L. Carter, L.P.N. Page 6

Reporting Requirements of Licensee 15. MS. CARTER shall report to the Board, in writing, any violation of this Consent Agreement within thirty (30) days of the occurrence of the violation. MS. CARTER shall sign release of information forms allowing health professionals acid other organizations to submit requested documentation or information directly to the Board. MS. CARTER shall submit any and all information that the Board may request regarding her ability to practice according to acceptable and prevailing standards of safe nursing practice. MS. CARTER shall not submit or cause to be submitted any false, misleading, or deceptive statements, information, or documentation to the Board or to employers or potential employers, MS. CARTER shall submit the reports and documentation required by this Consent Agreement on forms specified by the Board. All reporting and communications required by this Consent Agreement shall be made to the Compliance Unit of the Board. MS. CARTER shall, submit the reports and documentation required by this Consent Agreement or any other documents required by the Board to the attention of the Compliance Unit, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, OH 43215-7410. MS. CARTER shall verify that the reports and documentation required by this Consent Agreement are received in the Board office. MS. CARTER shall inform the.Board within five (5) business days, in writing, of any change in employment status or of any change in address or telephone number.

16.

18.

19.

20.

21.

22.

Nnrsik

R esher Course or 0 en ation

MS. CARTER shall, prior to working in a position where a nursing license is required, complete and submit satisfactory documentation of completion of a nursing refresher course or an extensive orientation approved in advance by the Board or its designee. TEMPORARY NARCOTIC RESTRICTIONS MS, CARTER shall not administer, lave access to, or possess (except as prescribed for MS. CARTER'S use by another so authorized by law who has full knowledge of MS. CARTER'S history of chemical dependency and recovery status) any narcotics, other controlled substances, or mood altering drugs for a minimum period of NINE (9) MONTHS in which MS. CARTER 4

Samantha Carter, L.P.N. Page 7

is working in a position that requires a nursing license. At any time after the nine-month period previously described, MS. CARTER may submit a written request to the Board to have this restriction re-evaluated. In addition, MS. CARTER shall not count narcotics or possess or carry any work keys for locked medication carts, cabinets, drawers, or containers, MS. CARTER shall not tall in or order prescriptions or prescription refills.

PERMANENT PRACTICE RESTRICTIONS MS. CARTER further knowingly and voluntarily agrees with the Board to the following PERMANENT LICENSURE RESTRICTIONS: MS. CARTER shall not practice nursing as a licensed practical nurse (1) for agencies providing home care in the patient's residence; (2) for hospice care programs providing hospice care in the patient's residence; (3) for staffing agencies or pools; (4) as an independent provider where the nurse provides nursing care and is reimbursed for services by the State of Ohio through State agencies or agents of the State; or (5) for an individual or group of individuals who directly engage MS. CARTER to provide nursing services for fees, compensation, or other consideration or as a volunteer, MS. CARTER shall not function in a position or employment where the job duties or requirements involve management of nursing, nursing responsibilities, or supervising and evaluating nursing practice. Such positions include but are not limited to the following: Director of Nursing, Assistant Director of Nursing, Nurse Manager, Vice President of Nursing. FAILURE TO COMPLY The above described terms and conditions shall constitute "restrictions placed on a license" for purposes of Section 4723.28(B), ORC. If, in the discretion of the Board, MS. CARTER appears to have violated or breached any terms or conditions of this Consent Agreement, the Board reserves the right to institute formal disciplinary proceedings for' any and all possible violations or breaches, including, but not limited to, alleged violations of the laws of Ohio occurring before the effective date of this Consent Agreement. DURATION/ MODIFICATION OF TERMS The terms, limitations and conditions of this Consent Agreement, other than the permanent Iieensure restriction(s), may be modified or terminated, in writing, at any time upon the agreement of both MS. CARTER and the Board. The Board may only alter the indefinite suspension imposed. if: (I) MS. CARTER submits a written request for reinstatement; (2) the Board determines that MS. CARTER has complied with all conditions of reinstatement; (3) the Board determines that S. CARTER is able to_ practice according to acceptable and prevailing standards of safe nursing care based upon an interview with MS. CARTER and review of the documentation specified in this Consent

03/54/2011 1.a:45 5137710360

LATENIADENISEWRIGHT

PAGE 09/09

SarnarthbaL, Carter, LPN, Page /3 Agreement; and (4) MS. CARTER has entered into a Consent Agreement vith the Board for probationary toms, eonditiothg, and )imitations deteardned by the Board for a minimum period of three (.1) years following reinstatemenf-

MS. CARTER acknowledges that she. has had an opportunity to ask questions eeneerning,the terms of this Consent Agreement and that afl questions asked have been answered' in a satisfactory manner. MS. CARTER waives all of her rights under Chapter 119, ORC, as they relate to matters that. are the subject af. this Consent Agreement. MS. CARTER waives any and all claims or ceases of action she may have against the Board, and its members, officers, employees aDdior agents arising out, of matters which are the subject of this Consent Agreement, This Consent Agreement shall be considered a public record as that, terra is used. 'in Section 149.43, CRC, The information contained herein may be, reported to appropriate organizations. data banks and gown-numb-4 bodies. This Consent Agreement is not an adjudication order within the meaning of Section 19.0103), ORC. Any action initiated by the Board based on alleged violations of this Consent Agreement shall comply with the Administrztivc Procedures Act, Chapter i i 9, ORC, ME/a 1CT,WE_D.4...TE MS. CARTER understands that this Consent Agreement is subject to ratifi.mtion by the Board prior to signature by the Board President and shall become effective. upon the last date of signature below.

SAMANTHA L CARTER,

DATE

-1-tt

c8/9 0Akm-of
DAT E

ga6/1

MIZTTIA LOVELACE, President Ohio Board of Nursing

Z.,/Z96845

.101-11a0 )1t10..1

0 t 170 in IN

03/04/2011 FRI 14:18 [TX/RX NO 5837) Z008

Case # 09-6217

www.nursing,ohio..gov 17 South High Street, Suite 400 0. Columbus, Ohio 43215- 7410 h (614) 466- 3947
July 30, 2010

0.

Board of Nursirt

NOTICE OF OPPORTUNITY FOR HEARING

Samantha L Carter. L.P.N. 1310 Wiihelmina Drive Vandalia, OH 45377 Dear Ms. Carter: In accordance with. Chapter 119, Ohio Revised Code (ORC), you are hereby notified that the Board proposes under authority of Section 4723.28, ORC, to deny, revoke, permanently revoke, suspend or place restrictions on your license to practice nursing as a licensed practical nurse; reprimand or otherwise discipline you; or impose a flue of not more than five hundred dollars ($500.00) per violation for the following reasons: On or about December 18, 2009, while working as a nurse at Oak Creek Terrace in Kettering, Ohio, you submitted a specimen fox drug screening at the request of your employer. The results of your drug screen were. positive for Hydrocodone. Section 4723.28(B)(8), ORC, authorizes the Board to discipline a licensee for self-administering or otherwise taking into the body any dangerous drug, as defined in Section 4729.01, ORC, in any way not in accordance with a legal, valid prescription issued for that individual. 2. On or about December 28, 2009, you submitted a typed statement to the Board, in which you admitted to diverting narcotics from Oak Creek Terrace for approximately six (6) months. In your statement, you indicated that you diverted narcotics by signing the narcotics out for patients who did not need them. 4

Section 4723.28(B)(13), ORC, authorizes the Board to discipline a licensee for obtaining or attempting to obtain money or anything of value by intentional misrepresentation or material deception in the course of practice. Section 4723.28(B)(16), ORC, authorizes the Board to discipline a licensee for violation of Chapter 4723, ORC, or any rules adopted under it. Specifically, Rule 4723-4-06(G), Ohio Administrative Code (OAC), states that a licensed nurse shall not falsify any client record or any other document prepared or utilized in the course of, or in conjunction with, nursing practice. This includes, but is not limited to, case management documents or reports or time records, reports, and other documents related to billing for nursing services. Rule 4723-4-06(H), OAC, states that a licensed nurse shall implement measures to promote a safe environment for each client.

Samantha L. Carter, L.P.N. Page 2

Accordingly, the Board is authorized to impose one or more of the sanctions as cited in Section 4723.28, ORC. In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing in this matter. If you wish to request such hearing, the request must be made in writing and must be received in the Board office within thirty (30) days of the time of mailing of this notice.
4

T o tare hereby further informed that, if you timely request a hearing, you are entitled to appear
at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in writing. At the hearing you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter to: Lisa Ferguson-Ramos, Compliance Unit Manager, 17 South High Street, Suite 400, Columbus, OH 43215-7410, or to the email address, litaritg i ina,ohio.ov, If the. Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Opportunity for Hearing, deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely,

Anne Barnett, R.N., B.S.N., C.W.S. Supervising Member Certified Mail Receipt No. 7009 1680 0001 8226 8141

cc:

Melissa Wilburn, Assistant Attorney General

Case# 13-000357

Ohio Board of Nursing

wwwnursing.ohi.o.gov.

17 South High Street, Suite 400 cf Columbus, Ohio 43215-7410 t (614) 466-3947

March 22, 2013

NOTICE OF AUTOMATIC SUSPENSION AND OPPORTUNITY FOR HEARING

Shannon L. Cawthorn, R.N. 4933 Summerfield Road Toledo, Ohio 43623 Dear Ms. Cawthorn: You are hereby notified that, on or about May 20, 2011, you entered into a Consent Agreement (May 2011 Consent Agreement) with the Ohio Board of Nursing (Board), a copy of which is attached hereto and incorporated herein, in which you agreed with the Board that, upon meeting the requirements for licensure, your license to practice nursing as a registered nurse in the State of Ohio would be granted and suspended indefinitely, and that such suspension would be stayed subject to probationary terms, conditions, and limitations for a minimum period of two (2) years. A. Item 7. of the May 2011 Consent Agreement states, "Within sixty (60) days of the effective date of this Consent Agreement and continuing throughout the probationary period, MS. CAWTHORN shall begin submitting, at her expense and on the day selected, blood or urine specimens for drug and/or alcohol analysis at a collection site specified by the Board at such times as the Board may request. Refusal to submit such specimen, or failure to submit such specimen on the day she is selected, or in such a manner as the Board may request, shall constitute a violation of a restriction placed on a license for purposes of Section 4723.28(B), ORC. This screening shall require a daily call-in process. The specimens submitted by MS. CAWTHORN shall be negative, except for substances prescribed, administered, or dispensed to her by another so authorized by law who has full knowledge of MS. CAWTHORN's history of chemical dependency and recovery status." Despite this provision, on the dates set forth in Attachment A, attached hereto and incorporated herlin, you failed to call Firstlab, the Board's random drug/alcohol screen program administrator, to determine if you had been selected to provide a specimen for analysis. Furthermore, on the following dates, you were selected to provide a specimen for analysis and failed to do so: October 9, 2012; November 19, 2012; December 4, 2012; January 22, 2013; and February 18, 2013.

Shannon L. Cawthorn, R.N. Page 2 Section 4723.28(B)(17), Ohio Revised Code, ORC, authorizes the Board to discipline a licensee for violation of any restrictions placed on a nursing license by the Board. In accordance with the paragraph under "FAILURE TO COMPLY" of the May 2011 Consent Agreement, you are hereby notified that it appears to the Board that you have violated Item 7. of the May 201] Consent Agreement. YOU ARE FURTHER NOTIFIED THAT YOUR LICENSE TO PRACTICE NURSING AS A REGISTERED NURSE, RN-370043, IS HEREBY AUTOMATICALLY SUSPENDED. Continued practice after receipt of this notice of suspension shall be considered engaging in the practice of nursing as a registered nurse without a current, valid license, which is a violation of Section 4723.03(A), ORC. You are further notified that in accordance with Chapter 119, ORC, the Board proposes under authority of Section 4723.28, ORC, to deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: 1. On or about May 20, 2011, you entered into a Consent Agreement (May 2011 Consent Agreement) with the Ohio Board of Nursing (Board), a copy of which is attached hereto and incorporated herein, in which you agreed with the Board that, upon meeting the requirements for licensure, your license to practice nursing as a registered nurse in the State of Ohio would be granted and suspended indefinitely, and that such suspension would be stayed subject to probationary terms, conditions, and limitations for a minimum period of two (2) years. 2. Item 7. of the May 2011 Consent Agreement states, "Within sixty (60) days of the effective date of this Consent Agreement and continuing throughout the probationary period, MS. CAWTHORN shall begin submitting, at her expense and on the day selected, blood or urine specimens for drug and/or alcohol analysis at a collection site specified by the Board at such times as the Board may request. Refusal to submit such specimen, or failure to submit such specimen on the day she is selected, or in such a manner as the Board may request, shall constitute a violation of a restriction placed on a license for purposes of Section 4723.28(B), ORC. This screening shall require a daily call-in process. The specimens submitted by MS. CAWTHORN shall be negative, except for substances prewribed, administered, or dispensed to her by another so authorized by law who has full knowledge of MS. CAWTHORN's history of chemical dependency and recovery status." Despite this provision, on the dates set forth in Attachment A, attached hereto and incorporated herein, you failed to call Firstlab, the Board's random

Shannon L. Cawthorn, R.N. Page 3 drug/alcohol screen program administrator, to determine if you had been selected to provide a specimen for analysis. Furthermore, on the following dates, you were selected to provide a specimen for analysis and failed to do so: October 9, 2012; November 19, 2012; December 4, 2012; Jannary 22, 2013; and February 18, 2013. Section 4723.28(B)(17), Ohio Revised Code, ORC, authorizes the Board to discipline a licensee for violation of any restrictions placed on a nursing license by the Board. Accordingly, the Board is authorized to impose one or more of the sanctions as cited in Section 4723.28, ORC. In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing in this matter. If you wish to request such hearing, the request must be made in writing and must be received in the Board office within thirty (30) days of the time of mailing of this notice. You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in writing. At the hearing you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to: Lisa Ferguson-Ramos, Compliance Unit Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, Ohio 432157410, or to the e-mail address, hearingAnursing.ohio.gov. If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Automatic Suspension and Opportunity for Hearing, deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars (5500.00) per violation. Sincerely, XS' .A7/v

$) Rhonda S. Barkheimer, R.N., C.N.P. Supervising Board Member

Certified Mail Receipt No. 7012 2210 0000 6272 3834 cc: Henry G. Appel, Senior Assistant Attorney General

Case #2011-000021

Ohio Board of Nursing- www.rtursing.ohio.gov

17 South High Street, %tile 400 0 Columbus, Ohio 43215-7410 0 (614) 466-3947

CONSENT AGREEMENT BETWEEN SHANNON L. CAWTHORN, R.N. APPLICANT AND OHIO BOARD OF NURSING
This Consent Agreement is entered into by and between SHANNON L. CAWTHORN, R.N. APPLICANT (MS. CAWTEIORN) and the Ohio Board of Nursing (Board), the state agency charged with enforcing Chapter 4723. of the Ohio Revised Code (ORC), and all administrative rules promulgated thereunder. MS. CAWTHORN voluntarily enters into this Consent Agreement being fully informed of her rights under Chapter 119, ORC, including ,the right to representation by legal counsel and the right to a formal adjudicative hearing on the issues considered herein. This Consent Agreement contains the entire agreement between the parties, there being no other agreement of any kind, verbal or otherwise, which varies the terms of this Consent Agreement. BASIS FOR ACTION This Consent Agreement is entered into on the basis of the following stipulations, admissions and understandings: A. The Board is empowered by Section 4723.28, ORC, to deny, permanently revoke, revoke, suspend, or place restrictions on any license issued by the Board; reprimand or otherwise discipline a licensee; or impose a fine of five hundred dollars ($500.00) or less per violation. Section 4723.28(B)(8), ORC; authorizes the Board to deny a license or otherwise discipline a licensee.. for selfadministering or otherwise taking into the body any dangerous drug, as defined in Section 4729.01, ORC, in any way not in accordance with a legal, valid prescription issued for that individual. Section 4723.28(B)(9), ORC, authorizes the Board to deny a license or otherwise discipline a licensee for habitual indulgence in the use of controlled substances, other habit-forming drugs, or alcohol or other chemical substances to an extent that impairs 4bility to practice.

Shannon L. Cawthorn, R.N. Applicant Page 2

B.

In December 2010, MS. CAWTHORN submitted to the Board an Application for Licensure by Bxamination to Practice in Ohio as a Registered Nurse. MS. CAWTHORN knowingly and voluntarily admits that in May 2006, in Lucas County Court of Common Pleas, MS( CAWTHORN pled guilty to one (1) felony count of Theft of Drugs and was granted Treatment in Lieu of Conviction (ILC). MS. CAWTHORN completed the terms of the case and was released from ILE by the Court in 2007. MS. CAWTHORN's criminal case stemmed from her employment at a local animal emergency care and critical care center, where she, in 2005, while as a registered veterinary technician stole (diverted) Buprenex (an Opioid medication) for her own personal use. MS. CAWTHORN also reported to the Board that the Ohio Veterinary Medical Licensing Board took disciplinary action against her registration to practice as a registered veterinary technician. In MS. CAWTHORN's personal statement to the Board, MS. CAWTHORN reported that, at the time, she had numerous personal challenges that included chronic pain issues, heavy drinking, and very depressed. MS. CAWTHORN further reported that she completed chemical dependency treatment in April 2006 and has maintained her sobriety for over a five (5) year period. MS. CAWTHORN was permitted to take the NCLEX-RN, and on or about March 7, 2011, MS. CAWTHORN passed the NCLEXRN. AGREED CONDITIONS

C,

D.

B.

F.

Wherefore, in consideration of the foregoing and mutual promises hereinafter set forth, and in lieu of any formal proceedings at this time, MS. CAWTHORN knowingly and voluntarily agrees with the Board to the following terms, conditions, and limitations: Upon meeting the requirements for licensure, MS. CAWTHORN shall be granted a license to practice nursing as a registered nurse in the State of Ohio. MS. CAWTHORN's license to practice nursing as a registered nurse shall be suspended Such suspension shall be stayed, subject to the following indefinitely. PROBATIONARY terms, conditions, and limitations for a minimum period of at least two (2) years: I. MS. CAWTHORN shall obey all federal, state, and local laws, and all laws and rules governing the practice of nursing in Ohio,

Shannon L. Cawthorn, RN. Applicant Page 3

2.

MS. CAWTHORN shall appear in person for interviews before the full Board or its designated representative as requested by the Board or its designee.

Continuing Education Hours 3. Within ninety (90) days from the effective date of this Consent Agreement, MS. CAWTHORN shall, in addition to the requirements of licensure renewal, successfully complete and submit satisfactory documentation of successful completion of the following continuing education taken subsequent to the effective date of this Consent Agreement: two (2) hours of Ohio nursing law and rules; five point four (5.4) hours of Professional Accountability and Legal Liability for Nurses; and, ten (10) hours of Opiate Abuse & Dependence.

Criminal Records Check 4. Within ninety (90) days prior to submitting a request for release from the probationary terms, conditions and limitations of this Consent Agreement, MS. CAWTHORN agrees that she will submit a request to the Bureau of Criminal Identification and Investigation (BCII) to conduct a criminal records check of MS. CAWTHORN, including a check of Federal Bureau of Investigation (FBI) records, and shall cause BCII to submit MS. CAWTHORN's criminal records check reports to the Board. MS. CAWTHORN agrees that a request for release from the probational), terms of this Consent Agreement will not be considered by the Board until the completed criminal records check, including the FBI check, has been received by the Board.

Monitoring and Treatment 5. MS. CAWTHORN shall abstain completely from the personal use or possession of drugs, except those prescribed, administered, or dispensed to her by another so authorized by law who has full knowledge of MS. CAWTHORN's history of chemical dependency and recovery status. MS. CAWTHORN shall self-administer prescribed drugs only in the manner prescribed. MS. CAWTHORN shall abstain completely from the use of alcohol and/or substances containing alcohol. Within sixty 0 (60) days of the effective date of this Consent Agreement and continuing throughout the probationary period, MS. CAWTHORN shall begin submitting, at her expense and on the day selected, blood or urine specimens for drug and/or alcohol analysis

6.

7.

Shannon L. Cawthorn, R.N. Applicant Page 4

at a collection site specified by the Board at such times as the Board may request. Refusal to submit such specimen, or failure to submit such specimen on the day she is selected, or in such a manner as the Board may request, shall constitute a violation of a restriction placed on a license for purposes of Section 4723.28(B), ORC. This screening shall require a daily call-in process. The specimens submitted by MS. t CAWTHORN shall be negative, except for substances prescribed, administered, or dispensed to her by another so authorized by law who has full knowledge of MS. CA.WTHORN's history of chemical dependency and recovery status. 8. MS. CAWTHORN shall continue attending a minimum of one (1) meeting per week of a support or peer group meeting approved in advance by the Board, or a Twelve Step program, and MS. CAWTHORN shall provide satisfactory documentation of such attendance to the Board every six (6) months beginning July 1, 2011. Within sixty (60) days following the effective date of this Consent Agreement, MS. CAWTHORN shall, at her expense, obtain a chemical dependency evaluation by a Board approved chemical dependency professional and shall provide the Board with complete documentation of this evaluation. Prior to the evaluation, MS. CAWTHORN shall provide the chemical dependency professional with a copy of this Consent Agreement, Further, MS. CAWTHORN shall execute releases to permit the chemical dependency professional to obtain any information deemed appropriate and necessary for the evaluation. The evaluating professional shall submit a written opinion to the Board that includes diagnoses, recommendations for treatment and monitoring, any additional restrictions that should be placed on MS. CAWTHORN's license to practice, and a statement as to whether MS. CAWTHORN is capable of practicing nursing according to acceptable and prevailing standards of safe nursing care. MS. CAWTHORN shall provide the Board with satisfactory documentation of compliance with all aspects of the treatment plan developed by the chemical dependency professional described above until released. Further, MS. CAWTHORN agrees that the Board may utilize the professional's recommendations and conclusions from the evaluation as a basis for additional terms, conditions, and limitations on MS. CAWTHORN's license and that the terms, conditions, and limitations may be incorporated in an addendum to this Consent Agreement.

9.

10,

Shannon L. Cawthorn, R.N. Applicant Page 5

Psychiatric Evaluation & Treatment 11. Within ninety (90) days following the effective date of this Consent Agreement, MS. CAWTHORN shall, at her expense obtain a psychiatric evaluation from a Board approved psychiatrist and shall provide the Bord with complete documentation of this evaluation. Prior to the evaluation, MS. CAWTHORN shall provide the psychiatrist with a copy of this Consent Agreement and shall execute releases to permit the psychiatrist to obtain any information deemed appropriate and necessary for the evaluation. The evaluating psychiatrist shall submit a written opinion to the Board that includes diagnoses, recommendations for treatment and monitoring, any additional restrictions that should be placed on MS. CAWTHORN's license, and a statement as to whether MS. CAWTHORN is capable of practicing nursing according to acceptable and prevailing standards of safe nursing care. MS. CAWTHORN- shall provide the Board with satisfactory documentation of compliance with all aspects of the treatment plan developed by the psychiatrist until released, Further, MS. CAWTHORN agrees that the Board may use the psychiatrist's recommendations and conclusions from the evaluation as a basis for additional terms, conditions, and limitations on MS. CAWTHORN's license and that the terms, conditions, and limitations may be incorporated in an addendum to this Consent Agreement.

12.

Treating Practitioners and Reporting 13. Within sixty (60) days of the effective date of this Consent Agreement, MS. CAWTHORN shall provide a copy of this Consent Agreement to all treating practitioners and shall provide to the Board a list of all treating practitioners, including addresses and telephone numbers, Further, MS. CAWTHORN shall be under a continuing duty to provide a copy of this Consent Agreement, prior to initiating treatment, 'to additional treating practitioners, and to update the list of treating practitioners with the Board within forty-eight (48) hours of being treated by another practitioner. MS. CAWTHORN shall cause all treating practitioners to complete a medication prescription report that is to be mailed by the practitioner directly to the Board. The medication report is to be completed for any and all substances prescribed, administered, or dispensed to MS. CAWTHORN throughout the duration of this Consent Agreement.

14.

Shannon L. Cawthorn, R.N. Applicant . Page 6

15.

Within twenty-four (24) hours of release from hospitalization or medical treatment, MS. CAWTHORN shall notify the Board of any and all medicatiott(s) or prescription(s) received.

Employment Conditions 16. Prior to accepting employment as a nurse, each time with every employer, MS. CAWTHORN shall notify the Board. S. CAWTHORN is under a continuing duty to provide a copy of this Consent Agreement to any new employer prior to accepting employment in a position in which a nursing license is required. MS. CAWTHORN shall have her employer(s), if working in a position where a nursing license is required, submit written reports regarding job performance on a quarterly basis within thirty (30) clays of accepting nursing employment. MS. CAWTHORN shall have her employer(s) send documentation to the Board, along with the first employer report, of receipt of a copy of this Consent Agreement, including the date the Consent Agreement was received, 4

17.

Reporting Requirements of Licensee 18. MS. CAWTHORN shall report to the Board, in writing, any violation of this Consent Agreement within thirty (30) days of the occurrence of the violation. MS. CAWTHORN shall sign release of information forms allowing health professionals and other organizations to submit the requested documentation directly to the Board. MS. CAWTHORN shall submit any and all information that the Board may request regarding her ability to practice according to acceptable and prevailing standards of safe nursing practice. MS. CAWTHORN shall not submit or, cause to be submitted any false, misleading, or deceptive statements, information, or documentation to the Board or to employers or potential employers. MS. CAWTHORN shall submit the reports and documentation required by this Consent Agreement on forms specified by the Board. All reporting and communications required by this Consent Agreement shall be made to the Compliance Unit of the Board.

19.

20.

21.

22.

Shannon A.r. Cawthorn, R.N. Applicant Page 7

23.

MS. CAWTHORN shall submit the reports and documentation required by this Consent Agreement or any other documents required by the Board to the attention of the Compliance Unit, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, OH 43215-7410. MS. CAWTHORN shall verify that the reports and documentation required by this Consent Agreement are received in the Board office. S. CAWTHORN shall inform the Board within five (5) business days, in writing, of any change in employment status or of any change in residential or home address or telephone number.

24.

25.

Temporary Narcotic Restriction MS. CAWTHORN shall not administer, have access to, or possess (except as prescribed for MS. CAWTHORN's use by another so authorized by law who has full knowledge of MS. CAWTHORN's history of chemical dependency and recovery status) any narcotics, other controlled substances, or mood altering drugs for a minimum of six (6) months period of time in which MS. CAWTHORN is working in a position that requires a nursing license. At any time after the six (6) month period of time previously described, MS. CAWTHORN may submit a written request to the Board to have this restriction reevaluated. In addition, MS. CAVVTHORN shall not count narcotics or possess or carry any work keys for locked medication carts, cabinets, drawers, or containers. MS. CAWTHORN shall not call in or order prescriptions or prescription refills for narcotics, other controlled substances, or mood altering drugs. Temporary Practice Restrictions MS. CAWTHORN shall not practice nursing as a registered nurse (1) for agencies providing home care in the patient's residence; (2) for hospice care programs providing hospice care in the patient's residence; (3) for staffing agencies or pools; (4) as an independent provider where the nurse provides nursing care and is reimbursed for services by the State of Ohio through State agencies or agents of the State; or (5) for an individual or group of individuals who directly engage MS. CAWTHORN to provide nursing services for fees, compensation, or other consideration or as a volunteer. MS. CAWTHORN shall not function in a position or employment where the job duties or requirements involve management of nursing and nursing responsibilities, or supervising and evaluating nursing practice. Such positions include, but are not limited to, the following: Director of Nursing, Assistant Director of Nursing, Nurse Manager, Vice President of Nursing.

Shannon L. CawthOrn, R.N. Applicant Page 8

FAILURE TO COMPLY MS. CAWTHORN agrees that her license to practice nursing as a registered nurse will be automatically suspended if it appears to the Board that MS. CAWTHORN- has violated or breached any terms or conditions of the Consent Agreement. Following the automatic suspension, the Board shall notify MS. CAWTHORN via certified mail of the specific nature of the charges and automatic suspension of her license. Upon receipt of this notice, MS. CAWTHORN may request a hearing regarding the charges. The above described terms and conditions shall constitute "restrictions placed on a license" for purposes of Section 4723.28(B), ORC. If, in the discretion of the Board, S. CAWTHORN appears to have violated or breached any terms or conditions of this Consent Agreement, the Board reserves the right to institute formal disciplinary proceedings for any and all possible violations or breaches, including, but not limited to, alleged violations of the laws of Ohio occurring before the effective date of this Consent Agreement. DUR TION/ MQDIFICATIO OF TERMS The terms, limitations, and conditions, of this Consent Agreement, may be modified or terminated, in writing, at any time upon the agreement of both MS. CAWTHORN and the Board. The Board may only alter the probationary period imposed by this Consent Agreement if: (1) the Board determines that MS. CAWTHORN has complied with all aspects of this Consent Agreement; and (2) the Board determines that' MS. CAWTHORN is able to practice according to acceptable and prevailing standards of safe nursing care without Board monitoring, based upon an interview with MS. CAWTHORN and review of the reports as required herein. Any period during which MS. CAWTHORN does not work in a position for which a nursing license is required shall not count toward fulfilling the probationary period imposed by this Consent Agreement. ACKNOWLEDGMENTS/LIABILITY RELEASE MS. CAWTHORN acknowledges that she has had an opportunity to ask questions concerning the terms of this Consent Agreement and that all questions asked have been answered in a satisfactory manner. MS. CAWTHORN waives all of her rights under Chapter 119, ORC, as they relate to matters that are the subject of this Consent Agreement. MS. CAWTHORN waives any and all claims or causes of action she may have against the Board, and its members, officers, employees andior agents arising out of matters, which are the subject of this Consent Agreement.

Shannon L. Cawthorn, R.N. A plicant Page 9 This Consent Agreement shall be considered a public record as that term is used in Section 149.43, ORC. The information contained herein may be reported to appropriate organizations, data banks and governmental bodies. This Consent Agreement is not an adjudication order as discussed in Chapter 119, ORC. Any action initiated by the Board based on alleged violations of this Consent Agreement shall comply with the Administrative Procedures AA, Chapter 119, ORC. EFFECTIVE DATE MS. CAWTHORN understands that this Consent Agreement is subject to ratification by the Board prior to signature by the Board President and shall become effective upon the last date of signature below.

SHANNON L. CAWTHORN, R.N. APPLICANT

DATE

f.)1,)ib BERTHA LOVELACE, President Ohio Board of Nursing DATE

ii

ATTACHMENT A
Missed Call History: Date 08/19/2011 10/06/2012 10/31/2012 1 1/14/2012 12/09/2012 12/12/2012 12/17/2012 12/20/2012 12/21/2012 12/25/2012 12/26/2012 12/27/2012 12/29/2012 01/08/2013 01/11/2013 01/12/2013 01/13/2013 01/15/2013 01/17/2013 01/18/2013 01/19/2013 01/20/2013 01/21/2013 01/22/2013 01/23/2013 01/24/2013 01/25/2013 01/26/2013 01/27/2013 01/28/2013 01/29/2013 01/30/2013 01/31/2013 Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Calf Missed Call Missed Call Missed Call Missed Call Missed Call Missed Cali Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call ' Det,a i Is'

02/01/2013 02/02/2013 02/03/2013 02/04/2013 02/05/2013 02/06/2013 02/07/2013 t 02/08/2013 02/09/2013 02/10/2013 02/11/2013 02/12/2013 02/13/2013 02/14/2013 02/15/2013 02/16/2013 02/17/2013 02/18/2013 02/19/2013 02/20/2013 02/21/2013 02/22/2013 02/23/2013 02/24/2013 02/25/2013 02/26/2013 02/27/2013 02/28/2013 03/01/2013

Missed Call. Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call

-Missed Call
Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call '

Row Count: 62

Case #12-003901

Oho i Board of Nursing

17 South High Street, Suite 400

www.nursina Ohio oov-0 --0

6 (614) 466-3947

Columbus, Ohio 43215-7410

March 22, 2013

NOTICE OF OPPORTUNITY FOR HEARING

Vivian Lee Chapek, R.N. 8355 Raleigh PL Concord, Olt 44077 Dear Ms. Chapek: in accordance with Chapter 119. of the Ohio Revised Code (ORC), you are hereby notified that the Ohio Board of Nursing (Board) proposes under the authority of Section 4723.28, ORC, to deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: 1. On or about September 19, 2012, in Summit County Court of Common Pleas Case No. CR 12 07 1899, you pled guilty to two (2) amended counts of Attempted Assault on a Police Officer, both fifth degree felonies, in violation of Sections 2923.02/2903.13(A) ORC. The events underlying your conviction occurred on or about July 2012, in Fairlawn, Ohio. Section 4723.28(B)(4) [as in effect prior to March 20, 2013], ORC authorizes the Board to discipline a licensee for conviction of, a plea of guilty to, a judicial finding of guilt of, a judicial finding of guilt resulting from a plea of no contest to, or a judicial finding of eligibility for intervention in lieu of conviction for, any felony. Accordingly, the Board is authorized to impose one or more of the sanctions as cited in Section 4723.28 ORC. You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in writing. AOthe hearing you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to: Lisa Ferguson-Ramos, Compliance Unit Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, OH 43215-7410, or to the email address, hearkkg@nursing.ohio.gov.

Vivian Lee Chapel, R.N. Page 2 If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Opportunity for Hearing, deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than fiVe hundred dollars ($500.00) per violation. Sincerely,

Rhonda S. Barkheimer, R.N., C.N.P. Supervising Board Member

Certified Mail Receipt No. 7012 2210 0000 6272 3049 Attorney Certified Mail Receipt No. 7012 2210 0000 6272 3056 cc: Barry Doyle, Esq. Henry G. Appel, Senior Assistant Attorney General

Case #12-003787

Ohio BoArd of Nursing

17 South 'High Street, Suite 400
e,

www.nu sing ohio.gov

(614) 466-3947

Columbus, Ohio 43215-7410

March 22, 2013

NOTICE OF OPPORTUNITY FOR HEARING

Tinita M. Coaster, R.N. Applicant 18036 Pine East Brownstown, MI 48193 Dear Ms. Coaster: In accordance with Chapter 119 Ohio Revised Code (ORC), you are hereby notified that the Ohio Board of Nursing (Board) proposes under authority of Section 4723.28, ORC, to permanently deny or deny your application for licensure to practice nursing in Ohio; permanently revoke, revoke, suspend or place restrictions a license granted to you to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: On or about March 8, 2012, the State of Michigan, Department of Licensing and Regulatory Affairs, Bureau of Health Professions, Board of Nursing, Disciplinary Subcommittee (Michigan Board), issued a Consent Order and Stipulation (2012 Michigan Consent Order), which placed your license to practice nursing as a licensed practice nurse on probation. A copy of the 2012 Michigan Consent Order and related Administrative Complaint are attached hereto and incorporated herein. Section 4723.28(B)(1) [as in effect prior to March 20, 2013], ORC, authorizes the Board to discipline a license for denial, revocation, suspension, or restriction of authority to practice a health care occupation, including nursing, for any reason other than a failure to renew, in Ohio or another state or jurisdiction. Accordingly, the Board is authorized to impose one or more of the sanctions as cited in Section 4723.28 ORC. In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing on this matter. If you wish to request such hearing, the request must be made in writing and must be received in the Board office within thirty (30) days of the time of mailing this notice. You are hereby further informed that if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to

Tinita M. Coaster, R.N. Applicant Page 2 practice before the Board, or you may present you position, argument, or contentions in writing. At the hearing you may also present evidence and examine witnesses appearing for laid against you. Should you choose to request a bearing, please mail or deliver the request, in addition to any other correspondence regarding this matter to: Lisa Ferguson-Ramos, Compliance Unit Manager, 17 South High Street, Suite 400, Columbus, OH 43215-7410, or to the email address, hearing@nursngoho,gov. If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in the Notice of Opportunity for Hearing, to permanently deny or deny your application for licensure to practice nursing in Ohio; permanently revoke, revoke, suspend or place restrictions a license granted to you to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely,

Rhonda S. Barkheimer, G.N.P. Supervising Board Member Certified Mail Receipt No. 7012 2210 0000 6272 3087 cc: Henry G. Appel, Senior Assistant Attorney General

 STATEOF MICHIGAN 'DEPARTMENT OF. LICENSING AND REGULATORY AFFAIRS BUREAU .OF HEALTH PROFESSIONS BOARD OF. NURSING DISCIPLINARY SUBCOMMI1 1EE In the Matter of TINITA MARIE COASTER, LIDA. License Number: 47-03-099126

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N.)

CONSENT ORDER AND STIPuaTRN

6-)

File Number: 47-114.4.19Q99 :"1"1

CONSENT ORDER WHEREAS, an Administrative Complaint, hereafter Complaint, was issued on November 3, 2011, charging Tinita Marie Coaster, L.P.N., hereafter Respondent, with having violated section 16221(a) of the Public Health Code, 1978 PA 368, as amended; MCL 333.1101 et seq; and

WHEREAS, Respondent has adrnitted, by Stipulation submifted herewith, that the facts alleged in the Complaint are true and constitute violations of the Public Health Code; and

WHEREAS, the Disciplinary Subcommittee of the Michigan Board of Nursing, hereafter Disciplinary Subcommittee, has reviewed the Stipulation and, based upon the matters asserted therein, agrees that the public interest is best served by resolution of the outstanding Complaint; now, therefore,
GOI "44 $110V cf*C"4 tow eki

IT IS HEREBY FOUND that the allegations of fact and law set forth in the pcirnglaiht ate true and 'constitute vielationa of section 16221(a) of the Public supra. Code,

Accordingly,

IT IS HEREBY ORDERED that for the aforesaid violations of the Public Health Code,. Respondent is placed on PROBATION fora period of SIX MONTHS, commencing on the effective date of this Order. Reduction of the probationary period shall only occur while Respondent is employed as a nurse. The terms of probation shall be as follows: 1, CONTINUING EDUCATION: Within six months of the effective date of this Order, Respondent shall successfully complete one course of continuing education accepted by the Michigan Board of Nursing, hereafter Board, in each of the following areas: a) professional accountability and legal liability; and . b) medication administration. This continuing education shall pot apply 'in computing Respondent's current continuing education requirements for license renewal. Respondent shall seek and obtain pre-approval of the continuing education courses from the Chairperson of the Board or the Chairperson's designee. With regard to the continuing education relating to professional accountability and legal liability, Respondent may successfully' complete Professional Accountability & Legal .Liability for Nurses" offered by the National Council of State Boards of Nurding, available at wvvvv.learninoext.com or request pre-approval of a comparable continuing education course. Respondent shall mail requeSts for pre-approval and proof of the successful completion of the continuing education to the Department of Licensing and RegulatorY Affairs, hereafter Department, at the address set forth beloW,

2.

EMPLOYER REPORTS: In the event Respondent is employed as a nurse, Respondent shall immediately provide copies of this Order and the Complaint dated. November 3, 2011, to. Respondent's employer and supervisor, Respondent's employer or supervisor shall be knowledgeable of Respondent's history and shall file reports With the Department, as further provided herein, advising of Respondent's work performance. In the event, Respondent, et any time, fails to comply with the minimal standards of acceptable and prevailing practice or appears unable to practice with reasonable skill and safety, the Department shall be immediately so notified by Respondent's employer or supervisor.

3.

EMPLOYMENT CHANGE: Respondent shall report to the Department, in writing, any and all changes in Respondent's employment within 15 days of such change, if Respondent's employment requires Respondent to have a license to practice nursing. Respondent shall provide copies of this Order and the Complaint dated November 3, 2011, to each successor employer and supervisor, if the employment requires Respondent to have a nursing license. The successor employer shall be knowledgeable of Respondent's history and shall continue to file reports with the Department advising of Respondent's work performance, as set forth above.

4.

REPORT OF NON-EMPLOYMENT: If at any time during the period of probation Respondent is not employed as a nurse, Respondent shall file a report of non-employment with the Department within 15 days after beconling unemployed. Respondent shall continue to file a report of non-employment on a quarterly basis until Respondent returns to employment as a nurse, at which time Respondent shall notify the Department of this fact within 15 days after returning to practice. COMPLIANCE WITH THE PUBLIC HEALTH CODE: Respondent.shall comply with all applicable provisions' of the Public Health Code and rules promulgated thereunder.

5.

6.

RESIDENCY AND PRACTICE OUTSIDE MICHIGAN: Periods of residency and practice outside Michigan shall not reduce the probationary period of this Order. Respondent shall report any change of residency or practice outside Michigan no more than 15 days after the change occurs. Compliance with this provision does not satisfy the requirements of sections 16192(1) and 16221(g) of the Public Health Code, supra, regarding Respondent's duty to report name or mailing address changes to the Department. REPORTING. PROCEDURE'. Unless requiring immediate notification as indicated above, all reports required herein shall be filed on a quarterly basis, the first report to be flied at the end of the third month of probation, and subsequent reports to be filed every three months thereafter. in addition to receiving reports as required herein, the Department or its authorized representative may periodically contact the reporting individuals or agencies to inquire of Respondent's progress. Respondent authorizes release of said information as specifically set forth in the stipulation made a part hereof. Respondent -shall direct all communications required by the terms of this Order to: Department of Licensing and Regulatory Affairs, Bureau of Health Professions, Sanction Monitoring, P.O. Box 30670, Lansing, MI 48909. The timely filing of all information relating to this Order shall be Respondent's responsibility, and failure to file said information within the time limitations provided shall be deemed a violation of an order of the Disciplinary Subcommittee,

7.

8.

COSTS: Respondent shall be solely responsible for payment of all costs incurred in complying with the terms of this Order.

IT IS FURTHER ORDERED that Respondent shall be automatically discharged from probation at the end of the probationary period, PROVIDED Respondent has complied with the terms of this Order and has not violated the Public Health Code; 0.

IT 1S FURTHER ORDERED that In the event Respondent violates any provision of this order, and if such violation is deemed to constitute an independent violation of the Public Health Code or the rules promulgated thereunder, the Disciplinary Subcommittee may proceed to take disciplinary action pursuant to 1996 AACS, R 338.1632 and section 16221(h) of the Public Health Coe,.supra.

IT IS FURTHER ORDERED that this order shall be effective 30 days from the date signed by the Disciplinary Subcommittee, as set forth below.

Dated:

-D-3 t1,1

MICHIGAN BOARD OF NURSING By: Chairperson, Disciplinaly Sub mmittee

STIPULATION

The allegations of fact and taw contained in the. Complaint dated

November 3, 2011, are true and constitute violations of section 16221(a) of the Public Health Code, supra.

2.

Respondent understands and intends that by signing this Stipulation

Respondent is waiving the right, pursuant to the Public Health Code, the rules promUlgated thereunder, and the Administrative Procedures Act of 1969, 1969 PA 306, as amended; MCL 24.201 .et seq, to require the Department to prove the charges set forth in the

Complaint by presentation Of evidence and legal authority, and to appear with an attorney and such witnesses as Respondent may desire to present a defense to said charges..

3.

Respondent hereby authorizes the individuals and entities required to

repTrt pursuant to the foregoing Consent Order, to release to the Department and the Department of Attorney General any arid all information necessary for full compliance with the foregoing Consent Order and to assure protection of the public health, safety and welfare.

4.

Factert taken into consideration in the formUlation of rte Within

Consent Order were as follows: in her Written response to the Complaint, Respondent stated that prior to being employed at Triumph Hospital, she worked in facilities that were equipped with. medication carts, not medication dispensing .machines (MedDispense). Respondent indicated that she was unfamiliar with the MedDiSpense machine and received no training prior to using it. Respondent stated that she had been pressing the wrong button on the MedDispense machine, unbeknownst to her, and reported this to her supervisor. Respondent acknowledged that she made the errors. Additionally, the Department's investigator requested documentation from the facility verifying that Respondent was oriented on the MedDispense machine, which could not be located. The facility indicated that at no time was Respendent suspected of diversion and there was no reason for the facility to believe Respondent was using contrelled substances. in addition, a Michigan Automated Prescription System report revealed that Respondentis not prescribed any controlled substances. Respondent offered to submit to a drug screen prior to being terminated from the facility, but was not aliowed to take &

one. Respondent was provided with a Health. Professional Recovery Program Pamphlet and was evaluated, Respondent entered into a one-year monitoring agreement with no restrictions. The only term of the monitoring agreement is that Respondent submit to random drug screens. Respondent was fully cooperative in the resolution of this matter. Respondent has been licensed as a licensed practical nurse in the state of Michigan since 2006 and has no other Complaints or allegations against her license. 5, Kathleen 'Lavery, R.N., C.N.M., a member of the Michigan 'Board

of Nursing. who supports this proposal, and the Department's representative are both free to discuss this matter with the DisciplinarySubcomrnittee and recommend acceptance of the resolution set forth in the foregoing gonsent Order.

The foregoing Consent Order is approved as to form and substance by

Respondent and the Department and may be entered as the final order of the Disciplinary Subcommittee in said cause.

CONTINUED ON NEXT PAGE

fiTiFFE'OF MICHIGAN ifilGyINMJC,X3ptiTY fruat o:;011,; c: :1:::qou C' 6( al?. the ofi( of :N ss Suotopti

7.

The foregoing proposal is conditioned upon aooeptance by the

Disciplinary Subcommittee, Respondent and the Department expressly reserving the right to further prooeedings without prejudice should the Consent Order be rejected. AGREED TO BY: 4 Rae Ramsdell, Director Bureau of Health Professions Department of Licensing and Regulatory Affairs Dated: AGREED TO BY: r\I Tinita Marie Coaster, L.P.11, Respondent

4),

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Dated:

t 1 30 )

This is the last and final page of a Consent Order and Stipulation in the matter of Tinita Marie Coaster, 1.,P,N, File Number 47-11-118008, before. the Disciplinary Subcommittee of the Michigan Board of kiiirsing,
consisting of eight pages, this page included. BP

ING'rIAM QC/ONV

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C.i.;:nclUNIII);

ory Malts c.-1 Octiparti attre t+fftFiealtilbarstinfices.

cri STATE OF 'MICHIGAN DEPARTMENT OF LICENSING AND- REGULATORY AFFAIRS? :;FO BUREAU OF ,HEALTH PROFESSIONS c:: BOARD OF NURSING CD
DISCIPLINARY SUBCOMMITTEE

-r,

CD "

In the Matter of TINITA MARIE COASTER, L.P.N. License Number: 47-03-099126

I File Number: 47,11-119009

ADMINISTRATIVE COMPLAINT NOW COMES the Michigan Department of Licensing and Regulatory Affairs, hereafter Complainant, by Rae Ramsdell, Director, Bureau of Health Professions, and files this complaint against TinIta Marie Coaster, L.P.N., hereafter Respondent, alleging upon information and belief as foilaws:

1.

The Michigan Board of Nursing, hereafter Board, is an administrative

agency established by the Public Health Code, 1978 PA 368, as amended; MCL 333.1101 et seq. Pursuant to section 16226 of the Public Health Code, supra, the Board's Disciplinary Subcommittee is empowered to discipline licensees for- violations ofthe Public Health Code,

2.

Respondent is currently licensed to practice as a licensed practical

nurse lb the state of Michigan.

3,

Hydromorphone and oxycodone are schedule 2 controlled substances.

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4.

Between September 14, 2010, and December 22, 2010, Respondent

was employed as a licensed practical nurse at Triumph Hospital, hereafter facility, in Detroit, Michigan.

5.

On December 20, 2010, .facility administraters noted discrepancies

with regard . to Respondent's use of controlled substances. The facility's subsequent investigation revealed the following:

a.

On December 14, 2010, at 7:30 p.m., Respondent removed hydrornorphone 2 mg from the facility's medication dispensing system for patient C.S. (initials used throughout to protect At 7:31 p.m., Respondent wasted patient privacy). hydromorphone 2 mg. At 9:00 p.rn Respondent documented on the patient's medication administration record, hereafter MAR, that she administered hyd.romorphone 2 mg to patient C On December 14, 2010, at 10:45 p.m., Respondent removed oxycodone 40 mg from th.e medication dispensing system for patient C.S. Respondent documented on the patient's MAR that she administered the medication to patient C.S. at 9:00 p.m, one hour and 45 minutes prior to removing the medication; On December 15, 2010, and on December 17., :2010., Respondent removed hydromorphone . 2 mg from the medication dispeneing sySteM for patient C.S<,., with no Corresponding documentation on the MAR that she administered the medication. ReSpondent documented that she wasted hydromorphone 2.mg on both dates at the times she removed the medication from the dispensing system; and On.Decerribeel7 2010, at 9:00 p.m., 'Respondent removed. hydrornorphone2mg from the medication dispensing system for patient C.S. .Respondent documented Wasting the dose, but :also documented- on: th.e patient's MAR that she. . administered the dose 04'9:00 p.m...
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6.

On December20, 2010, Respondent admitted to facility administrators

that she made errors with regard to her handling of controlled substanoes. Subsequently, the facility terminated Respondent's employment and reported the termination to Complainant pursuant to section 20175(5) of the public Health Code, su ra.

7..

On August 8, 2011, during an interview with Complainant's

investigator, Respondent admitted that she made documentation errors with regard to her use of controlled substances while she was employed at the facility;

COUNT I Respondent's conduct, as set forth above, evidences violations of general duty, consisting of negligence or failure to exercise due care, whether or not injury results, in violation of section 16221(a) of the Public Health Code, supra.

WHEREFORE, Complainant requests that the within complaint be served, upon Respondent and that Respondent be offered an opportunity to show compliance with all lawful requirements for retention of the license. If compliance Is not shown, Complainant further requests that formal proceedings be commenced pursuant to the PLiblic Health Code, rules promulgated thereunder, and theAdministrative Procedures Act of 1969, 1969 PA 306, as amended; MCL 24201 et seq.

RESPONDENT IS HEREBY NOTIFIED that, pursuant to section 16231(7) of the Public Health Code, ;supra, Respondent has 30 days from the-date of receipt of this complaint to submit a written response to the allegations contained herein. Ole written
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tigpirulan'It. di.

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response shall be submitted to Complainant, Rae Ramsdell, Director, Bureau of Health Professions, Department of LioenSing and Regulatory Affairs, P.0, Box'30870, Lansing, MI 4-8g09-,

RESPONDENT IS FURTHER NOTIFIED that, pursuantto section X5231(3} of the Public Health Code, supra, Respondents failure to submit a written response within 30 days, as noted above, shall be treated as an admission of the allegations contained herein and shall result in transmittal of this complaint directly to the Board's Disciplinary Subcomrniftee for imposition of an appropriate sanction.

DATED: 11- )-611

Rae 'Rarns'ciell, Director Bureau of Health Professions

This is the !sat and final ppge of an -Administrative Complaint ln the matter of Tinita ivlarie Coaster, L.P.N., File Number 47-11-119009, before the Disciptinary.Subcommittee of the Michigan Board of Nursing, consisting of four pages, this page included.
db

0041g TMICHIPAN.:-:PIP.HAaCOURTY. 4 t lpirs 1.c:2,ot:54;4y fii .0s of lisaithiew0 Seoleei soreflia

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4 4

Casey 13-000395

Ohio BOard of Nursing

17 South High Street, Suite 400

www.nursing.ohio.gov

Columbus, Ohio 43215-7410 0 (614) 466-3947

March 22,2013

NOTICE OF AUT MATIC SUSPENSION AND OPPORTUNITY FO HEARING

Carolyn M. Cook, R.N. 1070 Church Avenue Glendale, Ohio 45246 Dear Ms. Cook: You are hereby notified that, on or about November 16, 2012, the Ohio Board of Nursing (Board) issued an Adjudication Order (November 2012 Adjudication Order), a copy of which is attached hereto and incorporated herein, in which the Board ordered that your license to practice nursing as a registered nurse in the State of Ohio be suspended indefinitely and that such suspension would be stayed subject to probationary terms, conditions, and limitations for a minimum period of one (1) year. Attached to and incorporated within the November 2012 Adjudication Order is the October 3, 2012 Report and Recommendation of Beth A. Lewis. A. Item 4. of the November 2012 Adjudication Order states, "Within forty-five (45) days of the effective date of this Order, MS. COOK shall, at her own expense, obtain a chemical dependency evaluation by a Board approved chemical dependency professional and shall provide the Board with complete documentation of this evaluation. Prior to the evaluation, MS. COOK shall provide the chemical dependency professional with a copy of this Order and Notice of Opportunity for Hearing. Further, MS. COOK shall execute releases to permit the chemical dependency professional to obtain any information deemed appropriate and necessary for the evaluation. The chemical dependency professional shall submit a written opinion to the Board that includes diagnoses, recommendations for treatment and monitoring, any additional restrictions that should be placed on MS. COOK's license, and a statement as to whether S. COOK is capable of practicing nursing according to acceptable and prevailing standards of safe nursing care." Despite this provision, as of March 5,2013 you have failed to provide the Board with complete documentation of a chemical dependency evaluation 'and have failed to cause an approved chemical dependency professional to submit to the Board a completed chemical dependency evaluation. Section 472328(B)(17), ORC, authorizes the Board to discipline a licensee for violation of any restrictions placed on a nursing license by the Board. B. Item 8. of the November 2012 Adjudication Order states, "Within forty-five (45) days of the effective date of this Order, during the probationary period, MS. COOK shall begin submitting, at her expense and on the day selected, blood or urine specimens for drug and/or alcohol analysis at a collection site

Carolyn M. Cook, R.N. Page 2 specified by the Board at such times as the Board may request. Refusal to submit such specimen, or failure to submit such specimen on the day she is selected, or in such a manner as the Board may request, shall constitute a violation of a restriction placed on a license for purposes of Section 4723.28(B), ORC. This screening shall require a daily call-in process. The specimens submitted by MS. COOK shall be negative, except for substances prescribed, administered, or dispensed to her by another so authorized by law who has full knowledge of MS. COOK's history." Despite this provision, as of March 5, 2013, you have failed to register with FirstLab, the Board's random drug/alcohol screen program administrator, to determine if you had been selected to provide a specimen for analysis. C. Item 9. of the November 2012 Adjudication Order states, "MS. COOK shall attend a minimum of one (1) meeting per week of a support or peer group meeting approved in advance by the Board, or a Twelve Step program, and MS. COOK shall provide satisfactory documentation of such attendance to the Board every six (6) months, beginning forty-five (45) days after the effective date of this Order." Despite this provision, as of March 5, 2013, you have failed to attend meetings as required and/or to provide satisfactory documentation of such attendance to the Board. Section 4723.28(B)(17), Ohio Revised Code, ORC, authorizes the Board to discipline a licensee for violation of any restrictions placed on a nursing license by the Board. In accordance with the paragraph under "FAILURE TO COMPLY" of the November 2012 Adjudication Order, you are hereby notified that it appears to the Board that you have violated Items 4., 8., and 9. of the November 2012 Adjudication Order. YOU A E FURTHER NOTIFIED THAT YOUR LICENSE TO PRACTICE NURSING AS A REGISTERED NURSE, RN-154555, IS HEREBY AUTOMATICALLY SUSPENDED. Continued practice after receipt of this notice of suspension shall be considered engaging in the practice of nursing as a registered nurse without a current, valid license, which is a violation of Section 4723.03(A), ORC. You are further notified that in accordance with Chapter 119, ORC, the Board proposes under authority of Section 4723.28, ORC, to deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise discipline'you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: 1. On or about Noveniber 16, 2012, the Ohio Board of Nursing (Board) issued an Adjudication Order (November 2012 Adjudication Order), a copy of which is attached hereto and incorporated herein, in which the Board ordered that your license to practice nursing as a registered nurse in the State of Ohio be suspended indefinitely and that such suspension would be stayed subject to

Carolyn M. Cook, R.N. Page 3 probationary terms, conditions, and limitations for a minimum period of one (1) year. Attached to) and incorporated within the November 2012 Adjudication Order is the October 3, 2012 Report and Recommendation of Beth A. Lewis. 2. Item 4. of the November 2012 Adjudiqation Order states, "Within forty-five (45) days of the effective date of this Order, MS. COOK shall, at her own expense, obtain a chemical dependency evaluation by a Board approved chemical dependency professional and shall provide the Board with complete documentation of this evaluation. Prior to the evaluation, MS. COOK shall provide the chemical dependency professional with a copy of this Order and Notice of Opportunity for Hearing. Further, MS. COOK shall execute releases to permit the chemical dependency professional to obtain any infoiination deemed appropriate and necessary for the evaluation. The chemical dependency professional shall submit a written opinion to the Board that includes diagnoses, recommendations for treatment and monitoring, any additional restrictions that should be placed on MS. COOK's license, and a statement as to whether MS. COOK is capable of practicing nursing according to acceptable and prevailing standards of safe nursing care." Despite this provision, as of March 5, 2013 you have failed to provide the Board with complete documentation of a chemical dependency evaluation and have failed to cause an approved chemical dependency professional to submit to the Board a completed chemical dependency evaluation. Section 4723 .28(B)(17), ORC, authorizes the Board to discipline a licensee for violation of any restrictions placed on a nursing license by the Board. 3. Item 8. of the November 2012 Adjudication Order states, "Within forty-five (45) days of the effective date of this Order, during the probationary period, MS. COOK shall begin submitting, at her expene and on the day selected, blood or urine specimens for drug and/or alcohol analysis at a collection site specified by the Board at such times as the Board may request. Refusal to submit such specimen, or failure to submit such specimen on the day she is selected, or in such a manner as the Board may request, shall constitute a violation of a restriction placed on a license for purposes of Section 4723.28(B), CRC. This screening shall require a daily call-in process. The specimens submitted by MS. COOK shall be negative, except for substances prescribed, administered, or dispensed to her by another so authorized by law who has full knowledge of MS. COOK's hiskory." Despite this provision, as of March 5, 2013, you have failed to register with Firstleab, the Board's random drug/alcohol screen program administrator, to determine if you had been selected to provide a specimen for analysis. 4. Item 9. of the November 2012 Adjudication Order states, "MS. COOK shall attend a minimum of one (1) meeting per week of a support or peer group

Carolyn M. Cook, R.N. Page 4 meeting approved in advance by the Board, or a Twelve Step program, and

-"MS. COOK shall provide satisfactory documentation of such attendance to

the Board every six (6) months, beginning forty-five (45) days after the effective date of this Order." Despite this provision, as of March 5, 2013, you have failed to attend meetings as required and/or to provide satisfactory documentation of such attendance to the Board. Section 4723 .28(B)(17), Ohio Revised Code, ORC, authorizes the Board to discipline a licensee for violation of any restrictions placed on a nursing license by the Board. Accordingly, the Board is authorized to impose one or more of the sanctions as cited in Section 4723.28, ORC. In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing in this matter. If you wish to request such hearing, the request must be made in writing and must be received in the Board office within thirty (30) days of the time of mailing of this notice. You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in writing. At the hearing you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to: Lisa Ferguson-Ramos, Compliance Unit Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, Ohio 432157410, or to the e-mail address, hearing*,nursing.ohio.gov. If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Automatic Suspension and Opportunity for Hearing, deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars (8500.00) per violation. Sincerely, X.AZ Rhonda S. Barkheimer, R.N., C.N.P . Supervising Board Member Certified Mail Receipt No. 7012 2210 0000 6272 3803 Attorneys' Certified Mail Receipt No. 7012 2210 0000 6272 3896 cc: Henry G. Appel, Senior Assistant Attorney General Elizabeth Cooke, Esq./Daniel Best and Lindsay Nichols, Certified Legal Interns

Ohio Board

sin n

www.nursing.ohio.gov

17 South High Street, Suite 400 4. Columbus, Ohio 43215-7410 ,o (614) 466-3947

BEFORE THE OHM BOARD OF NURSING

IN THE MATTER OF: CASE #10-3274 CAROLYN M. COOK, R.N.

ADJUDICATION ORDER
This matter came for consideration before the Ohio Board of Nursing (hereinafter "Board") on November 16, 2012. At such time the Board verified that it reviewed the following materials prior to consideration of this matter: Hearing Transcript; State's Exhibits; Respondent's Exhibits; Hearing Examiner's Report and Recommendation; and Respondent's Objections to the Report and Recommendation. Beth A. Lewis was the Hearing Examiner designated in this smatter pursuant to Section 119.09, Ohio Revised Code (ORC). A true copy of the Report and Recommendation of Beth A. Lewis is attached hereto and incorporated herein. On this date, the Board granted the State's motion to redact confidential personal information from State's Exhibit 14. Further, on this date, the Board accepted all of the Findings, of Fact and Conclusions of Law of the Hearing Examiner, and the Recommendation in the Hearing Examiner's Report and Recommendation, and ordered that CAROLYN M. COOK's license to practice nursing as a registered nurse is hereby suspended for an indefinite period oftime and that the suspension is stayed subject to the probationary terms, conditions, and limitations for a minimum period of one (1) year, with the Temporary Practice Restrictions set forth below. MS. COOK's license to practice nursing as a registered nurse shall be subject to the following probationary terms, conditions, and limitations for a minimum period of one (1) year: 1. MS. COOK shall obey all federal, state, and local laws, and all laws and rules governing the practice of nursing in. Ohioi 2. MS. COOK shall appear in person for interviews before the full Board or its designated representative as requested by the Board.

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3. MS. COOK shall submit a request to the Bureau of Criminal Identification and Investigation (BCII) to conduct a criminal records check of MS. COOK, including a check of Federal Bureau of Investigation (FBI) records, and shall cause BCH to submit MS. COOK'S crirninal records check reports to the Board. MS. COOK's completed criminal records check, including the FBI check, 'must be received by the Board within six (6) months of effective date of this Order. Monitoring 4. Within forty-five (45) days of the effective date of this Order, MS. COOK shall, at her own expense, obtain a chemical dependency evaluation by a Board approved chemical dependency professional and shall provide the Board with complete documentation of this evaluation, Prior to the evaluation, S. COOK shall provide the chemical dependency professional with a copy of this Order and Notice of Opportunity for Hearing, Further, MS.. COOK shall execute releases to permit the chemical dependency professional to obtain any information deemed appropriate and necessary for the evaluation. The chemical dependency professional shall submit a written opinion to the Board that includes diagnoses, recommendations for treatment and monitoring, any additional restrictions that should be placed on MS. COOK's license, and a statement as to whether MS. COOK is capable of practicing nursing according to acceptable and prevailing standards of safe nursing care 5. MS. COOK shall provide the Board with satisfactory documentation of compliance with all aspects of the treatment plan developed by the chemiCal dependency professional described above until released. Further, the Board may utilize the professional's recommendations and conclusions from the evaluation as a basis for additional terms, conditions, and limitations on MS. COOK'S license, 6. S. COOK shall abstain completely from the personal use or possession of drugs, except those prescribed, administered, or dispensed to her by another so authorized by law who has full knowledge of MS. .COOK's history. MS. COOK shall self-administer prescribed drugs only in the manner prescribed.

7. MS. COOK shall abstain completely from the use of alcohol or any products containing alcohol. 8. Within forty-five (45) days of the effective date of this Order, during the probationary period, MS. COOK shall begin submitting, at her expenSe and on the day selected, blood or urine specimens for drug and/or alcohol analysis at a collection site specified by the Board at such times as the Board may request. Refusal to submit such specimen, or failure to submit such specimen on. the day she is selected, or in such a manner as the Board May request, shall constitute a violation of a restriction placed on a license for purposes of Section 4723.28(B), ORC. This screening shall require a daily call-in process. The specimens submitted by MS. COOK shall be negative, except for substances prescribed, administered, or dispensed to her by another so authorized by law

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who has full knowledge of S. COOK'S history. 9, MS. COOK shall attend a minimum of one (1) meeting pey week of a support or peer group meeting approved in advance by the Board, or a Twelve Step prograin, and MS. COOK shall provide satisfactory documentation of such attendance to the Board every six (6) months, beginning forty-five (45) days after the effective date of this Order, Treating Practitioners and Reporting
t

10,Prior to initiating screens, MS. COOK shall provide a copy of this Order to all treating practitioners and shall provide to the Board a list of all treating practitioners, including addresses and telephone numbers. Finther, MS COOK shall be under a continuing duty to provide a copy of this Order, prior to initiating treatment, to additional treating practitioners, and to update the list of treating practitioners with the Board within fortyeight (48) hours of being treated by another practitioner,

M. COOK shall cause all treating practitioners to complete a medication prescription 11.
report that is to be mailed by the practitioner directly to the Board. The medication report is to be completed for any and all substances prescribed, administered, or dispensed to MS. COOK throughout the duration of this Order. 12.Within twenty-four (24) hours of release from hospitalization or medical treatment, MS. COOK shall notify the Board of any and all medication(s) or prescription(s) received. Employment Conditions 13.MS. COOK shall notify the Board, in writing, of the name and address of any current employer within thirty (30) days following the effective date of this Order, or any new employer prior to accepting employment. 14.MS. COOK, within fifteen (15) days of the effective date of this Order, if working in a position in which a nursing license is required, shall provide her employer(s) with a copy of this Order and the Notice of Opportunity for Hearing, Further, MS. COOK is under a continuing duty to provide a copy of this Order and Notice of Opportunity for Hearing to any new employer prior to accepting nursing employment. MS. COOK shall have her employer(s), if working in a position where a nursing license is required, submit written reports regarding job performance on a quarterly basis beginning within thirty (30) days of the effective date of this Order or beginning within thirty (30) days of working in a nursing position. MS. COOK shall have her employer(s) send documentation to the Board, along with the first employer report, of receipt of a copy of this Order and Notice of Opportunity for Hearing, including the date they were received. Reporting Requirements of MS. COOK 15.MS. COOK shall sign release of information forms allowing health professionals and . other organizations to submit the requested documentation directly to the Board.

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16, MS. COOK shall submit any and all information that the Board may request regarding her ability to practice according to acceptable and prevailing standards of safe nursing practice, 17.MS. COOK shall not submit or cause to be submitted any false, misleading, or deceptive statements, information, or documentation to the Board or to employers or potential employers. 18.MS. COOK shall submit the reports and documentation required by thiS Order on forms specified by the Board. All reporting and communications required by this Order shall be made to the Compliance Unit of the Board. 19.MS. COOK shall submit the reports and documentation required by this Order or any other documents required by the Board to the attention of the Compliance Unit, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, OH 43215-74.10. 20. MS. COOK shall verify that the reports and documentation required by this Order are received in the Board office. 21. MS. COOK shall inform the Board within five (5) business days; in writing, of any change in employment - status or of any change in residential or home address or telephone number. Temporal** Practice Restrictions MS. COOK shall not practice nursing as a registered nurse (1) for agencies providing home care in the patient's residence; (2) for hospice care programs providing hospice care in the patient's residence; (3) for staffing agencies or pools; (4) as an independent provider where the nurse provides nursing care and is reimbursed for services by the State of Ohio through State agencies or agents of the State; or (5) for an individual or group of individuals who directly' engage MS. COOK to provide nursing services for fees, compensation, or other consideration or as a volunteer. S. COOK shall not function in a position or employment where the job duties or requirements involve management of nursing and nursing responsibilities, or supervising and evaluating nursing practice. Such positions include but are not limited to the following: Director of Nursing, Assistant Director of Nursing, Nurse Manager, Vice President of Nursing. FAILURE TO COMPLY The stay of MS. COOK's suspension shall be lifted and MS. COOK's license to practice nursing as a registered nurse will be automatically suspended if it appears to the Board that MS. COOK has violated or breached any terms or conditions of this Order. Following the automatic suspension, the Board shall notify MS. COOK via certified mail of the specific nature of the charges and automatic suspension of her license. Upon receipt of this notice, MS. COOK may 4 Page 4-of 7

request a hearing regarding the charges. DURATION The Board may only alter the probationary period imposed by this Order if: (1) the Board determines that MS. COOK has complied with all aspects of this Order; and (2) the Board determines that MS. COOK is able to practice according to acceptable and prevailing standards of safe nursing care without Board monitoring, based upon at interview with MS. COOK and review of the reports as required herein. Any period during which MS. COOK does not work in . a position for which a nursing license is required. shall not count toward fulfilling the probationary period imposed by this Order, This ORDER shall become effective immediately and is hereby entered upon the Journal of the Board for the 16th day of November, 2012.

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TIME AND METHOD TO PERFECT AN APPEAL

Any party desiring to 'appeal shall file a Notice of Appeal :with the Ohio Board of Nursing, 17 S. High St., Suite 400, Columbus OH 43215-7410, setting forth the order appealed from and stating that the agency's order is not supported by reliable, probative, and substantial evidence and is tot in accordanCe with law, The notice of appeal may, but need not, set forth the specific grounds of the party's appeal: A copy of such Notice of Appeal shall also be filed by the appellant with the Franklin County Court ofCommon Pleas, Columbus, Ohio, In filing a notice of appeal with the agency or court, the notice that is filed may be either the original notice or a copy of the original notice. Such notices of appeal shall be filed within fifteen (15) days after the mailing of the notice of the Ohio Board of Nursing's Order as provided inn. Section 119.12 of the Ohio Revised Code.

CERTIFICATION
The State of Ohio County of Franklin I, the undersigned Betsy J. Houchen, Executive Director for the Ohio Board of Nursing, hereby certify that the foregoing is a true and exact reproduction of the original Order of the Ohio Board of Nursing entered on its journal, on the 16th day of November 2012.

Betsy J. Houchen, R.N., M.S., S.D. Executive Director November 16, 2012 Date

(SEAL)

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CERTIFICATE OF SERVICE
I hereby certify that a true and accurate copy of the foregoing Order, concerning CAROLYN M. COOK, was sent via certified mail, return receipt requested, this 11th flay of December, 2012 to CAROLYN M. COOK, at 1070 Church Avenue, Glendale, Ohio 45246.

I also certify that a copy of the same was sent via regular U.S. mail this lith day of December, 2012 to Lamont Pugh, SAC, Sanctions & Exclusions, Department of Health and Human Services, Office of Inspector. General, Office of Investigations, P.O. Box $1020, Chicago, IL 60601-81020.

Betsy J. 'loll en, R.N., M.S., S.D. Executive Director

bcmf cc: Charissa Payer, Assistant Attorney General

Certified Mail Receipt No. 7012 2210 0000 6270 5977

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Sta0,0.f -OW Board of NUrsing 17. South High Stitet,, Suite 400 Ohio' 432157440 et tun r the lyiatter of Carolyn Respondent

EWE kJ 2012 OCT -3 PM kV

BOARD op Ofil0

Bet11 A, .Lewis; J.p,. iriez Chief HearingCase No. 10-3274 .0:ctotser 3, 20.12 Report. and R:eaorninendafiOn

or. the Ohio Bowe dO f Niar4hg MiOhaOlDeWihe, OHIO ATTOWY APPPti, OENEjtA), ap:d qatissa D. Payer, gsti, Assistant Alto. ey General, riegth & lium4h..erOpos' `eetion, 30 East Broad .Street, 26ffi 11904 COhnnbtm, On 43215-3428, Telephone: 6:14466: 8600, Fax: 614-466.6090, F the! Werieet.ReVolid0.5.t.! !Ceit*i), M. ONjoic, 107% Cluitth rovidedi Nature,of the.Case This is ari. Orniastretiv.e proceeding. under. Chapter 119 (the Administrative. Procedure A-zOi.,atia Chapter 472 (the 'Nine Practice Act), of:the 0-4i9 .RoNti*1 Code ("OW). The we ivriiOlv0. a NOti'06 of Oppcatunoity :for HeAring'(''Notice) fme:d, to the RAvorident, Ceroly.0 M, 'Cook, RN. !(aespoildent" of "M, Cdok"), oli Septeniber ni 1. (State MOIL 1..). in the Notim the Ohio Board of Nursing (' Board!') informed Ms.. Cooke:, that it intended to take discip1414ry action against her., 1feense based 0,4 her' testing Po.i:ijve for Marijt.lana on a pro, 41-010Y.nYellt dnig; sateen, (Id,,) .14 Qte..Ngtiee' sent to. Ms, .Coo1c the Board set, forth ifs reason's fc sirepreposed ketion identified the ckiarges.against:he4 andAdViSed:Ms. C00% at.her right to a hearing, (id.) Ms. COok made a tfinety request folie,heerittg, (State BAibit .2) The Board appointed we. to serve as its Hearing Examiner.. A. hearing. was conducted on JUly 20122 at thAprfics presented their eViOenee on the charges against. Ms. Cools. Ms. Co* was ptesentat .theheating, and .N.vas noh'epresented by counsel. This report is based oh the eVklerie6. aril testiniony presented at tl*:bedring, Glat14.1e,

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Summary of the Issues The Board charged Ms, Cook With testing positive for Ivrarijuana on a post-offer, preemployment drug screen, (State Exhibit 1.) -Self-administration of a dangerous drug, as defined in Section 4729.01, ORC, in any way not in accordance with a legal, valid prescription, is grounds for disciplinary action pursuant to Section 4.723.28(B)(&), ORC. The Board submitted .copies of the drug test results that indicated Ms. Cook submitted a urine sampielon July 14, 2010, that. tested positive for marijuana. (State Exhibit 13.) Ms. Cook -denied using marijuana. (See Tr., p. 27.) The Board is required to consider the merits of each ease, and May, based upon the circumstances leading to the charges, consider both aggravating and mitigating circumstances shown in the record. FrOm the evidence before me, I find a sufficient basis to conclude that the charges against
Ms,

Cook have been proved. Because I find the evidence establishes a valid

basis for disciplinary action, I recommend that MS. Cook's license to practice as a registered nurse in Ohio be subject to a stayed suspension and probationary terms, conditions, and limitations as determined by the Board, for a minimum period of one (1) year, with random drug screens and temporary practice restrictions. My analysis follows, Evidence Examined. The parties presented evidence in the form of exhibits, identified in the record at pages 34 of the transcript of proceedings. The State called Ms. Cook to testify as on cross-examination; Ms. Cook provided testimony on her own behalf. The State also called Rebecca Green, Board Supervising attorney, and Linda Pieszala, Human Resources Director at Saint Joseph Home, to testify, All testimony and exhibits admitted in the hearing of this matter, whether or not specifically referred to in this Report, were thoroughly reviewed and considered by the Hearing Examiner prior to the entry of the findings, conclusions and recommendations shown below. Summary of the Evidence The State presented evidence that Ms. Cook has been licensed to practice nursing as a registered nurse in the State of Ohio since ,September 11, 1978. (State Exhibit 11; see Tr., p. 12.) Ms..Cook testified that she has also been licensed in Florida, Alaska, and Hawaii, (tIsr., pp, 12. 14,) Ms.. Cook indicated that several of her positions involved her working with chronically ill

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children on ventilators, (See. Tr., pp. 14-15.) Ms. Cook testified that she worked .for Maxim Healthcare Agency from approximately 2006, until she quit her job in May or June of 2012, when she accepted a pOsition as a Welder. (Tr., p. 15.) On June 11, 2010, Ms. Cook subinitted an application for a nursing position at Saint Joseph Home of Cincinnati, (See State Exhibit 14; see Tr., pp. 19-20.) Linda Pieszaia, Human Resources Director at saint Joseph Home, testified that the normal hiring procedure at Saint Joseph Home begins with the Director of Nursing reviewing the applications and selecting candidates to interview. (Tr., p. 55.) The candidates are interviewed, and then invited back to observe a shift so they may determine whether Saint Joseph is the type of place they would like to work, (See id)' Finally, a selected candidate is called back to the facility and Ms. Pieszaia offers the position to the candidate in person, (a., p. 63.) Ms, Pieszala -reviews information with the.selected candidate at this meeting using an "Employment Offer Checklist," (See Tr 64-65; see State Exhibit 16.) At the time the employment offer is made, the candidate is informed that he will be required to submit a pre-employment drug screen and physical. (See id.) The parties were not certain of the date on which Ms. Cook interviewed for a position at Saint Joseph Home, (See Tr., pp. 77, 79.) Ms. Pieszaia testified that Ms. Cook came' to the Home on June 30, 2010, to participate in an observation. p. 73.) On July 13, 2010, at 3:40 p.m., Ms. Cook was invited back to Saint Joseph Home and offered a position as a registered nurse. (See Tr., p. 63; see State Exhibit 16.) At that dine, Ms. Pieszala told Ms. Cook that she would be required to take a pre-employment drug screen at 9:00 a.m., on July 14, 2010, (See Tr p. 65; see State Exhibit 16.) Ms. Cook testified that, after her observation, she no longer wanted to work at Saint Joseph Home. (See Tr., p. 32.) She claimed, "1 was trying to tell Linda [Pieszala] that, you knoW, because of what I saw; and I didn't get very far because she could probably tell that I was reluctant to go onward. And she said, 'If you don't take this [drug] test, I'm going to call them [the Board of NUrsing] up 'and .01 them you're a drug addict,'" (Id,) Ms. Cook stated that she was concerned about procedures she had observed at Saint Joseph Home snob as children being fed with enema bags with no farrell, and that "they expect their nurses to hide things from the State." (Tr., pp. 29, 33,) At some point, Ms. Cook sent a 'Thank-You" note to Ms, Pieszala, thanking her for the job interview. (State Exhibit 19.) Ms. Cook wrote, "St Joseph Home is a very nice facility. I
t '

Togo 3 or s

did not realize how large it was, Very spacious. Pleasant place to call home and I enjoyed finding out more about the work that is done at your .facility." (State Exhibit 19.) Ms; Cook first testified that she sent the Thank-You note prior to her July 14, 2010 drug screen. (Tr., p, 34.) She next testified that she sent the note "when they offered me a job [on July 13, 2010)." (Id) Finally, Ms. Cook testified that she 'sent the note "before T went through the two-hour riled pass [observation on June 30, 20101" (Tr., pp. 34..35,) In spite of her claimed reservations about working at Saint Joseph Home, Ms. Cook submitted a urine sample for drug screening on July 14, 2010. (See Tr., p. 32; see State Exhibit 13,) The drug screen returned a positive result for marijuana. (State Exhibit 13.) information included in State Exhibit 13 indicates that the Medical. Review Officer ("MRO"), Dr. James Keller, contacted Ms. Cook on July 19, 2010, and informed her of the results. (Id) The ,information also indicates that the MRO informed Ms, Cook that she had a right to re-test the same sample at her cost. (id.) Although subpoenaed by the State, Dr, James Keller was released from the subpoena issued to him, and did not testify. (See Tr., p. 86.) Ms. Cook disputed the accuracy of the drug test results. (See Tr., p. 83,) Ms, Cook noted that the creatinine level reported for her drug screen was "greater than 20" (see State Exhibit 13), and claimed, "an adult creatinine should be 0.5 to 1.2." (Tr., p. 84.) Ms. Cook also claimed that the phone call she received from Dr. Keller was unusual, (See Tr., p. 27.) She testified, "1 had sonic man call me up, mutter a name, said, 'You're positive for marijuana,' 1 said, 'Yeah, Right. don't use marijuana, you .know,' And he said, 'Liar,' and hung up on me. So if that person is the doctor that called, yes." (1d.)- Ms. Cook concluded that Saint Joseph must have "framed" her. (Tr., pp. 30, 94.) She stated, "I'm a paranoid person trying to figure out how this [the drug screen) ended up positive." (Tr., p, 95,) On July 20, 2010, Linda Pieszala called Ms. Cook and rescinded the offer of employment at Saint JoSeph Home. (See Tr,, p. 71; see State Exhibit 18.) On September 23,.2011, the Board issued a Notice of Opportunity to Ms:. Cook, (State Exhibit 1.) Analysis From the record now before the Board, it appears that there is a preponderance of evidence that Ms. Cool; underwent a pre-employment drug screen and tested positive tor Marijuana. (State Exhibit 13.)

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Ms, Cook submitted no documentary evidence or testimony to support her`contention that the results from her drug screen were not reliable. (See Tr., p. 84.) Her contention that she was "framed" by Saint Joseph florae with a positive drug test result is not credible. (See Tr,, pp, 30, 94.) Ms. Cook's belief that she was "framed" rests on the assumption that staff at Saint Joseph home were aware of Ms. Cook's concerns regarding the alleged faulty practices and procedure, However, MS. Cook did .not mAntion her concerns about the working and living conditions atSaint Joseph Home to anyone until after she had taken the drug test and the results came back as positive for marijuana. (See Tr., p. 31, emphasis added,) Ms. Cook submitted a written statement and the results of an August 11, 2010 drug test that returned negative results for all substances tested, including marijuana. (Respondent Exhibit A.) She also submitted a performance evaluation dated February 6, 2012, in which her performance was rated as "satisfactory" in all areas, (Id.) Finally, Ms. Cook submitted letters of recommendation from two families with chronically ill children for whom Ms. Cook had provided nursing care. (Id.) On parent described Ms. Cook as providing "the gold standard of care," and being "attentive, hardworking, fast thinking and quick-acting in case of crisis," (Id.) Another parent wrote that Ms, Cook "is the most professional and highest skilled nurse [the agency] has ever presented to us." (Id.) Ms. Cook's infraction is a single event over a lengthy career. She has had no prior disciplinary action taken against her by the Board. Ms. Cook's violation caused no harm to any of her patients. However, the use of marijuana could lead to Ms. Cook practicing as a nurse in an impaired state: Ms. Cook did not acknowledge responsibility for her conduct. The Board should take steps to ensure that Ms, Cook remains drug-free. The State recommended that Ms.. Cook's nursing license be, indefinitely suspended, followed by a probationary period with conditions, including that Ms. Cook be required to obtain a chemical dependency evaluation and participate in random drug screening. The State also recommended that Ms. Cook's license be subject to temporaly practice restrictions, After considering all of the evidence, including the evidence offered in aggravation and mitigation, I recommend that Ms. Cook's license to practice 'as a registered nurse 'in Ohio be subject to. a stayed suspension with probationary terms and conditions to be determined by the Board, for a period of not less than. cite (1) year. During the probationary period, Ms. Cook should be required to obtain a chemical dependency evaluation by a Board-approved chemical

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dependency professional, and to participate in random drug screening. Ms; Cook's license should also be subjeet to temporary practice restrictions prohibiting her from working in unsupervised settings or from supervising other nurses. Findings of P'aet Having heard the testimony of the witnesses and the oral argument of counsel, and( having examined the exhibits admitted into evidence, I make the following findings of fact and conclusions of law, To the extent that any findings of fact constitute conclusions of law, they are offered as such. To the extent that any conclusions of law constitute findings of fact, they are so offered, 1. Respondent Carolyn M. Cook holds an active license With the Ohio Board of Nursing as a registered nurse, She has been licensed in Ohio since September 11, 1978. 2, The State has established by at least a prepOnderance of the evidence, that on or about July 14, 2010, alley accepting employment as a registered nurse at Saint Joseph Home of Cincinnati, in Cincinnati, Ohio, Ms, Cook submitted a urine sample for an employment drug screen that tested positive for Marijuana, 3. On or about September 23, 2011, the Board issued a Notice of Opportunity for Hearing to Ms. Cook. 4. On or about September 27, 2011, Ms. Cook requested a hearing on the charges appearing in the Board's Notice of Opportunity for Hearing. Conclusions , Because she holds a license as a registered nurse issued by the Ohio Board of Nursing, Respondent Carolyn M, Cook, R N., is subject to the jurisdiction of the Boaiil in actions taken pursuant to chapter 4723 of the Ohio Revised Code, 2, Upon sufficient cause to believe a licensee of the Board of Nursing has violated a provision of the Nurse Practice Act, the Board is authorized to take action with respect to that licensee's nursing license. Upon her receipt of the Board's charging document, the Respondent timely requested an evidentiary hearing before the Board took any final action based Upon the Board's charges, Upon its receipt of Respondent's request for an administrative hearing, the Board set the matter for hearing, in. the manner provided for

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by Chapter 119, ORC (Ohio Administrative - Procedure Act), and provided the Respondent with an opportunity to be h,eard before it took any final action with respect to the Respondent'a license as. a registered nurse, in the Manner provided for by law. 3, SectiOn 472328(B)(8), ORC, authorizes the Board to discipline a licensee for selfadMinistering or otherwise taking into the body any dangerous drug, as defined in Section 4729.01, ORC, in any way not 14 accordance with a legal valid prescription issued for that individual. Marijuana is a Schedule I controlled substance (Section 3719,41(C), ORC), which in turn is a dangerous drug (Section 4729.01(F), ORC), 4, Where by at least a preponderance of the evidence the State establishes, as is the case here, that the Respondent self-administered Marijuana, as dernonstrated through her positive drug screen, the State has proved the Respondent violated Section 4723.28(B)(8), ORC. Pursuant to Section 4723,28(B), ORC, upon proof that the Respondent has violated a provision of the Nurse Practice Act as set forth in Section 4723.28, ORC, the Board, by a vote of a quorum, may impose one or more of the following sanctions: it may' deny, permanently, revoke, revoke, suspend, or place restrictions on any nursing license issued by the Board; it may reprimand or otherwise discipline a holder of a nursing license; or it may impose a fine of not more than five hundred dollars per violation. Upon sufficient proof, as has been, shown in this evidentiary proceeding, that the Respondent has violated the provisions of the Nurse Practice Act and rules as concluded by the Hearing Committee, the Board may implement any of the foregoing disciplinary actions. Recommendation Upon sufficient proof that the Respondent, Carolyn M, Cook, has violated .provisions of the Nurse Practice Act as shown above, it is my recommendation that the Respondent's license to practice as a registered nurse in Ohio be subject to a stayed suspension with probatidnary term and conditions to be determined by the Board, for a period of not less than one (1) year. During the probationary period, Ms. Cook should be required to obtain a chemical dependency evaluation by a Board-approved chemical dependency professional, and to participate in random drug screening. Ms. Cook's. license should also be subject to temporary practice restrictions prohibiting her from working in unsupervised settings or from supervising other nurses.

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This, is a recOMtheildati'on onit

lief a 5n.61 Order, On& the, f6,11 Board. has the

authority .to enter thAal order in this administrative qctiOne The: Board has. the authority to 440Pt, niodify: or reject this recommendation; andlhi-sreconimendation.:Wiall'hawfnolegal:effeet until and Unless adopted by the Boat& anci.a fhiai. ord0 isisenecl by the .13Pard a provided. POE' by Ct0,15td:4723. and 119 Of. the Revised. dote,

- Date'

Beth A. tewisi.,Attp at Law - Chief Hearing Exathiner, Ohio .Boalst_ ofNursiiig CERTIFICATE OF SERVICE

I certify thatOeoriginatof this report and recommendation wg.seryed won the Ohio Board Of Nursing at.its offieesin Columbus, Ohio, by hand delivery.,. on Qctdber 3, 2012:

B th A, Lewis, Chic,

tingT ,xaminer

PAge 8 of. 8

Cases # 12-005889, 12-005401

Ohi
March 22, 2013

gard of Nursing

www.nursing.ohio.gov

17 South High Street, Suite 400

Columbus, Ohio 43215-7410 0- (614) 466-3947

NOTICE OF OPPORTUNITY FOR HEARING

Kenyana Nicole Cunningham, L.P.N. 2350 Henrianne Court Cincinnati, Ohio 45225 Dear Ms. Cunningham: In accordance with Chapter 119, Ohio Revised Code (ORC), you are hereby notified that the Ohio Board of Nursing (Board) proposes under authority of Section 4723.28 ORC, to deny, revoke, permanently revoke, suspend or place restrictions on your license to practice nursing as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: 1. On or about 'September 14, 2012, you were assigned to provide home nursing care to Patient #1 See attached Patient Key to remain confidential and not subject to public disclosure], a pediatric patient with Cerebral Palsy, a tracheostomy, and developmental delays in speech, through the Ohio Home Care Program. Your nurse's notes for Patient #1 show that at 3:30 P.M., Patient #1 arrived home from school with signs and symptoms of distress, increased perspiration and a distended abdomen. You failed to document any vital signs for Patient #1. You did not contact Patient #1's physician or take appropriate action to address Patient #1's change in condition. Section 4723.28(B)(19), ORC, authorizes the Board to discipline a licensee for failure to practice in accordance with acceptable and prevailing standards of safe nursing care. Section 4723.28(B)(16), ORC, authorizes the Board to discipline a licensee for violation of Chapter 4723, ORC, or any rules adopted under it. Specifically, Rule 4723-4-04(C), Ohio Administrative Code (OAC), states that a licensed practical nurse shall demonstrate competence and accountability in all areas of practice in which the nurse is engaged which includes, but is not limited to, the following: (1) Consistent performance of all aspects of nursing care; and (2) Appropriate recognition, referral or consultation, and intervention, when a complication arises. Rule 4723-4-06(E), OAC, states that a licensed nurse shah, in a complete, accurate, and timely manner, report and document nursing assessments or observations, the care provided by the nurse for the client, and the client's response to that care. 2. From on or about May 3, 2012 to June 5, 2012, you were assigned to provide home nursing care, within the Ohio Home Care Waiver Program, to Patient #2, an individual with, among other things, Short-term memory loss, Insulin-Dependent Diabetes Mellitus

Kenyana Nicole Cunningham, L.P.N. Page 2 (IDDM), Seizure disorder, and COPD, with physician orders for daily doses of medications such as Lantus and Topamax and as-needed Oxygen. You submitted! a signed, written statement to the Board dated October 4, 2012 (Statement), in which you admit that you did not provide nursing care to Patient #2 on May 9, 10, or 11, 2012 because Patient #2 asked you not to come to her home. In your Statement, you stated that you did not provide nursing care to Patient #2 on May 24 through May 29, 2012 because you were out of the country. You never notified Patient #2's physician, the supervising registered nurse or case manager that you did not provide nursing care on the dates you were absent. You did not arrange for substitute nursing care while you were out of the country. Section 4723.28(B)(19), ORC, authorizes the Board to discipline a licensee for failure to practice in accordance with acceptable and prevailing standards of safe nursing care. Section 4723.28(B)(16), ORC, authorizes the Board to discipline a licensee for violation of Chapter 4723, ORC, or any rules adopted under it. Specifically, Rule 4723-4-04(C), OAC, states that a licensed practical nurse shall demonstrate competence and accountability in all areas of practice in which the nurse is engaged which includes, but is not limited to, the following: (1) Consistent perfouuance of all aspects of nursing care. Rule 4723-4-04(E), OAC, states that a licensed practical nurse shall, in a timely manner: (1) Implement any order or direction for a client unless the licensed practical nurse believes or should have reason to believe the order or direction is: (a) Inaccurate; (b) Not properly authorized; (c) Not current or valid; (d) Harmful, or potentially harmful to a client; or (e) Contraindicated by other documented information; and (2) Clarify any order or direction for a client when the licensed practical nurse believes or should have reason to believe the order or direction is: (a) Inaccurate; (b) Not properly authorized; (c) Not current or valid; (d) Harmful, or potentially harmful to a Client; or (e) Contraindicated by other documented information. Rule 4723-4-04(F), OAC, states that when clarifying an order or direction, the licensed practical nurse shall, in a timely manner: (1) Consult with an appropriate licensed practitioner; (2) Notify the prescribing practitioner when the licensed nurse makes the decision not to follow the direction or administer the medication or treatment as prescribed; (3) Document that the practitioner was notified of the decision not to follow the direction or administer the medication or treatment, including the reason for not doing so; and (4) Take any other action needed to assure the safety of the client. Rule 4723-4-06(F), OAC, states that a licensed nurse shall, in an accurate and timely manner, report to the appropriate practitioner errors in or deviations from the current valid order. Accordingly, the Board is authorized to impose one or more of the sanctions cited in Section 4723.28, ORC.

in accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing
in this matter. If you wish to request such hearing, the request must be made in writing and must be received in the Board office within thirty (30) days of the time of mailing of this notice. You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in

Kenyana Nicole Cunningham, L.P.N. Page 3 writing. At the hearing, you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to Lisa Ferguson-Ramos, Compliance Unit Manager, Ohio Board of Nursing, 17 Souti High Street, Suite 400, Columbus, Ohio 432157410 or to the email address, hearinOnursiug.ohio,gov. If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Opportunity for Hearing, deny, revoke, permanently revoke, suspend, or place restrictions on your license to practice nursing as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely, At / Rhonda S. Barkheimer, R.N., C.N.P. Supervising Board Member Certified Mail Receipt No. 7012 2210 0000 6272 3551 cc: Henry G. Appel, Senior Assistant Attorney General

Case #12-00/1A26

Ohio Board of Nursing

17 South High Street, Suite 400

www.nursingohio..gov

Columbus, Ohio 43215-7410 6 (614) 466-3947

March 22, 2013

NOTICE OF OPPORTUNITY FOR HEAT NG

Rosemary Daull, L.P.N. 9102 Bernwood Court Mentor, Ohio /1/1060 Dear Ms. Daull: In accordance with Chapter 119 Ohio Revised Code (ORC), the Ohio Board of Nursing (Board) proposes under authority of Section 4723.28, ORC, deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: 1. In January 2011, you submitted an Application for Licensure by Examination to Practice Nursing in Ohio as a Registered Nurse (Application). On the Compliance portion of your Application, you answered "No" to the question, "Are you currently engaged in the illegal use of chemical substances or controlled substances?" with currently meaning "recently enough so that the use of drugs may have an ongoing impact on one's functioning as a certificate holder or licensee, or within the past two years." On the Affidavit portion of your Application, you swore that the statements made within your Application were true. Despite this, on or about November 23, 2012, you admitted to a Board Compliance Agent that you had been addicted to Heroin for the past three years and that you had falsified your application. Section 4723.28(A) [as M effect prior to March 20, 2013], ORC, authorizes the Board to revoke the license or refuse to grant a license to a person who has been found by the Board to have committed fraud, misrepresentation, or deception in applying for or securing any license issued by the Board. Accordingly, the Board is authorized to impose one or more of the sanctions as cited in Section 4723.28 ORC. In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing in this matter. If you wish to request such hearing, the request must be made in writing and must be received in the Board office within thirty (30) days of the time of mailing of this notice. You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in

Rosemary Dau11,1_,:P.N. Page 2 writing. At the hearing you may also present evidence and examine witnesses appearing for and against you. t Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to: Lisa Ferguson-Ramos, Compliance Unit Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus OH 43215741O, or to the email address ! , hearingqnursing,ohio,goy. If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Opportunity for Hearing, deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely,

Rhonda S. Barkheimer, R.N., C .N .P . Supervising Board Member Certified Mail Receipt No. 7012 2210 0000 6272 3209 cc: Henry G. Appel, Senior Assistant Attorney General

Case# 12-005631

Board of Nursing
17 South High Street, Suite 400 March 22, 2013

www.nursing.ohio.gov

Columbus, Ohio 43215-7410- (614) 466-3947

NOTICE OF AUTOMATIC SUSPENSION AN OPPORTUNITY FOR HEARING

Cindy Jo Hess DiSalvio, R.N. 53292 East Captina Highway Powhatan Point, Ohio 43942 Dear Ms. DiSalvio: You are hereby notified that, on or about July 27, 2012, you entered into a Consent Agreement (July 2012 Consent Agreement) with the Ohio Board of Nursing (Board), a copy of which is attached hereto and incorporated herein, in which you agreed with the Board that your license to practice nursing as a registered nurse in the State of Ohio would be suspended indefinitely and that such suspension would be stayed subject to probationary terms, conditions, and limitations for a minimum period of two (2) years. A. Item 4. of the July 2012 Consent Agreement states, "By November 1, 2012, in addition to the requirements for licensure renewal, MS. DISALVIO shall successfully complete and submit documentation of satisfactory completion of the following continuing nursing education taken subsequent to the effective date of this Consent Agreement: five (5) hours of Documentation; five (5) hour of Medication Administration; (5) hours of Substance Abuse; and two (2) hours of Law/Rules governing the practice of nursing in Ohio." Despite this provision, as of as of February 12, 2013, you have failed to submit to the Board documentation of successful completion of five (5) hours of Documentation; five (5) hour of Medication Administration; (5) hours of Substance Abuse; and two (2) hours of Law/Rules governing the practice of nursing in Ohio. Section 4723.28(B)(17), ORC, authorizes the Board to discipline a licensee for violation of any restrictions placed on a nursing license by the Board. B. Item 6. of the July 2012 Consent Agreement states, "Within forty-five (45) days of the effective date of this Consent Agreement and continuing throughout the probationary period, MS. DISALVIO shall submit, at her expense and on the day selected, blood, breath, hair; or urine specimens for drug and/or alcohol analysis at a collection site specified by the Board at such times as the Board may request. Refusal to submit such specimen, or failure to submit such specimen on the day she is selected, or in such a manner as the Board may request, shall constitute a violation of a restriction placed on a

Cindy Jo Hess DiSalvio, R.N. Page 2 license for purposes of Section 4723.28(B), ORC. This screening shall require a daily call-in process. The specimens submitted by MS. DISALVIO shall be negative, except for substances prescribed, administered, or dispensed to her by another so authorized by law who has received a complete copy of this Consent Agreement prior to prescribing for MS. DISALVIO." Despite this provision, on or about the following dates you failed to call Firstlab to determine if you had been selected to provide a specimen for analysis: November 25, 2012; December 28, 2012; January 17, 2013; February 5, 201.3; and February 10, 2013. In addition, on the following dates, you were selected to provide a specimen for analysis and failed to do so: November 26, 2012 and February 4, 2013. In a letter received by the Board on or about December 27, 2012, you stated you failed to provide a specimen on November 26, 2012 due to a mechanical problem with your automobile. Section 4723 .28(B)(17), ORC, authorizes the Board to discipline a licensee for violation of any restrictions placed on a nursing license by the Board. C. Item 6.a, of the July 2012 Consent Agreement states, "Prior to initiating drug screens, MS. DISALVIO shall provide a copy of this Consent. Agreement to all treating practitioners and shall provide to the Board a list of all treating practitioners, including addresses and telephone numbers and cause all treating practitioners to complete a medication prescription report that is to be mailed by the practitioner directly to the Board. The medication report is to be completed for any and all substances prescribed, administered, or dispensed to MS. DISALVIO." Despite these provisions, on or about December 21, 2012, you obtained medical treatment from your primary care physician and were issued a prescription for Xanax. As of February 13, 2013, you have failed to cause your primary care physician to mail a medication prescription report directly to the Board regarding the prescription issued to you for Xanax. Section 472328(B)(17), ORC, authorizes the Board to discipline a licensee for violation of any restrictions placed on a nursing license by the Board. D. Item 7. of the July 2012 Consent Agreement states, "Within sixty (60) days of the effective date of this Consent Agreement, MS. DISALVIO shall, at her expense, obtain a chemical dependency by a Board approved chemical dependency professional and shall provide the Board with complete documentation of this evaluation. Prior to the evaluation, MS. DISALVIO shall provide the professional with a copy of this Consent Agreement. Further, MS. DISALVIO shall execute releases to permit the professional to obtain any information deemed appropriate and necessary for the evaluation. The professional shall submit a written opinion to the Board that includes diagnoses, recommendations for treatment and monitoring, any additional

Cindy Jo Hess DiSalvio, R.N. Page 3 restrictions that should be placed on MS. DISALVIO's license to practice, and stating whether MS. DISALVIO is capable of practicing nursing according to acceptable and prevailing standards of safe nursing care." Despite this provision, you failed to complete a chemical dependency evaluation until October 23, 2012, the results of the evaluation were not received by the. Board until on or about December 27, 2012, and there is no evidence that you provided a copy of the July 2012 Consent Agreement to the chemical dependency evaluator prior to the evaluation as required by the July 2012 Consent Agreement. In a letter received by the Board on or about December 27, 2012, you stated, "it was entirely my fault that Ms. Goddard was unable to complete her evaluation and send the results to you in a timely fashion," and further admit that you failed to provide a copy of the July 2012 Consent Agreement to the evaluator prior to the evaluation. Section 4723.28(B)(17), Ohio Revised Code, ORC, authorizes the Board to discipline a licensee for violation of any restrictions placed on a nursing license by the Board_ In accordance with the paragraph under "FAILURE TO COMPLY" of the July 2012 Consent Agreement, you are hereby notified that it appears to the Board that you have violated Items 4., 6., 6.a., and 7. of the July 2012 Consent Agreement. YOU ARE FURTHER NOTIFIED THAT YOUR LICENSE TO PRACTICE NURSING AS A REGISTERED NURSE, RN-230188, IS HEREBY AUTOMATICALLY SUSPENDED. Continued practice after receipt of this notice of suspension shall be considered engaging in the practice of nursing as a registered nurse without a current, valid license, which is a violation of Section 4723.03(A), ORC. You are further notified that in accordance with Chapter 119, ORC, the Board proposes under authority of Section 4723.28, ORC, to deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: 1. On or about July 27, 2012, you entered into a Consent Agreement (July 2012 Consent Agreement) with the Ohio Board of Nursing (Board), a copy of which is attached hereto and incorporated herein, in which you agreed with the Board that your license to practice nursing as a licensed practical nurse in the bState of Ohio would be suspended indefinitely and that such suspension would be stayed subject to probationary terms, conditions, and limitations for a minimum period of two (2) years. 2. Item 4. of the July 2012 Consent Agreement states, "By November 1, 2012, in addition to the requirements for licensure renewal, MS. DISALVIO shall successfully complete and submit documentation of satisfactory completion of the following continuing nursing education taken subsequent to the effective

Cindy Jo Hess DiSalvio, R.N. Page 4 date of this Consent Agreement: five (5) hours of Documentation; five (5) hour of Medication Adrninistraltion; (5) hours of Substance Abuse; and two (2) hours of Law/Rules governing the practice of nursing in Ohio." Despite this provision, as of as of February 12, 2013, you have failed to submit to the Board documentation of successful completion of five (5) hours of Documentation; five (5) hour of Medication Administration; (5) hours of Substance Abuse; and two (2) hours of Law/Rules governing the practice of nursing in Ohio. Section 4723 .28(B)(17), ORC, authorizes the Board to discipline a licensee for violation of any restrictions placed on a nursing license by the Board. 3, Item 6. of the July 2012 Consent Agreement states, "Within forty-five (45) days of the effective date of this Consent Agreement and continuing throughout the probationary period, MS. DISALVIO shall submit, at her expense and on the day selected, blood, breath, hair, or urine specimens for drug and/or alcohol analysis at a collection site specified by the Board at such times as the Board may request. Refusal to submit such specimen, or failure to submit such specimen on the day she is selected, or in such a manner as the Board may request, shall constitute a violation of a restriction placed on a license for purposes of Section 4723.28(B), ORC. This screening shall require a daily call-in process. The specimens submitted by MS. DISALVIO shall be negative, except for substances prescribed, administered, or dispensed to her by another so authorized by law who has received a complete copy of this Consent Agreement prior to prescribing for MS. DISALVIO." Despite this provision, on or about the following dates you failed to call Firstlab to determine if you had been selected to provide a specimen for analysis: November 25, 2012; December 28, 2012; January 17, 2013; February 5, 2013; and February 10, 2013. In addition, on the following dates, you were selected to provide a specimen for analysis and failed to do so: November 26, 2012 and February 4, 2013. In a letter received by the Board on or about December 27, 2012, you stated you failed to provide a specimen on November 26, 2012 due to a mechanical problem with your automobile. Section 4723 .28(B)(17), ORC, authorizes the Board to discipline a licensee for violation of any restrictions placed on a nursing license by the Board. 4. Item 6.a. of the July 2012 Consent Agreement states, "Prior to initiating drug screens, MS. DISALVI shall provide a copy of this Consent Agreement to all treating practitioners and shall provide to the Board a list of all treating practitioners, including addresses and telephone numbers and cause all treating practitioners to complete a medication prescription report that is to be mailed by the practitioner directly to the Board. The medication

Cindy Jo Hess DiSalvio, R.N. Page 5 report is to be completed for any and all substances prescribed, administered, or dispensed to MS. DISALVIO." Despite these provisions, on or about December 21, 2012, you obtained medical treatment from your primary care physician and were issued a prescription for Xanax. As of February 13, 2013, you have failed to cause your primary care physician to mail a medication prescription report directly to the Board regarding the prescription issued to you for Xanax. Section 4723 .28(B)(17), ORC, authorizes the Board to discipline a licensee for violation of any restrictions placed on a nursing license by the Board, 5. Item 7. of the July 2012 Consent Agreement states, "Within sixty (60) days of the effective date of this Consent Agreement, MS. DISALVIO shall, at her expense, obtain a chemical dependency by a Board approved chemical dependency professional and shall provide the Board with complete documentation of this evaluation. Prior to the evaluation, MS. DISALVIO shall provide the professional with a copy of this Consent Agreement. Further, MS. DISALVIO shall execute releases to permit the professional to obtain any information deemed appropriate and necessary for the evaluation. The professional shall submit a written opinion to the Board that includes diagnoses, recommendations for treatment and monitoring, any additional restrictions that should be placed on MS. DISALVIO's license to practice, and stating whether MS. DISALVIO is capable of practicing nursing according to acceptable and prevailing standards of safe nursing care." Despite this provision, you failed to complete a chemical dependency evaluation until October 23, 2012, the results of the evaluation were not received by the Board until on or about December 27, 2012, and there is no evidence that you provided a. copy of the July 2012 Consent Agreement to the chemical dependency evaluator prior to the evaluation as required by the July 2012 Consent Agreement. In a letter received by the Board on or about December 27, 2012, you stated, "it was entirely my fault that Ms. Goddard was unable to complete her evaluation and send the results to you in a timely fashion," and further admit that you failed to provide a copy of the July 2012 Consent Agreement to the evaluator prior to the evaluation. Section 4723.28(B)(17), Ohio Revised Code, ORC, authorizes the Board to discipline a licensee fo4violation of any restrictions placed on a nursing license by the Board. Accordingly, the Board is authorized to impose one or more of the sanctions as cited in Section 4723.28, ORC. In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing in this matter. If you wish to request such hearing, the request must be made in writing and must be received in the Board office within thirty (30) days of the time of mailing of this notice.

Cindy Jo Hess DiSalvia, R.N. Page 6

You are hereby further informed ttat, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as, is permitted to practice before the Board, or you may present your position, arguments, or contentions in writing. At the hearing you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to: Lisa Ferguson-Ramos, Compliance Unit Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, Ohio 432157410, or to the e-mail address, hearing@nursing.ohio.00v. If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Automatic Suspension and Opportunity for Hearing, deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely,
A' ry L. 7 A/..7, 7

Rhonda S. Barkheimer, RN., C.N.P. Supervising Board Member Certified Mail Receipt No. 7012 2210 0000 6272 3759 cc: Henry G. Appel, Senior Assistant Attorney General

Case..# 11-00872 Ohl

oard f 'Nursing

ohio 00-v
air

1. 7 Smith I Iii 1i $t.roet, Suite 40t) m Columbus, Ohio 4.:?;21.57410 ` GO. 14) 466-3947

CONSENT AGREEMENT BETWEEN CINDY JO HESS DISALYIO, R.N, AND OHIO BOARD OF NURSING

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m m

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This Consent Agreement is entered into by and between CINDY JO HESS MALVJO, R,N. (M&. DISALVIO) and the Ohio Board of Nursing. (Board); the state agency charged with enforcing Chapter 4723. of the Ohio Revised Code (ORC), and all administrative rules promulgated thereunder, This Consent Agreement contains the entire agreement between the parties, there being no other agreernent of any kind, verbal or otherwise, which varies the terms of this CCOS6tit Agreement:

MS18 FOR ACTION

This Consent Agreement is entered into on the basis of the following stipulations, admissions and understandings: A. The Board is empowered by Section 472328, ORC, to deny, permanently revoke,' revoke, .suspend, or place restrictions on any license issued by the Board; reprimand or otherwise discipline a licensee; or impose a fine of five hundred dollars ($500.00) or less per violation, Section 4723.28(8)(11), ORC, authorizes the Board tO discipline a licensee for impairment of the ability to practice according to acceptable and prevailing standards of safe nursing practice because of a physical or mental disability, Section 4723.28(B)(19),. ORC, authorizes the Board to discipline a licensee, for failure to practice in accordance with acceptable and prevailing standards of safe purging care. Section 472328(B)(16), ORC, authorizes the Board to discipline a licensee for, violation of this chapter or any rules adopted under it. Specifically, Rule 47234-06(E), OAC, states that a licensed nurse shall, in a complete, accurate, and timely manner, report and document nursing assessments or observations, the care provided by the nurse for the client, and the client's response to that care. Rule 4723-4-06(0), OAC, states that a licensed nurse shall not falsify any client record or any other document prepared or utilized in the course of, or in conjunction with, nursing practice. This includes, but it is not limited to, ease management documents or reports or time records, reports, and other documents related to billing for nursing services. Rule 4723-4-06(H), Ohio Administrative Code, states that a licensed nurse shall implement measures to promote a safe environment for each client.

Cindy Jo Hess DiSalvio, R.N. Page 2 B. S. DISALVIO has an active license to practice nursing as a registered nurse, RN-230188, in the State of Ohio. MS. DISALVIO was initially licensed as a registered nurse in Ohio in October 1990. MS. DISALVIO voluntarily surrendered her West Virginia nursing license and has a lapsed Pennsylvania nursing license. MS. DISALVIO knowingly and voluntarily admits to the following: 1) On or around December 25, 2010, while working as a nurse at East Ohio Regional Hospital in Martins Ferry, Ohio, MS. DISALVIO was confronted about her administration and documentation of medication. MS. DISALVIO was subsequently terminated from employment for failure to administer medication to two patients and for falsely documenting such administration. MS. DISALVIO admitted that she bad documentation and administration issues when she worked at East Ohio Regional Hospital, but MS. DISALVIO attributed her practice issues on December 25, 2010 to her Diabetes since she was eating too many cookies and sweets that night. MS. DISALVIO also admitted in a telephone interview with a Board Compliance Agent that she "inadvertently" voluntarily, surrendered her West Virginia Nursing License in September 2000, after she resigned from Wheeling Hospital in Wheeling, West Virginia. Prior to her resignation from Wheeling Hospital, MS. DISALVIO was confronted about discrepancies M her administration and documentation of narcotics. MS. DISALVIO is willing to cooperate with the Board in order to maintain her nursing license. AGREED CONDITIONS Wherefore, in consideration of the foregoing and mutual promises hereinafter set forth, and in lieu of any formal proceedings at this time, MS. DISALVIO knowingly and voluntarily agrees with the Board to the following terms, conditions, and limitations: MS. DISALVIO's license to practice nursing as a registered nurse shall be suspended indefinitely. Such suspension is hereby stayed, subject to the following probationary terms, conditions, and limitations for a minimum period of two (2) years: 1. 2. MS. DISALVIO shall obey all federal, state, and local laws, and all laws and rules governing the practice of nursing in Ohio. MS. ISALVIO shill appear in person for an interview before the full Board or its designated representative, as requested by the Board or its designee.

C.

2)

3)

4)

Cindy Jo Hess DiSalvio, page 3 -Background Check 3, Als& DISALVIO agrees that she will submit a request to the. Bureau of Criminal Identification and Investigation (BCH) to conduct a criminal records check of MS. MALMO, including a check of Federal Bureau of Investigation (FBI) records, and shall cause BCII to submit MS. 1 !SALM% criminal records check reports to the Board. MS. ISALVIO's completed criminal records check, including the FBI check, must be received by the Board prior to release of these probation terms.

Continuing Education 4. By November 1, 2012, in addition to the requirements for licensure renewal, MS. DIES/UW][0 shall successfully complete and submit documentation of satisfactory completion of the following continuing nursing education taken subsequent to the effective date of this Consent Agreement: five (5) hours of Documentation; five (5) hour of Medication Administration; (5) hours of Substance Abuse; and two (2) hours of Law/Rules governing the practice of nursing in Ohio.

Monitoring of Rehabilitation and Treatment 5. MS. DISALVIO shall abstain completely from the personal use or possession of drugs, except those prescribed, administered, or dispensed to her by another so authorized by law who has received a complete copy of this Consent Agreement prior to prescribing for MS. DISALVIO. MS. DISALVIO shall self-administer the prescribed drugs only in the manner prescribed. Within forty-five (45) days of the effective date of this Consent Agreement and continuing throughout the probationary period, MS. DISALVIO shall submit, at her expense and on the day selected, blood, breath, hair, or urine specimens for drug and/or alcohol analysis at a collection site specified by the Board at such times as the Board may request. Refusal to submit such specimen, or failure to submit such specimen on the day she is selected; or in such a manner as the Board may request, shall constitute a violation of a restriction placed on a license for purposes of Section 4723.28(B), {SRC. This screening shall require a daily call-in process, The specimens submitted by MS. DISALVIO shall be negative, except for substances prescribed, administered, or dispensed to her by another so authorized by law who has received a complete copy of this Consent Agreement prior to prescribing for MS. DISALVIO. a, Prior to initiating drug screens, MS. MALMO shall provide a copy of this Consent Agreement to all treating practitioners and shall provide to the Board a list of all treating practitioners, including addresses and

6.

Cindy Jo Hess DiSalvio, RN. Page 4 telephone numbers and cause ail treating practitioners to complete a medication prescription report that is to be mailed by the practitioner directly to the Board. The medication report is to be completed for any and all substances prescribed, administered, or dispensed to S. DISALVIO. b. After initiating drug screens, MS. DISALVIO shall be under a continuing duty to provide a copy of this Consent Agreement, prior to initiating treatment, to additional treating practitioners, and to update the list of treating practitioners with the Board within forty-eight (48) hours of being treated by another practitioner. Further, MS. DISALVIO shall notify the Board of any and all medication(s) or prescription(s) received within twenty-four (24) hours of release from hospitalization or medical treatment. 7, Within sixty (60) days of the effective date of this Consent Agreement, MS. DISALVIO shall, at her expense, obtain a chemical dependency by a Board approved chemical dependency professional and shall provide the Board with complete documentation of this evaluation. Prior to the evaluation, MS. ISALVfO shall provide the professional with a copy of this Consent Agreement, Further, MS. DISALVIO shall execute releases to permit the professional to obtain any information deemed appropriate and necessary for the evaluation. The professional shall submit a written opinion to the Board that includes diagnoses, recommendations for treatment and monitoring, any additional restrictions that should be placed on. MS. DISALVIO's license to practice, and stating whether MS. DISALVIO is capable of practicing nursing according to acceptable and prevailing standards of safe nursing care. MS. DISALVIO shall provide the Board with satisfactory documentation of compliance with all aspects of the treatment plan developed by the chemical dependency professional described above until released, Further, MS. DISALVIO agrees that the Board may utilize the professional's recommendations and conclusions from the evaluation as a basis for additional terms, conditions, and limitations on MS. DISALVIO's license and that the terms, conditions, and limitations may be incorporated in an addendum to this Consent Agreement.

8.

Fitnp_ss for Duty Evaluation Upon Request 9. Upon request by the Board or its designee and within sixty (60) days of such a request, MS. MALMO shall, at her expense, obtain a comprehensive physical examination by a Board approved physician for the purposes of evaluating MS. DISALVIO's fitness for duty and safety to practice nursing as a registered nurse. This Board approved physician shall provide the Board with complete documentation of MS. DISALVIO's comprehensive physical exankination and with a comprehensive assessment regarding MS. DISALVIO's ritness for duty and safety to practice nursing as

Cindy So Hess DiSalvio, Page 5 a registered nurse. Prior to the examination, MS. DISALVIO shall provide the Board approved physician with a copy of this Consent Agreement. Further, MS. DISALVE0 shall execute releases to permit the Board approved physician performing the comprehensive physical examination and assessment to obtain any information deemed appropriate and necessary for the assessment. The evaluating physician shall submit a written opinion to the Board that includes diagnoses, recommendations for treatment and monitoring, any additional restrictions that should be plated on MS. iiillSALVIO's license to practice, and stating whether MS. DISALVIO is capable of practicing nursing according to acceptable and prevailing standards of safe nursing care. 10, .11:f a fitness for duty examination is requested i the above paragraph, MS. DISALVIO agrees that the Board may use the physician's recommendations and conclusions from the evaluation as a basis for additional terms, conditions, and limitations on S. DISALVIO's license and that the terms, conditions, and limitations may be incorporated in an addendum to this Consent Agreement,

Employment Conditions 11. if working in a position in which a nursing license is required, MS. DISALVIO shall notify the Board, in writing, of the name and address of any current employer within thirty (30) days following the effective date of this Consent Agreement, or any new employer prior to accepting employment. MS. DISALVIO, within fifteen (15) days of the effective date of the Consent Agreement, if working in a position in which a nursing license is required, shall provide her employer(s) with a copy of this Consent Agreement. Further, MS. DISALVIO is under a continuing duty to provide a copy of this Consent Agreement to any new employer prior to accepting employment in a position in which a nursing license is required. MS. EbISALVIO shall have her employer(s), if working in a position where a nursing license is required, submit written reports on a quarterly basis regarding job performance beginning within thirty (30) days of the effective date of the Consent Agreement or beginning within thirty (30) days of accepting employment as a nurse.. MS. DISALVIO shall have her employer(s) send documentation to the Board, along with the first employer report, of receipt of a copy of this Consent Agreement, including the date the Consent Agreement was received.

12.

eporting Requirements of Licensee 13, MS. DISALVIO shall report to the Board, in writing, any violation of this Consent Agreement within thirty (30) days of the occurrence of the violation.

Cindy So Hess DiSalvio, Page 6 14. MS. DISALVIO shall submit any and all information, which the Board or its designee may request, regarding her ability to practice nursing according to acceptable and prevailing standards of safe nursing care. MS. 1111SALVIO shall not submit or cause to be submitted any false, misleading, or deceptive statements, information, or documentation to the Board or to employers or potential employers. MS. DISALVIO shall submit the reports and documentation required by this Consent Agreement on forms specified by the Board. All reporting and communications required by this Consent Agreement shall be made to the Compliance Unit of the Board. MS. MAINE shall submit all documentation required by this Consent Agreement or requested by the Board to the attention of the Compliance Unit, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, Ohio 43215-7410. DISALVIO shall verify that the reports and documentation required by this Consent Agreement are received in the Board office. MS. DISALYJO shall inform the Board within five (5) business days, in writing, of any change in employment status or of any change in residential or home address or telephone number. rr rcor on

15.

16.

17.

18.

19.

Unless otherwise approved in advance, in writing, by the Board or its designee, MS. DISALVIO shall not administer, have access to, or possess (except as prescribed for MS. DISALVIO's use by another so authorized by law who has received a complete copy of this Consent Agreement prior to prescribing for MS. DISALVIO) any narcotics, other controlled substances, or mood altering drugs for a minimum of six (6) months in which MS. DISALVIO is working in a position that requires a nursing license. At any time after the six (6) month period previously described, MS. DISALVIO may submit a written request to the Board to have this restriction re-evaluated. in addition, MS. DISALVIO shall not possess or carry any work keys for locked medication carts, cabinets, drawers, or containers. MS. DISALVIO shall not count narcotics, MS. DLSALVIO shall not call in or order prescriptions or prescription refills for narcotics, other controlled substances, or mood altering drugs, poLaiyh r . e

Unless otherwise approved in advance, in writing, by the Board or its designee, MS. DISALVIO shall not practice nursing s a registered nurse (1) for agencies providing home care in the patient's residence; (2) for hospice care programs

Cindy Jo Hess DiSalvio, R.N. Page 7 providing hospice care in the patient's residence; (3) for staffing agencies or pools; (4) as an independent provider where the nurse provides nursing care and is reimbursed for services by the State of Ohio through State agencies or agents of the State; or (5) for an individual or group of individuals who directly engage MS. DISALVIO to provide nursing services for fees, compensation, or other consideration or as a volunteer. Unless otherwise approved in advance, in writing, by the Board or its designee, MS. IMSALVIO shall not function in a position or employment where the job duties or requirements involve management of nursing and nursing responsibilities or supervising and evaluating nursing practice. Such positions include but are not limited to the following: Director of Nursing, Assistant Director of Nursing, Nurse Manager, Vice President of Nursing. FAILURE TO comeLy MS. DISALVE0 agrees that her license to practice nursing as a registered nurse will be automatically suspended if it appears to the Board that MS. DISALVIO has violated or breached any terms or conditions of the Consent Agreement. Following the automatic suspension, the Board shall notify MS. DISALVIO via certified mail of the specific nature of the charges and automatic suspension of her license. Upon receipt of this notice, MS. DISALVIO may request a hearing regarding the charges. The above described terms and conditions shall constitute "restrictions placed on a license" for purposes of Section 4723.28(B), ORC. If, in the discretion of the Board, MS. DISALVIO appears to have violated or breached any terms or conditions of the Consent Agreement, the Board reserves the right to institute formal disciplinary proceedings for any and all possible violations or breaches, including, but not limited to, alleged violations of the laws of Ohio occurring before the effective date of this Consent Agreement. DURATION/MODIFICATION OF TERMS The terms, limitations and conditions of this Consent Agreement may be modified or terminated, in writing, at any time upon the agreement of both MS. DISALVIO and the Board. The Board shall only alter the probationary period imposed by this Consent Agreement if: (I) MS. DISALVIO has complied with all aspects of this Consent Agreement; and (2) the Board determines that MS. MAIM is able to practice according to acceptable and prevailing standards of safe nursing care without Board monitoring based upon an interview with MS. DISALVIO and review of the reports required herein. Any period during which MS. DISALVIO does not work in a position for which a nursing license is required shall not count toward fulfilling the probationary period imposed by this Consent Agreement.

Cindy Jo Hess DiSalvio, Page 8

AC TO'

RELEASE

MS. DISALVIO acknowledges that she has had an opportunity to ask questions concerning the terms of this Consent Agreement and that all questions asked have been answered in a satisfactory manner, MS. DISALVIO waives all of her rights under Chapter 119, ORC as they relate to matters that are the subject of this Consent Agreement.. MS. DISALVIO VaiVes- Any and all claims or causes of she may have: against the Board,. and members., officers, employees and/or agents of either, arising out of .matters that are the subject of this Consent Agreement. This Consent Agreement is not ari adjudication order 'as discussed in' Chapter 119, ORE. However, any action initiated 'by the Board. based. on alleged violations of this Consent Agreement shall comply with the .Adininistrative Procedures Act,, Chapter 119, ORC. This Consent Agreement shall be considered a public record as that term IS Used in Section 149.43, ORC. The infoimatiOn contained herein may be reported to appropriate organizations, data banks and governmental bodies.

FiXFECTIVE DATE
MS. DISALVIO understands that this Consent Agreement is subject to ratification by the Board prior to signature by the Board President and shall becoine effective upon the last date of signature below.

S DISALVIO, R.N.

TODD W. COLLIS, ESQ. Attorney for MS. DISALVIO

DATE

8,9,0AUPr / RAI
BERTHA LOVELACE, Pre.sident Ohio Board of Nursing DATE

ai

Case #12-007320

Ohio Board of Nursing

www,nursing.ohio.gov

17 South Nigh Street, Suite 400 Columbus, Ohio 43215-7410 a (014) 466-3947

March 22, 2013

NOTICE OF OPPORTUNITY FOR HEARING

Amy Catherine Eloshway 1518 Elbur Avenue Lakewood, Ohio 44107 Dear Ms. Eloshway: In accordance with Chapter 119, Ohio Revised Code (ORC), you are hereby notified that the Ohio Board of Nursing (Board) proposes under authority of Section 4723.28, ORC, to deny or permanently deny reinstatement of your license to practice nursing as a licensed practical nurse; permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: 1. On or about March 20, 2009, you entered into a Consent Agreement (March 2009 Consent Agreement) with the Ohio Board of Nursing (Board), a copy of which is attached hereto and incorporated herein, in which you agreed with the Board that your license to practice nursing as a licensed practical nurse would be suspended indefinitely, with conditions for reinstatement. Attached to and incorporated within the March 2009 Consent Agreement is a March 14, 2008 Notice of Immediate Suspension and Opportunity for Hearing. Documents are redacted according to Sections 2953.32 and/or 2953.52, ORC. You requested reinstatement on or about October 14, 2012. 2. Item 2. of the March 2009 Consent Agreement states, in pertinent part, "MS. ELOSI{WAY shall obey all federal, state, and local laws and all laws and rules governing the practice of nursing in Ohio." Section 4723 .28(B)(4) [as in effect prior to March 20, 2013] ORC, authorizes the Board to discipline a licensee for conviction of, a plea of guilty to, a judicial finding of guilt of, a judicial finding of guilt resulting from a plea of no contest to, or a judicial finding of eligibility for intervention in lieu of conviction for, any felony or of any crime involving gross immorality or moral turpitude. Despite this provision, on or about April 26, 2011, in Geauga County Court of Common Pleas Case No. 10 C 000135, you were convicted of Theft, a misdemeanor of the first degree, in violation of Section 2913.02(A)(1), ORC.

Amy Catherine Eloshway Page 2 Section 4723.28(B)(17), ORC, authorizes the Board to discipline a licensee for violation of any restrictions placed or a nursing license by the Board. 3. Item 6. of the March 2009 Consent Agreement states, "MS. ELOSHWAY shall abstain completely from the personal use or possession of drugs, except those prescribed, administeredjor dispensed to her by another so authorized by law who has full knowledge of MS. ELOSHWAY's history of chemical dependency and recovery status. MS. ELOSHWAY shall self-administer the prescribed drugs only in the manner prescribed." Despite this provision, on or about October 26, 2012, you sent a statement to the Board, which indicated that you were introduced to Heroin, after using pain medication for a long period of time. You stated, "it was easier to get and it was cheaper. I used Heroin intravenously for approximately 9 months." You further stated that your sobriety date from Heroin was March 21, 2011. Section 4723.28(B)(8) [as in effect prior to June 8, 2012], ORC authorizes the Board to discipline a licensee for self-administering or otherwise taking into the body any dangerous drug, as defined in Section 4729.01, ORC, in any way not in accordance with .a legal, valid prescription issued for that individual. Section 4723.28(B)(17), ORC, authorizes the Board to discipline a licensee for violation of any restrictions placed on a nursing license by the Board. Accordingly, the Board is authorized to impose one or more of the sanctions cited in Section 4723.28, ORC. In accordance with Chapter 119, ORC, you. are hereby informed that you are entitled to a hearing in this matter. If you wish to request such hearing, the request must be made in writing and must be received in the Board office within thirty (30) days of the time of mailing of this notice. You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in writing. At the hearing you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to Lisa Ferguson-Ramos, Compliance Unit Manager, Ohio Board of Nursing, 17 Nouth High Street, Suite 400, Columbus OH 43215-7410, or to the email address, hearing@nursing,gov. If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Opportunity for Hearing, deny or permanently deny reinstatement of your license to practice- nursing as a licensed practical nurse;

Amy Catherine Eloshway Page 3 permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely, XAt Rhonda S. Barkheimer, R.N., C.N.P. Supervising Board Member Certified Mail Receipt No. 7012 2210 0000 6272 3346 cc: Henry G. Appel, Senior Assistant Attorney General

Bioard
'

Musia

wwwmursing ohio go),

17 South High Street, Suite 400 .4' Columbus, Ohio 43215-7410 e (614) 4661947

To Whom It May Concern:

You recently requested records regarding public Board action. Enclosed are records in response to your request. Information has been redacted, per Section(s) 2953;32 and / or 2953.52 of the Ohio Revised Code, If you have any further questions or concerns, please contact the Compliance Unit Manager or a Supervising Attorney.

Thank you. Compliance Unit Ohio Board of Nursing

Case 1106.2003

Ohio Board of Nursing

17 South High Street, Suite 4011 4
Columbus,

wwwnursing.ohio.gov

Ohio 43215-7410 R (614)466-3947

CONSENT AGREEMENT BETWEEN AMY C. ELOSHWAY, L.P.N. AND OHIO BOARD OF NURSING

.1)
73'
;k3 ni 0

741
C)

'c: r3 1 This Consent Agreement is entered into by and between AMY C. ELOSHWAY, L.P. (gS, F ELOSHWAY) and. the Ohio Board of Nursing (Board), the state agency charged with efforOg Chapter 4723. of the Ohio Revised Code (ORC), and all administrative rules promulgated thereunder. MS. ELOSHWAY voluntarily enters into this Consent Agreement being fully informed of her rights under Chapter 119, ORC, including the right to representation by legal counsel and the right to a formal adjudicative hearing on the issues considered herein. This Consent Agreement contains the entire agreement between the parties, there being no other agreement of any kind, verbal or otherwise, which varies the terms of this Consent Agreement. 13ASIS FOR ACTION This Consent Agreement is entered into on the basis of the following stipulations, admissions and understandings:

A,

The Board is empowered by Section 4723:28, ORC, to deny permanently revoke, revoke, suspend, or place restrictions on any license issued by the Board; reprimand or otherwise discipline a licensee; or impose a fine of five hundred dollars ($500.00) or less per violation. Section 4723.28(B)(4), ORC, authorizes the. Board to discipline a licensee who has been convicted of, pled guilty to, a judicial finding of guilt of, a judicial finding of guilt resulting from a plea of no contest to, or a judicial finding of eligibility for Intervention in Lieu of Conviction for any felony or of any crime involving gross immorality or motel turpitude. Section 4723.28(B)(5), ORC, authorizes the Board to discipline a licensee who has been convicted of, pled guilty to, a judicial finding of guilt of, a judicial finding of guilt resulting from a plea of no contest to, or a judicial finding of eligibility for . lute) vention in Lieu of Conviction for violating any municipal, state, county or federal drug law. Section 4723_20)(8), ORC, authorizes the Board to discipline a licensee for self-administering or otherwise taking into the body any dangerous drug, as defined in Section 4729.01, ORC, in any way not in

Amy C. Bloshway, L.P.N. Page 2 accordance with a legal, valid prescription issued for that individual. Section 4723.28(B)(9), ORC, authorizes the Board to discipline a licensee for habitual indulgence in the use of controlled substances, other habitforming drugs, or alcohol or other chemical substances to an extent that impairs ability to practice. Section 4723.28(B)((3), ORC, authorizes the Board to discipline a licensee for obtaining or attempting to obtain money or anything of value by intentional misrepresentation or material deception in the course of practice. Section 4723.28(B)(19), ORC, authorizes the Board to discipline a licensee for failure to practice in accordance with acceptable and prevailing standards of safe nursing CRTC. Section 4723.28(8)06), ORC, authorizes the Board to discipline a licensee for violation of Chapter 4723, ORC, or any rules adopted under it. Specifically, Ohio Administrative Code (OAC), Rule 4723-4-06(G), states that a licensed nurse shall not falsify any client record or any other document prepared or utilized in the course of, or in conjunction with, nursing practice. This includes, but is not limited to, case management documents or reports or time records, reports, and other documents. related to billing for nursing services. Rule 4723-4-06(H), OAC, states that a licensed nurse shall implement measures to promote a safe environment for each client. B. MS. ELOSHWAY's license, P.N. 113135, was immediately suspended by the Board on or about March 14, 2008_ MS. ELOSHWAY was initially licensed as a nurse in the State of Ohio on or about July 23, 2003. On August 29, 2006, MS. ELOSWHAY requested that her license be placed on inactive status. MS. ELOSHWAY knowingly and voluntarily admits to the factual and legal allegations set forth in the Notice of immediate Suspension and Opportunity for Hearing Issued to her by the Board on or about March 14, 2008 (March 2008 Notice), a copy of which is attached hereto and incorporated herein. MS. ELOSHWAY reports that she suffered from T1v1.1 at the time of incidents described in the March 2008 Notice,

C.

O.

E.

MS. ELOSHWAY, through her counsel, submitted some of her treatment documents for the Board's review. On September 12, 2006, MS. ELOSHWAY submitted to a chemical dependency evaluation with Oriana House, Inc., Akron, Ohio. The evaluator diagnosed MS. ELOSHWAY as Oploid Dependent, with physiological dependence.
On December 18, 2006, MS. ELOSHWAY entered an Intensive Outpatient Program for Opioid Dependence at the- Department of Public Health and Counseling Services and Alcoholism Division, Akron, Ohio. MS. ELOSHWAY completed her Intensive Outpatient Progr on April 26,

F.

Amy C. Eloshway, L.P.N. Page 3 2007. MS. ELOSHWAY has also provided the results of three negative drugs screens submitted during her Intensive Outpatient treatment. G. t MS. ELOSHWAY's

MS. ELOSHWAY expresses remorse for her actions and is willing to cooperate with the Board to ensure her safe return to the practice of nursing. AGREED CONDITIONS Wherefore, in consideration of the foregoing and mutual promises hereinafter set forth, and in lieu of any formal proceedings at this time, MS. ELOSHWAY knowingly and voluntarily agrees with the Board to the following terms, conditions, and limitations: SUSPENSION OF LICENSE 1. MS. ELOSHWAY's license to practice nursing as a licensed practical nurse is hereby suspended for an indefinite period of time, but not less than FIVE (5) YEARS from MS. the date MS. ELOSHWAY's license was placed on inactive status. ELOSHWAY may request reinstatement at anytime after August 201I.

CONDITIONS FOR REINSTATEMENT 2. MS. ELOSHWAY shall obey ail federal, state, and local laws, and all laws and rules governino the practice o nursin in Ohio. MS. ELOSHWAY shall corn I with all of the

3.

MS. ELOSHWAY shall appear in person for interviews before the full Board or its designated representative as requested by the Board or its designee. Prior to reinstatement, MS. ELOSHWAY shall enter into a Consent Agreement with the Board for probationary terms, conditions, and limitations determined by the Board fora minimum period of THREE (3) YEARS following reinstatement. . Within three (3) months prior to requesting reinstatement, MS. ELOSHWAY agrees that she will submit a request to the Bureau of Criminal Identification and Investigation (BCII) to conduct a criminal records check of MS. ELOSHWAY, including a check of Federal Bureau of investigation (FBI) records, and request Bell to submit MS. ELOSHWAY's criminal records check reports to the Board. MS. ELOSHWAY agrees that a request for reinstatement will not be considered by the Board until the completed criminal records check, including the FBI check, has been received by the Board. (

4.

S.

Amy C. EloshNvay, L P.N. Page 4 Monitoring of Rehabilitation and Treatment 6. MS, ELOSHWAY shall abstain completely from the personal use or possession of drugs, except those prescribed, administered, or dispensed to her by another so authorized by law who has full knowledge of MS. ELOSHWAY's history of chemical dependency and recovery status. MS. ELOSHWAY shall self-administer the prescribed drugs only in the manner prescribed. MS. ELOSHWAY shall abstain completely from the use of alcohol. Within six (6) months prior to requesting reinstatement, MS. ELOSHWAY shall, at her own expense, seek a chemical dependency evaluation by a Board approved chemical dependency professional and shall provide the Board with complete documentation of this evaluation. Prior to the evaluation, MS. ELOSHWAY shall provide the chemical dependency professional with a copy of this Consent Agreement with the March 2008 Notice. Further, MS. ELOSHWAY shall execute releases to permit the chemical dependency professional to obtain any information deemed appropriate and necessary for the evaluation. The chemical dependency professional shall submit a written opinion to the Board that includes diagnoses, recommendations for treatment And monitoring, and any information deemed appropriate and necessary for the evaluation: The chemical dependency professional shalt submit a written opinion to the Board that includes any additional restrictions to be placed on MS. ELOSHWAY's license to practice, and stating whether MS. ELOSHWAY is capable of practicing nursing according to acceptable and prevailing standards of safe nursing care. Prior to reinstatement, MS. ELOSHWAY shall provide the Board with satisfactory documentation of complience with All aspects of the treatment plan developed by the chemical dependency professional described above until released. Further, MS. ELOSHWAY agrees that the Board may utilize the professional's recommendations and conclusions from the evaluation as a basis for additional terms, conditions, and limitations on MS. ELOSHWAY's license and that the terms, conditions, and limitations shall be incorporated in an addendum to this Consent Agreement. For a minimum, continuous period of twelve (12) months immediately prior to requesting reinstatement, MS. ELOSHWAY shall submit, at her expense and on the day selected, blood or urine specimens for drug and/or alcohol analysis at a collection site specified by the Board at such times as the Board may request.. Upon and after MS. ELOSHWAY's initiation of drug screening, refusal to submit such specimen, or failure to submit such specimen on the day she is selected, or in such a manner as the Board may request, shall constitute a violation of a restriction placed on a license for purposes of Section 4723.28(B), ORC. This screening shall require a daily call-in process. The specimens submitted by MS. ELOSHWAY shall be negative, except for substances prescribed, administered, or dispensed to her by another so authorized by

7_ 8.

9.

10.

Amy C. Elositway, L.P.N. Page 5 law who has full knowledge of MS. ELOSHWAY's history of chemical dependency and recovery stoats. a. Within thirty (30) days prior to MS. ELOSTIWAY initiating drug screening, MS. ELOSHWAY shall provide a copy of this Consent Agreement and the March 2008 Notice to all treating practitioners and shall provide to the. Board a list of all treating practitioners, including addresses and telephone numbers and cause all treating practitioners to complete a medication prescription report that is to be mailed by the practitioner directly to the Board. The medication report is to be completed for any and all substances prescribed, administered, or dispensed to MS, ELOSHWAY. b. After initiating drug screening, MS. ELOSHWAY shall be under a continuing duty to provide a copy of this Consent Agreement and the March 2008 Notice, prior to initiating treatment, to additleonal treating practitioners, and to update the list of treating practitioners with the Board within forty-eight (48) hours of being treated by another practitioner, Further, MS. ELOSHWAY strati notify the Board of any and all medication(s) or prescription(s) received within twenty-four (24) hours of release from hospitalization or medical treatment. 11. For a minimum, continuous period of twelve (12) months immediately prior to requesting reinstatement, MS. ELOSHWAY shall attend a minimum of one (1) meeting per week of a support or peer group meeting approved in advance by the Board, or a Twelve Step program, and MS. ELOSHWAY shall provide satisfactory documentation of such attendance to the Board prior to reinstatement.

Comprehensive Physical Evaluation 12. Upon the request of the 13oard or its designee and prior to reinstatement, MS. ELOSHWAY shall, at her own expense, obtain a comprehensive physical examination by a Board approved physician for the purposes of evaluating MS. ELOSHWAY's fitness of duty and safety to practice nursing as a licensed practical nurse. This Board approved physician shall provide the Board with complete documentation of MS. ELOSHWAY's comprehensive physical examination and with a comprehensive assessment regarding MS. ELOSHWAY's fitness for duty and safety to practice nursing as a licensed practical nurse in the State of Ohio. Prior to the examination, MS. ELOSHWAY shall provide the Board approved physician with a copy of this Consent Agreement, end the March 2008 Notice, Further, MS. ELOSHWAY shall execute releases to permit the Board approved physician performing the comprehensive physical examination and assessment to obtain any information deemed appropriate and necessary for the assessment. This Board approved physician shall submit a written opinion to the Board that includes diagnoses, recommendations for treatment and monitoring, any additional restrictions that should be placed on MS. ELOSHWAY's license to practice, and stating whether 4

Amy C. Eloshway, L. P.N. Page 6 MS. ELOSHWAY is capable of practicing nursing according to acceptable and prevailing standards of safe nursing care. 13. rf requested by the Board or its designee, MS. ELOSHWAY agrees that the Board may utilize the Board approved physician's recommendations and concllisions from this comprehensive physician examination and assessment as a basis for additional terms, conditions, and limitations on MS. ELOSHWAY's license and that the terms, conditions, and limitations may be incorporated in an addendum to this Consent Agreement.

Reporting Requirements of Licensee 14, MS. ELOSHWAY shall report to the Board, in writing, any violation of this Consent Agreement within thirty (30) days'of the occurrence of the violation. MS. ELOSHWAY shall sign release of information forms allowing health professionals and other organizations to submit requested documentation or information directly to the Board, MS. ELOSHWAY shall submit any and all information that the Board may request regarding her ability to practice according to acceptable and prevailing standards of safe nursing practice.

15.

16.

17_

MS, ELOSHWAY shall not submit or cause to be submitted any false, misleading, or deceptive statements, information, or documentation to the Board or to employers or potential employers. MS. ELOSHWAY shall submit the reports and documentation required by this All reporting and Consent Agreement on forms specified by the Board. communications required by this Consent Agreement shall be made to the Compliance Unit of the Board.
MS. ELOSHWAY shall submit the reports and documentation required by this Consent Agreement to the attention of the Compliance Unit, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, OH 43215-7410. MS. ELOSHWAY shall verify that the reports and documentation required by this Consent Agreement are received in the Board office. MS. ELOSHWAY shall inform the Board within three (3) business days, in writing, of any change in address and/or telephone number.

18.

19.

20.

21.

it

Amy C. Eioshway, L.P.N. Pagel Refresher Course or Extensive Orientation MS. ELOSHWAY shall, prior to working in a position where a nursing license is required, complete and submit satisfactory documentation of completion of a nursing refresher course or an extensive orienta(ion to be approved in advance by the Board or its designee. PERMANENT NARCOTIC RESTRICTION MS. ELOSHWAY further knowingly and voluntarily agrees with the Board to the following PERMANENT LICENSURE RESTRICTIONS; Unless otherwise approved in advance by the Board or its designee, MS. ELOSHWAY shall not administer, have access to, or possess (except as prescribed for MS. ELOSHWAY's use by another so authorized by law who has full knowledge of MS. ELOSHWAY's history of chemical dependency and recovery status) any narcotics, other controlled substances, or mood altering drugs. In addition, MS. ELOSHWAY shall not count narcotics or possess or carry any work keys for locked medication carts, cabinets, drawers, or containers. MS. ELOSHWAY shall not call in or order prescriptions or prescription refills for narcotics, other controlled substances, or mood altering drugs. PERMANENT PRACTICE RESTRICTIONS MS. ELOSHWAY further knowingly and voluntarily agrees with the Board to the following PERMANENT LICENSURE RESTRICTIONS: Unless otherwise approved In advance by the Board or its designee, MS. ELOSHWAY shall not practice nursing as a licensed practical nurse (1) for agencies providing home care in the patient's residence; (2) for hospice care programs providing hospice care in the patient's residence; (3) for staffing agencies or pools; (4) as an Independent provider where the nurse provides nursing care and is reimbursed for services by the State of Ohio through State agencies or agents of the State; or (5) for an individual or group of individuals who directly engage MS. ELOSHWAY to provide nursing services for fees, compensation, or other consideration or as a volunteer'. Unless otherwise approved in advance by the Board or its designee, MS. ELOSHWAY shall not function in a position or employment where the job duties or requirements involve management of nursing and nursing responsibilities, or supervising and evaluating nursing practice. Such positions include, but arc not limited to, the following; Director of Nursing, Assistant Director of Nursing, Nurse Manager, andtor V ice President of Nursing.

Amy C. Eloshway, Page 8

FAILURE TO COMPLY
The above described terms and conditions shall constitute "restrictions placed on a license" for purposes of Section 4723.28(B), ORC. If, in the discretion of the Board, MS. ELOSHWAY appears to have violated or breached any terms or conditions of this Consent Agreement, Hire Board reserves the right to institute formal disciplinary proceedings for any rind all possible violations or breaches, Including, but not limited to, alleged violations of the laws of Ohio occurring before the effective date of this Consent Agreement.

OUR ATM /VIODWICATION OF TERM

The terms, limitations, and conditions of this Consent Agreement, other then the pormnnent lieensore restrictions, may be modified or terminated, in writing, at any time upon agreement of both MS, ELOSHWAY and the Board. The Board may only alter the indefinite suspension imposed if: (1) MS. ELOSHWAY submits a written request for reinstatement; (2) the Board determines that MS. ELOSHWAY has complied with all conditions of reinstatement; (.3) the Board determines that MS. ELOSHWAY is able to practice according to acceptable and prevailing standards of safe nursing care based upon an Interview with MS. ELOSHWAY and review of the documentation specified in this Consent Agreement; and (4) MS. ELOSHWAY has entered into a Consent Agreement with the Board for probationary terms, conditions, and limitations determined by the Board for a minimum period of THREE (3) YEARS following reinstatement.

LOCNOWLEDGMENTS/LIABILITY RELEASE MS. ELOSHWAY acknowledges that she has had an opportunity to ask questions concerning
the terms of this Consent Agreement and that all questions asked have been answered in a satisfactory manner_ MS. ELOSHWAY waives all of her rights under Chapter 119, ORC, as they relate to matters that are the subject of this Consent Agreement. MS. ELOSHWAY waives any and all claims or causes of action she may have against the Board, and its members, officers, employees and/or agents arising out of matters that are the subject of this Consent Agreement. This Consent Agreement is not an adjudication order as dismissed in Chapter 119, ORC. Any action initiated by the Board based on alleged violations of this Consent Agreement shall comply with the Administrative Procedures Act, Chapter 119, CRC, This Consent Agreement shall be considered a public record as that term is used in Section 149.43, ORC. The information contained herein may be reported to appropriate organizations, data banks. and governmental bodies,

Amy C. Bloshway, Page 9

BiencrivE DATE
MS. ELOSHWAY understands that this Consent Agreement is subject to ratification by the Board prior to signature by the Board President and shall become effective upon the last date of signature below,

1N.

. a EY--4-405,

3
DATE

AMY C. iLOSHWAY,

3- 3'O/
JAYE SCHLACHET Counsel for Amy C. Eloshway, LPN DATE

fai
LISA KLENEE, PreSident Ohio Board of Nursing

3.@b.or-1
DATE

Case i/06-2Q03

Ohio. Board of Nursing

www.nursing.ohio.gov

17 South High Street, Suite 400 4 Columbus, Ohio 43215-7410 {6141466.3947

March 14, 2008

NOTICE OF IMMEDIATE SUSPENSION AND OPPORTUNITY FOR. HEARING

Amy C. Eloshway, L.P.N. 1600 Westwood Drive Twinsburg, Ohio 44087 and 119 Downing Drive Apt. 207 Cleveland, Ohio 44124 Dear Ms. Bloshway: In accordance with Section 2929.42 and/or 3719.12 of the Ohio Revised Code (ORC), the Ohio Board of Nursing (Board) has been notified that on or about

Section 3719.121 (C), ORC, states in pertinent part as follows: On receiving notification pursuant to Section 292942 or 3719,12 of the Revised Code, the board under which a person has been issued a license, certificate or evidence of registration immediately shall suspend the license, certificate, or registration of that person on a plea of guilty to a finding by a jury or court of the person's guilt of, or conviction of, a felony drug abuse offense, a finding by a court of the person's eligibility for intervention in lieu of conviction, a plea of guilty to, or a finding by a jury or court of the person's guilt of, or the person's conviction of an offense in another jurisdiction that is essentially the same as a felony drug abuse offense, or finding by a court of the person's eligibility for treatment or intervention in lieu of conviction in another jurisdiction.

Amy C, Eloshway, L.P.N. Page 2

WHEREFORE, PURSUANT TO SECTION 3719.121(C), ORC, YOU ARE HEREBY NOTIFIED THAT YOUR LICENSE TO PRACTICE NURSING AS A LICENSED PRACTICAL NURSE IS HEREBY SUSPENDED, Continued practice after receipt of this notice of suspension shall be considered engaging in the practice of nursing without a current, valid license, which is a violation of Section 4723.03(B), ORC. You are hereby ordered to surrender your Ohio license to practice nursing as a licensed practical nurse P.N. #113135, to the Board within ten (10) days of receipt of this notice. You are further notified that in accordance with Chapter 119, ORC, the Board proposes under authority of Section 4723.28, ORC, to deny, revoke, permanently revoke, suspend or place restrictions on your license to practice nursing as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons:

1.

Section 4723.28(B)(4), ORC, authorizes the Board to discipline a licensee who has been convicted of, pled guilty to, a judicial finding of guilt of, a judicial finding of guilt resulting from a plea of no contest to, or a judicial finding of eligibility for Intervention in Lieu of Conviction for any felony. Section 4723.28(B)(5), ORC, authorizes the Board to discipline a licensee who has been convicted of, pled guilty to, a judicial finding of guilt of, a judicial finding of guilt resulting from a plea of no contest to, or a judicial finding of eligibility for Intervention in Lieu of Conviction for violating any municipal, state, county or federal drug law. 2. On or about August 29, 2006, you provided a written statement to the Board indicating that while employed as a licensed practical nurse at Walton Manor Health Care Center, Walton Hilts, Ohio, you became dependent on pain medications. You stated that in March 2006, you began to "self-medicate" by using patients' narcotic medications. You stated that you initially used one (1) Tylenol 1/3 per shift, but by the end of your employment, you stated: "I medicated my residents when they had pain, but documented on the narc count coeds I had taken for personal use. I was taking Some were documented on the MAR, some were not . approximately 6 pain pills/shift. These included Vicodin, percocet, and Tyl, #3. Patients included IVO, RE, WK, L13" [see Attached Patient Key to Remain Confidential and Not iSubject to Public Disclosure]. During an

Amy C. Elosliway, Page 3 interview with a Board investigator, you further stated that you administered Tylenol to a patient instead of administering ordered pain medication, and that you self-administered drugs while working. You reviewed with the Board investigator medical records from in or about June 14, 2006 to July 26, 2006, for Patients #1 4, and admitted to documenting the removal of pain medications for the patients, when you actually self-administered the pain medication. Section 4723.28(B)(8), ORC, authorizes the Board to discipline a licensee for self-administering or otherwise taking into the body any dangerous drug, as defined in Section 4729.01, ORC.; in any way not in accordance with a legal, valid prescription issued for that individual. Section 4723.28(B)(9), ORC, authorizes the Board to discipline a licensee for habitual indulgence, in the use of controlled substances, other habit-fonning drugs, or alcohol or other chemical substances to an extent that impairs ability to practice. Section 4723.28(B)(13), ORC, authorizes the Board to discipline a licensee for obtaining or attempting to obtain money or anything of value by intentional misrepresentation or material deception in the course of practice. Section 4723.28(B)(19), ORC, authorizes the Board to discipline a licensee for failure to practice in accordance with acceptable and prevailing standards of safe nursing care. Section 4723,28(B)(16), ORC, authorizes the Board to discipline a licensee for violation of Chapter 4723, ORC, or any rules adopted under it, Specifically, Ohio Administrative Code (OAC), Rule 4723-4-06(0), states that a licensed nurse shall not falsify any client record or any other document prepared or utilized in the course of, or in conjunction with, nursing practice. This includes, but is not limited to, case management documents or reports or time records, reports, and other documents related to billing for nursing services. Rule 4723.4-06(H), OAC, states that a licensed nurse shall implement measures to promote a safe environment for each client. Accordingly, the Board is authorized to impose one or more of the sanctions as cited in Section 4723,2g, ORC, In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing on this matter. If you wish to request such hearing, the request must be made in writing and must be received in the Board office within thirty (30) days of the time of mailing this notice. As required by Section 3719.121(C), ORC, the suspension ordered herein shall remain in effect until this hearing is held. You are hereby further informed that if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present you position, argument, or contentions In writing. At the hearing you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter to: Lisa Ferguson-Ramos, Compliance Unit Manager, 17 South High Street, Suitt 400, Columbus, OH 43215-7410.

Amy C. Eloshway, Page 4 if the Board falls to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in the Notice of Immediate Suspension and Opportunity for Hearing, deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a licensed practical nurse; reprimand or otherwise discipline yout or impose a fine of not more than five hundred dollars 0500.00) per violation. Sincerely,

46. d

iaad4e4x,

Debra A. Broadnax, RN, MSN, CNS Supervising Board Member Address #1 Certified Mail Receipt No. 7007 3020 0000 7377 5109 Address #2 Certified Mail Receipt No. 7007 3020 0000 7377 5116 Attorney Certified Mail Receipt No, cc; 7007 3020 0000 7377 5123

Leah O'Carroll, Assistant Attorney General Forrest A. Norman, Esq.

Case # 12-001340

Ohio Board of Nursing

wwwmursing.ohio.gov

17 South High Street, Suite 400 - Columbus, Ohio 43215-741.0 -4, (614) 466-3947

March 22, 2013

NOTICE OF OPPORTUNI]Y FOR HEARING

Dawn Fischer, L.P.N. 541 West Wayne Street Apartment 3 Lima, Ohio 45801 Dear Ms. Fischer: In accordance with Chapter 119, Ohio Revised Code (ORC), you are hereby notified that the Ohio Board of Nursing (Board) proposes under authority of Section 4723.28 ORC, to deny, revoke, permanently revoke, suspend or place restrictions on your license to practice nursing as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: 1. On or about February 13, 2012, in Lima Municipal Court, Lima, Allen County, Ohio, Case Number 2011CRB03360, you were found guilty of one (1) count of Illegal Use or Possession of Drug Paraphernalia, a misdemeanor of the fourth degree, in violation of Section 2925.14(C)(1), ORC. The acts underlying your conviction occurred on or about December 11, 2011, in Lima, Ohio, and involve you possessing and/or using drug paraphernalia. Section 4723.28(B)(5), ORC [as in effect prior to March 20, 20131 authorizes the Board to discipline a licensee for conviction of, a plea of guilty to, a judicial finding of guilt of, a judicial finding of guilt resulting from a plea of no contest to, or a judicial finding of eligibility for intervention in lieu of conviction for, violating any municipal, state, county, or federal drug law. Accordingly, the Board is authorized to impose one or more of the sanctions cited in Section 4723.28, ORC. In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing in this matter. If you wish to request such hearing, the requist must be made in writing and must be received in the Board office within thirty (30) days of the time of mailing of this notice. You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in writing. At the hearing, you may also present evidence and examine witnesses appearing-for and against you.

Dawn Fischer, L.P.N. Page 2

Should you choose to request a hearing, please mail or deliver the request, in addition tdir any other correspondence regarding this matter, to Lisa Ferguson-Ramos, Compliance Unit Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, Ohio 432157410 or to the email address, hearingriursin.0, - .ohio,g_g_v. If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Opportunity for Hearing, deny, revoke, permanently revoke, suspend, or place restrictions on your license to practice nursing as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely,

Rhonda S. Barkheimer, C.N.P. Supervising Board Member Certified Mail Receipt No. 7012 2210 0000 6272 3421 cc: Henry G. Appel, Senior Assistant Attorney General

Case #11-003030 & 12-003271

Otio.Board of IS utsing
March 22, 2013

www.nursing.ohio.gov

17 South High Street, Suite 400 .0 Columbus, Ohio 43215-7410 6 (61.4) 466-3947

NOTICE OF OPPORTUNITY FOR HEARING

Stephanie L. Frazier 4360 Magnolia Drive Perry, Ohio 44081 Dear Ms. Frazier: On or about February 4, 2013, the Ohio Board of Nursing (Board) issued to you a Notice of Immediate Suspension and Opportunity for Hearing, a copy of which is attached hereto and incorporated herein. You are notified that in accordance with Chapter 119, ORC, the Board proposes under authority of Section 4723.28 of the Ohio Revised Code, ORC, to deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: 1. On or about January 2, 2013, in Lake County Court of Common Pleas. Case Number 12-CR-000422, you pled guilty to two (2) counts of Aggravated Possession of Drugs, felonies of the fifth degree, in violation of Section 2925.11, ORC, and were found eligible for Intervention in Lieu of Conviction. The acts underlying this case occurred on or about June 7, 2012, and involve you obtaining, possessing, or using Methadone and Oxycodone. Section 4723 .28(B)(4) [as in effect prior to March 20, 2013], ORC, authorizes the Board to discipline a licensee for conviction of, a plea of guilty to, a judicial finding of guilt of, a judicial finding of guilt resulting from a plea of no contest to, or a judicial finding of eligibility for intervention in lieu of conviction for, any felony. Section 4723.28(B)(5) [as in effect prior to March 20, 2013] , ORC, authorizes the Board to discipline a licensee for conviction of, a plea of guilty to, a judicial finding of guilt of, a judicial finding of guilt resulting from a plea of no contest to, or a judicial finding of eligibility for intervention in lieu of conviction for, violating any municipal, state, county, or federal drug law. 2. In or about December, 2010, while working for Maxim Healthcare Services as home care nurse, you were assigned to care for two pediatric patients [see attached Patient Key - to remain Confidential and not subject to public disclosure]. You were photographed by

Stephanie L. Frazier Page 2

another nurse in a chair, covered by a large blanket, with 3/1:1$u eyes shut, while on duty. Section 4723 .28(B)(16), ORC, authorizes the Board to discipline a licensee for violation of Chapter 4723, ORC, or any rules adopted under it. Specifically, Ohio Administrative Code (OAC), Rule 4723-4-06(H), states that a licensed nurse shall implement measures to promote a safe environment for each client. Accordingly,, the Board is authorized to impose one or more of the sanctions as cited in Section 4723.28, ORC. In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing in this matter. If you wish to request such hearing, the request must be made in writing and must be received in the Board office within thirty (30) days of the time of mailing of this notice. You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in writing. At the hearing you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to: Lisa Ferguson-Ramos, Compliance Unit Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus OH 43215-7410, or to the email address, hearin. 1 nursing.ohio.gov. If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Opportunity for Hearing, deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a licensed practical nurse;' reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely, X.A/ Rhonda S. Barkheimer, R.N., C.N.P. Supervising Board Member Certified Mail Receipt No. 7012 2210 0000 6272 3858 c Henry G. Appel, Senior Assistant Attorney General

Case #11-003030 & 12-003271

Ohio Board of Nursing

17 South High Street, Suite 400 February 4, 2013

www.nursing.ohio. gay
(614) 466-3947

Columbus, Ohio 43215-7410

NOTICE OF IMMEDIATE SUSPENSION AND OPPORTUNITY FOR HEARING

Stephanie L. Frazier, L.P.N. 4360 Magnolia Drive Perry, Ohio /14081 Dear Ms. Frazier: In accordance with Sections 2929.42 and/or 3719.12 of the Ohio Revised Code (ORC), the Ohio Board of Nursing (Board) has been notified that, on or about January 2, 2013, in Lake County Court of Common Pleas Case Number 12-CR-000422, you pled guilty to two (2) counts of Aggravated Possession of Drugs, felonies of the fifth degree, in violation of Section 2925.11, ORC, and were found eligible for Intervention in Lieu of Conviction. Section 3719.121(C), ORC, states in pertinent part as follows: On receiving notification pursuant to Section 2929.42 or 3719.12 of the Revised Code, the board under which a person has been issued a license, certificate or evidence of registration immediately shall suspend the license, certificate, or registration of that person on a plea of guilty to, a finding by a jury or court of the person's guilt of, or conviction of a felony drug abuse offense; a finding by a court of the person's eligibility for intervention in lieu of conviction; a plea of guilty to, or a finding by a jury or court of the person's guilt of, or the person's conviction of an offense in another jurisdiction that is essentially the same as a felony drug abuse offense; or a finding by a court of the person's eligibility for treatment or intervention in lieu of conviction in another jurisdiction. Aggravated Possession of Drugs, felonies of the fifth degree, in violation of Section 2925.11, ORC, constitute "felony drug abuse offenses" as defined in Section 2925.01, ORC. WHEREFORE, PURSUANT TO SECTION 3719.121(C), ORC, YOU ARE HEREBY NOTIFIED THAT YOUR LICENSE TO PRACTICE NURSING AS A LICENSED PRACTICAL NURSE, PN-125282, IS HEREBY SUSPENDED. Continued practice after receipt of this notice of suspension shall be considered engaging in the practice of nursing without a current, valid license, which is a violation of Section 4723.03(B), ORC. In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing in this matter. If you wish to request such hearing, the request must be made in

Stephanie L. Frazier, L.P.N. Page 2 writing and must be received in the Board office within thirty (30) days of the time of mailing of this notice. As required by section 3719.121(C); ORC, the suspension ordered herein shall remain in effect until this hearing is held. You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in writing. At the hearing you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to: Lisa Ferguson-Ramos, Compliance Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, Ohio 43215-7410, or to the e-mail address, hearing@waring,phin,gpy. If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Immediate Suspension and Opportunity for Hearing, deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely,

Rhonda S. Barkheimer, RN., C.N.P. Supervising Board Member

Certified Mail Receipt No. 7012 2210 0000 6272 1489

cc:

Henry G. Appel, Senior Assistant Attorney General

Case #13-000093

Ohio Board of Nursing

www.ruirsing.ohlo.gov 17 South High Street, Suite 400 t, Columbus,- Ohio 43215-7410 6 (614) 466-3947

March 22, 2013

NOTICE OF OPPORTUNITY FOR HEARING

Kimberly Anne Fryer 6419 Tantamount Lane Dayton, Ohio 45419 Dear Ms. Fryer: In accordance with Chapter 119, Ohio Revised Code (ORC), you are hereby notified that the Ohio Board of Nursing (Board) proposes under authority of Section 4723.28, ORC, to deny or permanently deny reinstatement of your license to practice nursing as a registered nurse; permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: Effective January 16, 2009, you entered into a Consent Agreement (January 2009 Consent Agreement) with the Ohio Board of Nursing (Board), a copy of which is attached hereto and incorporated herein, in which you agreed with the Board that your license to practice nursing as a registered nurse in the State of Ohio would be suspended indefinitely, but for a period of not less than two years from September 19, 2008, with conditions for reinstatement. Attached to and incorporated within the January 2009 Consent Agreement is a September 19, 2008 Notice of Automatic Suspension and Opportunity for Hearing, a January 19, 2007 Consent Agreement, a January 21; 2005 Consent Agreement and a July 16, 2004 Notice of Immediate Suspension and Opportunity for Hearing. On December 12, 2012, you provided a specimen for analysis to Firstiab, the Board's random drug/alcohol screen program administrator, that tested positive for Oxymorphone. You did not have a valid, legal prescription for Oxymorphone. In a written statement to the Board submitted January 17, 2013, you indicate that: "I know it was wrong, but I took medication not prescribed to me for an illness early December." Section 4723.28 (B)(8), ORC, authorizes the Board to discipline a licensee for self-administering or otherwise taking into the body any dangerous drug, as defined in Section 4729.01, ORC, in any way not in accordance with a legal, valid prescription issued for that individual, or selfadministering or otherwise taking into the body any drug that is a schedule I controlled substance.

Kimberly Anne Fryer Page 2 Accordingly, the Board is authorized to impose one or more of the sanctions cited in Section 4723.28, ORC.. In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing in this matter. If you wish to request such hearing, the request must be made in writing and must be receivediin the Board office within thirty (30) days of the time of mailing of this notice. You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in writing. At the hearing, you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to Lisa Ferguson-Ramos, Compliance Unit Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, Ohio 432157410 or to the email address, hearino@nursina.ohio.gov. If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Opportunity for Hearing, deny or permanently deny reinstatement of your license to practice nursing as a registered nurse; permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely, A7 Rhonda S. Barkheimer, R.N., C.N.P. Supervising Board Member Certified Mail Receipt No. 7012 2210 0000 6272 3612 cc: Henry G. Appel, Senior Assistant Attorney General

Case /I 08-0912; 07-3496

Ohio Board of Nursing

www,nursing.ohio.gov
(614) 466-3947

17 South High Street, Suite 400 0 Columbus. Ohio 43215-7410

CONSENT AGREEMENT BETWEEN KIMBERLY A. FRYER, R.N. AND OHIO BOARD OF NURSING
This Consent Agreement is entered into by and between KIMBERLY A. FRYER, R.N. (MS. FRYER) and the Ohio Board of Nursing (Board), the state agency charged with enforcing Chapter 4723. of the Ohio Revised Code (ORC), and all administrative rides promulgated thereunder. MS. FRYER voluntarily enters into this Consent Agreement being fully informed of her rights under Chapter 119, ORC, including the tight to representation by legal counsel and the right to a formal adjudicative hearing on the issues considered herein. This Consent Agreement contains the entire agreement between the parties, there being no other agreement of any kind, verbal or otherwise, which varies the terms of this Consent Agreement.

BASISTOR ACTION
This Consent Agreement is entered into on the basis of the following stipulations, admissions and understandings; A. The Board is empowered by Section 4723 28, ORC, to deny, permanently revoke, revoke, suspend, or place restrictions on any license issued by the Board; reprimand or otherwise discipline a licensee; or impose a fine of five hundred dollars ($500.00) or less per violation. Section 4723.28(B)(8), ORC, authorizes the Board to discipline a licensee for self-administering or otherwise taking into the body any dangerous drug, as defined in Section 4729.01, ORC, in any way not in accordance with a legal, valid prescription issued for that individual. Section 4723.28(B)(17), Ohio Revised Code, ORC, authorizes the Board to discipline a licensee for violation of any restrictions placed on a nursing license by the Board. Section 4723.28(B)(31), ORC, authorizes the Board to discipline a licensee for failure to establish and maintain professional boundaries with a patient, as specified in rules adopted under section 4723.07, ORC. Section 4723.28(B)(16), ORC, authorizes the Board to discipline a licensee for violation of Chapter 4723, ORC, or any rules adopted under it. Specifically, Ohio Administrative Code (OAC), Rule 4723-4-06(M), Ohio Administrative Code, states that a licensed nurse shall not; (1) Engage in sexual conduct with a client; (2) Engage in conduct in the course of practice that may reasonably be interpreted as sexual; (3) Engage in anr-vetbal behavior that is seductive or sexually demeaning to a client; or (4) Engage in verbal behavior that may reasonably be interpreted as seductive, or sexually demeaning to a client. For, the

Kimberly A. Fryer, R.N Page 2 purpose of this paragraph, the client is always presumed incapable .of giving free, or informed consent to sexual activity with the nurse. Rule 4723-4-06(L), OAC, states that a licensed nurse shall not misappropriate a client's property or: (3) Engage in behavior that constitutes inappropriate involvement in the client's personal relationships; or (4) Engage in behavior that may reasonably be interpreted as inappropriate involvement in the client's personal relationships. For the purpose of this paragraph, the client is always presumed incapable of giving free, full, or informed consent to the behaviors by the nurse set forth in this paragraph, Section 4723,28(8)(17), ORC, authorizes the Board to discipline a licensed for violation of any restrictions placed on a nursing license by the Board. .

S. FRYER's license to practice nursing as a registered nurse in the State of Ohio, RN-228090, was initially issued on September 7, 1990, MS. FRYER has two prior Consent Agreements with the Board. On January 21, 2005, MS. FRYER entered into a suspension consent agreement with the Board (January 2005 Consent Agreement). MS. FRYER entered into a reinstatement Consent Agreement with the Board on January 10, 2007 (January 2007 Consent Agreement). Copies of the January 2005 Consent Agreement and the January 2007 Consent Agreement are attached hereto and incorporated herein.
On September 19, 2008, the Board issued a Notice of Automatic Suspension and Opportunity of Hearing (September 2008 Notice) against MS. FRYER's license. A copy of the SepteMber 2008 Notice is attached hereto and incorporated herein. MS. FRYER knowingly and voluntarily admits to the factual and legal allegations set forth in the September 2008 Notice. In response to the factual and legal allegations set forth in September 2008 Notice, MS. FRYER indicates that she was unable to comply with the financial restraints of her drug screens. MS. FRYER also indicates that she is seeking additional treatment for her chemical dependency. AGREED CONDITIONS

C.

D.

Wherefore, in consideration of the foregoing and mutual promises hereinafter set forth, and in lieu of any formal proceedings at this time, MS. FRYER knowingly and voluntarily agrees with the Board to the following terms, conditions, and limitations: SUSPENSION OF LICENSE MS. FRYER'S license to practice nursing as a registered nurse is hereby suspended for an indefinite period of time, but not less than TWO (2) years from the date of the September 2008 Notice. MS. FRYER may submit a written request for reinstatement -any time after September 2010 as long as the conditions for reinstatement herein have been met.

Kimberly A Fryer, R.N. Page 3 CONDITIONS FOR REINSTATEMENT 2. MS. FRYER shall obey all federal, state, and local laws, and all laws and rules governing the practice of nursing in Ohio. MS. FRYER shall appear in person for interviews before the full Board or its designated representative as requested by the Board or its designee. Within six (6) months prior to requesting reinstatement, MS. FRYER agrees that she. will submit a request to the Bureau of Criminal Identification and investigation (BCII) to conduct a criminal records check of MS. FRYER, including a check of Federal Bureau of Investigation (FBI) records, and request BCII to submit MS. FRYER's criminal records check reports to the Board. MS. FRYER agrees that a request for reinstatement will not be considered by the Board until the completed criminal records check, including the FBI check, has been received by the Board. Within six (6) months prior to requesting reinstatement and in addition to requirements for licensure renewal, MS. FRYER shall complete and submit satisfactory documentation of her successfully completing fifteen (15) hours of continuing education on Patient Boundaries and ten (10) hours of Patient Safety. Prior to reinstatement, MS. FRYER shall enter into a Consent Agreement with the Board for probationary terms, conditions, and limitations determined by the Board for a minimum period of THREE (3) YEARS following reinstatement.

3.

4.

5.

6.

Evaluation and Treatment 7. Within three (3) months prior to requesting reinstatement, MS. FRYER shall, at her own expense, obtain a psychiatric evaluation by a Board approved psychiatrist, and shall provide the Board with complete documentation of this evaluation. Prior to the evaluation, MS. FRYER shall provide the psychiatrist with a copy of this Consent Agreement, the September 2008 Notice, the January 2007 Consent Agreement, and the January 2005 Consent Agreement. Further, MS. FRYER shall execute releases to permit the psychiatrist to obtain any information deemed appropriate and necessary for the evaluation. The psychiatrist shall submit a written opinion to the. Board that includes diagnoses, recommendations for treatment and monitoring, any additional restrictions to be placed on MS. FRYER's license to practice, and stating whether MS. FRYER is capable of practicing nursing according to acceptable and prevailing standards of safe nursing care. MS. FRYER shall provide the Board with satisfactory documentation of compliance with all aspects of the treatment plan developed by the Board approved psychiatrist, until released. Further, MS. FRYER agrees that the Board may utilize her psychiatrist's recommendations and conclusions as a basis for additional terms, conditions, and limitations on MS. FRYER's license and that the terms, conditions, and limitations may be incorporated in an addendum to this ConSent Agreement.

8.

Kimberly A. Fryer, R.N Page 4 Monitoring and Treatment 9. MS. FRYER shall abstain completely from the personal use or possession of drugs, except those prescribed, administered, or dispensed to her by another so authorized by law who has full knowledge of MS. FRYER's history of chemical use and recovery status. MS. FRYER shall self-administer prescribed drugs only in the manner ( prescribed. MS. FRYER shall abstain completely from the use of alcohol. For a minimum of six (6) continuous months immediately prior to requesting reinstatement, MS. FRYER shall submit, at her expense and on the day selected, blood or urine specimens for drug and/or alcohol analysis at a collection site specified by the Board at such times as the Board may request. Refusal to submit such specimen, or failure to submit such specimen on the day she is selected, or in such a manner as the Board may request, shall constitute a violation of a restriction placed on a license for purposes of Section 4723.28(B), ORC. This screening shall require a daily call-in process. The specimens submitted by MS. FRYER shall be negative, except for substances prescribed, administered, or dispensed to her by another so authorized by law who has full knowledge of MS. FRYER's history of chemical use and recovery status. 12. Within three (3) months immediately prior to requesting reinstatement, MS. FRYER shall, at her own expense, obtain a chemical dependency evaluation by a Board approved chemical dependency professional, and shall provide the Board with complete documentation of this evaluation, Prior to the evaluation, MS. FRYER shall provide the chemical dependency professional with a copy of this Consent Agreement, the January 2008 Notice, the January 2007 Consent Agreement, and the January 2005 Consent Agreement. Further, MS. FRYER shall execute releases to permit the chemical dependency professional to obtain any information deemed appropriate and necessary for the evaluation. The chemical dependency professional shall submit a written opinion to the Board that includes diagnoses, recommendations for treatment and monitoring, any additional restrictions to be placed on MS. FRYER's license to practice, and stating whether MS. FRYER is capable of practicing nursing according to acceptable and prevailing standards of safe nursing care. MS, FRYER shall provide the Board with satisfactory documentation of compliance with all aspects of the treatment plan developed by the Board approved chemical dependency professional, until released. Further, MS. FRYER agrees that' the Board may utilize her treatment provider's recommendations and conclusions as a basis for additional terms, conditions, and limitations on MS. FRYER's license and that the terms, conditions, and limitations may be incorporated in an addendum to this Consent Agreement

10.

13.

Kimberly A. Fryer, R.N. Page 5 Treating Practitioners and Reporting 14. Within thirty (30) days of the execution of this Consent Agreement, MS. FRYER shall provide a copy of this Consent Agreement, the September 2008 Notice, the January 2007 Consent Agreement, the January 2005 Consent Agreement to all treating practitioners and shall provide to the Board a list of all treating practitioners, including addr6sses and telephone numbers, Further, MS., FRYER shall be under a continuing duty to provide a copy of this Consent Agreement with its attachments, prior to initiating treatment, to additional treating practitioners, and to update the list of treating practitioners with the. Board within forty-eight (48) hours of being treated by another practitioner. MS. FRYER shall cause all treating practitioners to complete a medication preScription report that is to be mailed by the practitioner directly to the Board. The medication report is to be completed for any and all substances prescribed, administered, or dispensed to MS. FRYER throughout the duration of this Consent Agreement, 16. Within twenty-four (24) hours of release from hospitalization or medical treatment, MS. FRYER shall notify the Board of. any and all medication(s) or prescription(s) received

Reporting Requirements of Licensee 17, MS. FRYER shall report to the Board, in writing, any, violation of this Consent Agreement within thirty (30) days of the occurrence of the violation. MS. FRYER shall sign release of information forms allowing health professionals and other organizations to submit requested documentation or information directly to the Board. MS. FRYER shall submit any and all information that the Board may request regarding her ability to practice according to acceptable and prevailing standards of safe nursing practice. MS. FRYER shall not submit or cause to be submitted any false, misleading, or deceptive statements, information, or documentation to the Board or to employers or potential employers MS. FRYER shall submit the reports and documentation required by this Consent Agreement on forms specified by the Board. Ail reporting and communications required by this Consent Agreement shall be made to the Compliance Unit of the Board.
??,

18..

19.

MS. FRYER shall submit the reports and documentation required by this Consent Agreement to the attention of Compliance Unit, Ohio Board of Nursing, 17 South High Street, tune 400, Columbus, OH 43215-7410

Kimberly A. Fryer, RN Page 6

23.

MS. FRYER shall verify that the reports and documentation required by this Consent Agreement are received in the Board office, MS. FRYER shall inform the Board within five (5) business days, in writing, of any change in address and/or telephone number.

24

Nursing Refresher Course or Orientation MS, FRYER shall, prior to working in a position where a nursing license is required; complete and submit satisfactory documentation of completion of a nursing refresher course or an extensive orientation approved in advance by the Board or its designee. PERMANENT PRACTICE RESTRICTIONS MS. FRYER further knowingly and voluntarily agrees with the Board to the following PERMANENT LICENSURE RESTRICTIONS: Unless otherwise approved in advance by the Board or its designee, MS. FRYER shall not practice nursing as a registered nurse (i) for agencies providing home care in the patient's residence; (2) for hospice care programs providing hospice care in the patient's tesidence; (3) for staffing agencies or pools; (4) as an independent provider where the nurse provides nursing care and is reimbursed for services by the State of Ohio through State agencies or agents of the State; or (5) for an individual or group of individuals who directly engage MS. FRYER to provide nursing services for fees, compensation, or other consideration or as a volunteer. Unless otherwise approved in advance by the Board or its designee, MS. FRYER shall not function in a position or employment where the job duties or requirements involve management of nursing and nursing responsibilities, or supervising and evaluating nursing practice. Such positions include, but are not limited to, the following: Director of Nursing, Assistant Director of Nursing, Nurse Manager, and/or Vice President of Nursing. Tern orar Narcotic Restriction MS. FRYER shall not administer, have access to, or possess (except as prescribed for MS. FRYER's use by another so authorized by law who has full knowledge of MS. FRYER's history of chemical dependency and recovery status) any narcotics, other controlled substances, or mood altering drugs for a minimum of six (6) months in which MS. FRYER is working in a positiOn that requires a nursing license. At any time after the six (6) month period previously described, MS. FRYER may submit a written, request to the Board to have this restriction re-evaluated. In addition, MS. FRYER shall not possess or carry any work keys for locked medication carts, cabinets, drawers, or containers. MS. FRYER shall not count narcotics. MS, FRYER shall not call in or order prescriptions or prescription refills for narcotics, other controlled substances, or mood altering drugs.

Kimberly A. Fryer, R.N Page 7 FAILURE TO COMPLY The above described terms and conditions shall constitute "restrictions placed on a license" for purposes of Section 472328(8), ORC. lf, in the discretion of the Board, MS. FRYER appears to have violated or breached any terms or conditions of this Consent Agreement, the Board reserves the right to institute formal disciplinary proceedings for any and all possible violations or breaches, including, bk not limited to, alleged violations of the laws of Ohio occurring before the effective date of this Consent Agreement DURATION / MODIFICATION OF TERMS The terms, limitations, and conditions of this Consent Agreement, other than the permanent restrictions, may be modified or terminated, in writing, at any time upon agreement of both MS. FRYER and the Board. The Board may only alter the indefinite suspension imposed if: (1) MS, FRYER submits a written request for reinstatement; (2) the Board determines that MS, FRYER has complied with all conditions of reinstatement; (3) the Board determines that MS. FRYER is able to practice according to acceptable and prevailing standards of safe nursing care based upon an interview with MS. FRYER and review of the documentation specified in this Consent Agreement; and (4) MS. FRYER has entered into a Consent Agreement with the Board for probationary terms, conditions, and limitations determined by the Board for a minimum period of TFIREE (3) YEARS following reinstatement. ACKNOWLEDGMENTS/LIABILITY RELEASE MS. FRYER acknowledges that she has had an opportunity to ask questions concerning the terms of this Consent Agreement and that all questions asked have been answered in a satisfactory manner. MS. FRYER waives all of her rights under Chapter 119, ORC, as they relate to matters that are the subject of this Consent Agreement. MS. FRYER waives any and all claims or causes of action she may have against the Board, and its members, officers, employees and/or agents- arising out of matters that are the subject of this Consent Agreement This Consent Agreement is not an adjudication order as discussed in Chapter 119, ORC. Any action initiated by the Board based on alleged violations of this Consent Agreement shall comply with the Administrative Procedures Act, Chapter 119, ORC. This Consent Agreement shall be considered a public record as that term is used in Section 149,43, ORC. The information contained herein may be reported to appropriate organizations, data banks and governmental bodies.

Kimberly A. Fryer, R.N. Page 8 EFFECTIVE DATE MS. FRYER understands that this Consent Agreement is subject to ratification by the Board prior to signature by the Board President and shall become effective upon the last date of signahire below,

A. FANNIN, EM nberly A. Fryer, R,N.

DATE -

1-Ila- Oci
LISA KLEMM, President Ohio Board of Nursing DATE

Caseir08f0912;-0T-3496

Ohio Board of Nursing

17 South High Street. Surle 400 September 19, 2008

www.nursing.ohio,gov

Columbus, Ohio 432 3 5-74 I 0 (614) 466-3947

NOTICE OF AUTOMATIC SUSPENSION AND OPPOLTUNITY FOR HEARING

Kimberly A. Fryer, R.N. 6419 Tantamount Lane Dayton, Ohio 45149 Dear. Ms. Fryer: You are hereby notified that on or about January 19, 2007, you entered into a Consent Agreement (January 2007 Consent Agreement) with the Ohio Board of Nursing (Board), a copy of which is attached hereto and incorporated herein. Attached to and incorporated within the January 2007 Consent Agreement are: January 21, 2005 Consent Agreement and July 16, 2004 Notice of Immediate Suspension and Opportunity for Hearing. Under the January 2007 Consent Agreement, you agreed with the Board that your license to practice nursing as a registered nurse in the State of Ohio would be indefinitely suspended for not less than sixty (60) days, and that you could submit a request for reinstatement on or after March 19, 2007, On or about May 18, 2007, your license was reinstated, subject to the probationary terms, conditions, and limitations contained in the January 2007 Consent Agreement for at least THREE (3) years. A. Item 2a) of the January 2007 Consent Agreement states, "MS. FRYER shall obey all federal, state and local laws, and all laws and rules governing the practice of nursing in Ohio." Section 4723.28(E)(8), ORC, authorizes the Board to discipline a licensee for self-administerig or otherwise'taking into the body any dangerous drug, as defined in Section 4729.01, ORC, in any way not in accordance .with a legal, valid prescription issued for that individual_ Item 2(e) of the January 2007 Consent Agreement states, "MS. FRYER shall abstain completely from the personal use or possession of drugs, except those prescribed, administered, or dispensed to her by another so authorized by law who has full knowledge of MS. FRYER's history of chemical dependency and recovery status. MS. FRYER shall self-administer the prescribed drugs only in the manner prescribed." Item 2e) of the January 2007 Consent Agreement states, "MS. FRYER shall continue to submit, at her expense and on the day selected, blood or urine specimens for drug and/or alcohol analysis at a collection site specified by the Board at such times as the Board may request. Refusal to submit such specimen, or failure to submit such specimen on the day she is selected, or in such a manner as the Board may request, shall constitute a violation of a rest(iction placed on a license for purposes of Section 4723.28(B), ORC. This screening shall require a daily call-in process, The specimens submitted by MS. FRYER shall be negative, except for

Kimberly A. Fryer, R.N. Page 2 substances prescribed, administered, or dispensed to her by another so authorized by law who has full knowledge of MS, FRYER's history of chemical dependency and recovery status." Despite these provisions, on or about February 20, 2008, you submitted a specimen to FirstLab, the Board's drug screening program administrator, that was positive for Codeine. You did not have a legal, valid prescription for Codeine, in addition, on the following dates, you failed to call FirstLab to determine if you had been selected: March 18, 2007; March 24, 2007; April 17, 2007; April 21, 2007; April 26, 2007; April 28, 2007; May 19, 2007; May 22, 2007; June 7, 2007; June 23, 2007; July 1, 2007; July 8, 2007; July 22, 2007; August 16, 2007; August 24, 2007; September 15, 2007; September 22, 2007; November 11, 2007; December 9, 2007; December 23, 2007; January 20, 2008; February 16, 2008; February 27, 2008; March 22, 2008; March 28, 2008; March 30, 2008; April 19, 2008; April 27, 2008; May 3, 2008; May 17, 2008; May 25, 2008; June 1, 2008; June 21, 2008; June 29, 2008; July 13, 2008; July 20, 2008; July 27, 2008; August 3, 2008; August 10, 2008. Section 4723.28(B)(8), ORC, authorizes the Board to discipline a licensee for self-administering or otherwise taking into the body any dangerous drug, as defined in Section 4729,01, ORC, in any way not in accordance with a legal, valid prescription issued for that individual. Section 4723.28(B)(17), Ohio Revised Code, ORC, authorizes the Board to discipline a licensee for violation of any restrictions placed on a nursing license by the Board. B. Item 2a) of the January 2007 ConSent Agreement states, "MS. FRYER shall obey all federal, state and local laws, and all laws and rules governing the practice of nursing in Ohio." Section 4723.28(B)(31), ORC, authorizes the Board to discipline a licensee for failure to establish and maintain professional boundaries with a patient, as specified in rules adopted under section 472.3.07, ORC. Section 4723.28(B)(16), ORC, authorizes the Board to discipline a licensee for violation of Chapter 4723, ORC, or any rules adopted under it. Specifically, Ohio Administrative Code (OAC), Rule 4723-4-06(M), Ohio Administrative Code, states that a licensed nurse shall not: (1) Engage in sexual conduct with a client; (2) Engage in conduct in the course of practice that may reasonably be interpreted as sexual; (3) Engage in any verbal behavior that is seductive or sexually demeaning to a client; or (4) Engage in verbal behavior that may reasonably be interpreted as seductive, or sexually demeaning to a client. For the purpose of this paragraph, the client is always presumed incapable of giving free, full, or informed consent to sexual activity with the nurse. Rule 4723-4-060A OAC, states that a licensed nurse shall not misappropriate a client's property or: (3) Engage in behavior that constitutes inappropriate involvement in the client's personal relationships; or (4) Engage in behavior that may reasonably be interpreted as inappropriate involvement in the client's personal relationships. For the purpose of this paragraph, the client is always presumed incapable of giving free, full, or informed consent to the behaviors by the nurse set forth in this paragraph. 4

Kimberly A. Fryer, .R.N. Page 3

Despite these provisions, the following occurred while you were. employed as a registered nurse by. Dayton Regional Dialysis, Dayton, Ohio (Dayton Regional). Beginning after your date of hire in March 2006, you provided nursing care to Patient II [see Attached Patient Key To Remain Confidential and Not Subject to Public Disclosure]. Patient #1 was diagnosed with chronic renal failure and received hemodialysis treatment at the facility beginning in or about May 2005. You were terminated from Dayton Regional on or about August 12., 2007. Following your termination, Patient #1 reported to staff members that during your employment at the facility, you had visited his personal residence multiple times and engaged in a sexual relationship. He stated that you had disclosed to him that you were on probation for drug abuse, and. that you requested that he sign a form indicating that he was your sponsor and that you were attending ANNA meetings. in a letter to the Board dated January 3, 2008, you state that while employed at Dayton Regional you engaged in "mutual, good-natured flirtation" with various patients and "developed a bond, or concerned attachment, to several of the patients." Regarding Patient #1, you indicated that you lent him a CD and later went to his personal residence to retrieve the CD. You stated that "I got my CD and with a hug and a kiss on the cheek, I left." You further stated that you shared personal information with many patients, concluding that: "It may be wrong but I was able to establish closer relationships with the patients than some of the staff" You indicate that based on your interactions, "it was only natural for several staff to assume and accuse." Section 4723.28(B)(31), ORC, authorizes the Board to discipline a licensee for failure to establish and maintain professional boundaries with a patient, as specified in rules adopted under section 4723.07, ORC. Section 4723.28(B)(16), ORC, authorizes the Board to discipline a licensee for violation of Chapter 4723, ORC, or any rules adopted under it. Specifically, Ohio Administrative Code (OAC), Rule 472.3-4-06(M), Ohio Administrative Code, states that a licensed nurse shall not: (1) Engage in sexual conduct with a client; (2) Engage in conduct in the course of practice that may reasonably be interpreted as sexual; (3) Engage in any verbal behavior that is seductive or sexually. demeaning to a client; or (4) Engage in verbal behavior that may reasonably be interpreted as seductive, or sexually demeaning to a client, For the purpose of this paragraph, the client is always presumed incapable of giving free; full, or informed consent to sexual activity with the nurse. Rule 4723-4-06(14, OAC, states that a licensed nurse shall not misappropriate a client's property or:- (3) Engage in behavior that constitutes inappropriate involvement in the client's personal relationships; or (4) Engage in behavior that may reasonably be interpreted as inapproPriate involvement in the client's personal relationships. For the purpose of this paragraph, the client is always presumed incapable of giving free, full, or informed consent to the behaviors by the nurse set forth in this paragraph. Section 4723.28(B)(17), ORC, authorizes the Board to discipline a licensee for violation of any restrictions placed on a nursing license by the 'Board.

Kimberly A. Fryer, R.N. Page 4 In accordance with the paragraph under "FAILURE TO COMPLY" of the January 2007 Consent Agreement, you are hereby notified that it appears to the Board that you have violated Items 2a)., 2c)., and 2e). of the January 2007 Consent Agreement, YOU ARE FURTHER NOTIFIED THAT YOUR LICENSE TO PRACTICE NURSING AS A REGISTERED NURSE IS HERESY AUTOMATICALLY SUSPENDED. Continued practice after receipt of this notice of suspension shall be considered engaging in the practice of nursing without a current, valid license, which is a violation of Section 4723.03(A), ORC. You are hereby ordered to surrender' your Ohio license to practice nursing as a registered nurse, RN228090, to the Board within ten (10) days of receipt of this notice. You are further notified that in accordance with Chapter 119, ORC, the Board proposes under authority of Section 4723.28, ORC, to deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: I. On or about January 19, 2007, you entered into a Consent Agreement (January 2007 Consent Agreement) with the Ohio Board. of Nursing (Board), a copy of which is attached hereto and incorporated herein. Attached to and incorporated within the January 2007 COnsent Agreement are: January 21, 2005 Consent Agreement and July 16, 2004 Notice of Immediate Suspension and Opportunity for Hearing. Under the January 2007 Consent Agreement, you agreed with the Board that your license to practice nursing as a registered nurse in the State of Ohio would be indefinitely suspended for not less than sixty (60) days, and that you could submit a request for reinstatement on or after March 19, 2007. On or about May 18, 2007, your license was reinstated, subject to the probationary terms, conditions, and limitations contained in the January 2007 Consent Agreement for at least THREE (3) years. 2. Item 2a) of the January 2007 Consent Agreement states, "MS, FRYER shall obey all federal, state and local laws, and all laws and rules governing the practice of nursing in Ohio." Section 4723.28(B)(8), ORC, authorizes the Board to discipline a licensee for self-administering or otherwise taking into the body any dangerous drug, as defined in Section 4729,0.1, ORC, in any way not in accordance with a legal, valid prescription issued for that indiViduaL Item 2(c) of the January 2007 Consent Agreement states, "MS. FRYER shall abstain completely from the personal use or possession of drugs, except those prescribed, administered, or dispensed to her by another so authorized by law who has full knowledge of MS, FRYER's history of chemical dependency and recovery status. MS. FRYER shall self-administer the prescribed drugs only in the manner prescribed." Item 2e) of the January 2007 Consent Agreement states, "MS. FRYER shall continue to submit, at her expense and on the day selected, blood or urine specimens for drug and/or alcohol analysis at a collection site specified by the Board at such times as the Board may request. Refusal to submit such specimen, or failure to. submit such specimen

Kimberly A. Fryer, R.N. Page 5 on the clay she is selected, or in such a manner as the Board may -request, shall constitute a violation of a restriction placed on a license for purposes of Section 4723.28(B), ORC. This screening shall require a daily call-in process: The specimens submitted by MS. FRYER shall be negative, except for substances prescribed, administered, or dispensed to her by another so authorized by law who has fidi knowledge of MS, FRYER'S history of chemical dependency and recovery status." Despite these provisions, on or about February 20, 2008, you submitted a specimen to FirstLab, the Board's drug screening program administrator, that was positive for Codeine. You did not have a legal, valid prescription for Codeine. In addition, on the following dates, you Failed to call FirstLab to determine if you had been selected; March 18, 2007; March 24, 2007; April 17, 2007; April 21, 2007; April 26, 2007; April 28, 2007; May 19, 2007; May 22, 2007; June 7, 2007; June 23, 2007; July 1, 2007; July 8, 2007; July 22, 2007; August 16, 2007; August 24, 2007; September 15, 2007; September 22, 2007; November 11, 2007; December 9, 2007; December 23, 2007; January 20, 2008; February 16, 2008; February 27, 2008; March 22, 2008; March 28, 2008; March 30, 2008; April 19, 2008; April 27, 2008; May 3, 2008; May 17, 2008; May 25, 2008; June 1, 2008; June 21, 2008; June 29, 2008; July 13, 2008; July 20, 2008; July 27, 2008; August 3, 2008; August 10, 2008. Section 4723.28(B)(8), ORC, authorizes the Board to discipline a licensee for self-administering or otherwise taking into the body any dangerous drug, as defined in Section 4729.01, ORC, in any way not in accordance with a legal, valid prescription issued for that individual. Section 4723.28(B)(17), Ohio Revised Code, ORC, authorizes the Board to discipline a licensee for violation of any restrictions placed on a nursing license by the Board. 3. item 2a) of the January 2007 Consent Agreement states, "MS. FRYER shall obey all federal, state and local laws, and all laws and rules governing the practice of nursing in Ohio." Section 4723.28(B)(31), ORC, authorizes the Board to discipline a licensee for failure to establish and. maintain professional boundaries with a patient, as specified. in rules adopted under section 4723.07, ORC. Section 4723.28(B)(16), ORC, authorizes the Board to discipline a licensee for violation of Chapter 4723, ORC, or any rules adopted under it. Specifically, Ohio Administrative Code (OAC), Rule 4723-4-06(M), Ohio Administrative Code, states that a licensed nurse shall not: (1) Engage in sexual conduct with a client; (2) Engage in conduct in the course of practice that may reasonably be interpreted as sexual; (3) Engage in any verbal behavior that is seductive or sexually demeaning to a client; or (4) Engage in verbal behavior that may reasonably be interpreted as seductive, or sexually demeaning to a client, For the purpose of this paragraph, the client is always presumed incapable of giving free, full, or informed consent to sexual activity with the nurse. Rule 4723-4-06(L), OAC, states that a lOcensed nurse shall not misappropriate a client's property or: (3.). Engage in behavior that constitutes inappropriate involvement in the client's personal relationships; or (4) Engage

Kimberly A. Fryer, R.N. Page 6 in behavior that may reasonably be interpreted as inappropriate involvement in the client's personal relationships. For the purpose of this paragraph, the client is always presumed incapable of giving free, fall, or informed consent to the behaviors by the nurse set forth in this paragraph. Despite these provisions, the following occurred while you were employed as a registered nurse by Dayton Regional Dialysis, Dayton, Ohio (Dayton Regional) Beginning after your date of hire in March 2006, you provided nursing care to Patient #1 isee Attached Patient Key To Remain Confidential and Not Subject to_ Public Disclosure), Patient #1 was diagnosed with chronic renal failure and received hemodialysis treatment at the facility beginning in or about May 2005. You were terminated from Dayton Regional on or about August 12, 2007. Following your termination, Patient #1 reported to staff members that during your employment at the facility, you had visited his personal residence multiple times and engaged in a sexual relationship. He stated that you had disclosed to him that you were on probation for drug abuse, and that you requested that he sign a form indicating that he was your sponsor and. that you were attending AA/NA meetings, In a letter to the Board dated January 3, 2008, you state that while employed at Dayton Regional you engaged in "mutual, good-natured flirtation" with various patients and "developed a bond, or concerned attachment, to several of the patients." Regarding Patient #1, you indicated that you lent him a CD and later went to his personal residence to retrieve the CD. You stated that "I got my CD and with a bug and. a kiss on the cheek, .1 left." You further stated that you shared personal information with many patients, concluding that: "It may be wrong but I was able to establish closer relationships with the patients than some of the staff." -You indicate that based on your interactions, "it was only natural for several staff to assume and accuse." Section 4723.28(B)(31), ORC, authorizes the Board to discipline a licensee for failure to establish and maintain professional boundaries with a patient, as specified in rules adopted under section 4723.07, ORC. Section 472328(8)(16), ORC, authorizes the Board to discipline a licensee for violation of Chapter 4723, ORC, or any rules adopted under it, Specifically, Ohio Administrative Code (OAC), Rule 4723-4-06(1v1), Ohio Administrative Code,.. states that a lidensed nurse shall not: (1) Engage in sexual conduct with a client; (2) Engage in conduct in the course of practice that may reasonably be interpreted as sexual; (3) Engage in any verbal behavior that is seductive or sexually demeaning to a client; or (4) Engage in verbal behavior that May reasonably be interpreted as seductive, or sexually demeaning to a client. For the purpose of this paragraph, the client is always presumed incapable of giving free, full, or informed consent to sexual activity with the nurse Rule 4723-4-06(L), OAC, states that a licensed nurse shall not misappropriate a client's property or: (3) Engage in behavior that. constitutes inappropriate involvement in the client's personal relationships; or (4) Engage in beha vior that may reasonably be interpreted as inappropriate involvement in the client's personal relationships, For the purpose of this paragraph, the client is always presumed incapable of giving free, full, or informed consent to the behaviors.by the nurse set forth in this paragraph. Section 4723.28(B)(17), ORC,

Kimberly A. Fryer, R N Page 7 authorizes the Board to discipline a licensee for violation of any restrictions plriced on a nursing license by the Board. Accordingly, the Board is authorized to impose one or more of the sanctions as cited in Section 4723.28, ORC. in accordance with Chapter 119, ORC, you are hereby informed that ou are entitled to a hearing in this matter. If you wish to request such hearing, the request -must be made in writing and must be received in the Board office within thirty (30) days of the time of mailing of this notice. You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before - the Board, or you may present your position, arguments, or contentions in writing. At the hearing you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to: Lisa Ferguson-Ramos, Compliance Unit Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, Ohio 432157410. if the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Automatic Suspension and Opportunity for Hearing, deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation, Sincerely,

Debra A. Broadnax, Supervising Member C.N.S.,

Certified Mail Receipt No. 7008 0150 0003 3672 7461 cc: Leah O'Carroll, Assistant Attorney General

C-ase-ft-c-3-1-44

Ohio Board of Nursing

17 South High Street, Suite 400

www.nursitig.ohio.gov Columbus, Ohio 43215-7410 d (614) 466-3947

CONSENT AGREEMENT BETWEEN KIMBERLY ANNE FRYER, R.N. AND 011110 BOARD OF NURSING
This Consent Agreement is entered into by and between KIMBERLY ANNE FRYER, R.N. (MS. FRYER) and the Ohio Board of Nursing (Board), the state agency charged with enforcing Chapter 4723. of the Ohio Revised Code (ORC), and all administrative rules promulgated thereunder. MS. FRYER voluntarily enters into this Consent Agreement being fully informed of her rights under Chapter 119, ORC, including the right to representation by legal counsel and the right to a formal adjudicative hearing on the issues considered herein. This Consent Agreement contains.the entire agreement between the parties, there being no other agreement of any kind, verbal or otherwise, which varies the terms of this Consent Agreement. BASIS FOR ACTION This Consent Agreement is entered into on the basis of the following stipulations, admissions and understandings: A. The Board is empowered by Section 4723.28, ORC, to deny, permanently revoke, revoke, suspend, or place restrictions on any license issued by the Board; reprimand or otherwise discipline a licensee; or impose a fine of five hundred dollars ($500.00) or less per violation, Section 4723.28(B)(8), ORC, authorizes the Board to discipline a licensee for self-administering or otherwise taking into the body any dangerous drug, as defined in Section 4729.01, ORC, in any way not in accordance with a legal, valid prescription issued for that individual. Section 4723.28(B)(17), ORC, authorizes the Board to discipline a licensee who violates any restrictions placed on a nursing license by the Board. S. FRYER has been licensed to practice nursing as a registered nurse, RN-228090, in the State of Ohio, since September 1990. On or about, MS. FRYER voluntarily placed her license on "inactive status." 4 On or about January 21, 2005, MS. FRYER entered into a Consent Agreement (January 2005 Consent Agreement) with the Board pursuant to a

B.

C.

Kimberly Anne Fryer, N. Page 2 Notice of Immediate Suspension and Opportunity for Hearing issued to her by the Board on July 16, 2004 (July 2004 Notice). Under the January 2005 Consent Agreement, S. FRYER's license to practice nursing as a registhred nurse,. RN-228090, in the State of Ohio, was indefinitely suspended and such suspension was stayed subject to the Consent Agreement's terms, conditions, and limitations until at least January 2008. Copies of the July 2004 Notice and the January 2005 Consent Agreement are attached hereto and incorporated herein, D. Paragraph 1_ on Page 2 of the .January 2005 Consent Ageament states: "MS. FRYER shall obey all federal, state, and local laws, and all laws and rules governing the practice of nursing in Ohio," Paragraph 5. on Page 3 of the January 2005 Consent Agreement states: "MS. FRYER shall abstain completely from the personal use or possession of drugs, except those prescribed, administered, or dispensed to her by another so authorized by law who has full knowledge of MS. FRYER's history of chemical dependency and recovery status. MS. FRYER shall self-administer prescribed drugs only in the manner prescribed," F, MS. FRYER knowingly and voluntarily admits that die following occurred while subject to the January 2005 Consent Agreement: On September 18, 2006, MS. FRYER submitted a urine specimen to FirstLab, the Board's drug screening program, which tested positive for Oxycodone. When questioned by a Board Monitoring Agent about the positive result, MS. FRYER admitted that she had taken what she had believed to be a "muscle relaxant" prescribed for her mother and for which she had no valid, legal prescription. MS. FRYER further explained that she suffered from "recurring back pain" and was without health insurance to seek appropriate treatment. O. MS. FRYER denied relapse and expressed remorse for her poor judgment. MS. FRYER has been compliant with her January 2005 Consent Agreement to date, including submitting to random drug tests since April 2005 that have been negative except for the September 18`b drug screen. AGREED CONDITIONS Wherefore, in consideration of the foregoing and mutual promises hereinafter set forth, and in lieu of any formal proceedings at this time, MS. FRYER knowingly and voluntarily agrees with the Board to the following terms, conditions, and limitations:

Anne Fryer, R.N. Page 3 I) MS. FRYER's license to practice nursing as a registered nurse is hereby suspended for an indefinite period of time, but not less sixty (60) days following the effective date of this Consent Agreement MS. FRYER may submit a written request for reinstatement anytime after March 19, 2007, as long as tb.e conditions for reinstatement have been met. The Board may consider reinstatement of S. FRYER's license only if all of the following conditions for reinstatement have been inet: (a) MS. FRYER shall surrender to the Board her Ohio registered nurse license, RN-22.8090, immediately. (b) Prior to seeking reinstatement by the Board, MS. FRYER shall, at her own expense, seek a chemical dependency evaluation by a Board approved chemical dependency professional and shall provide the Board with complete documentation of this evaluation. Prior to the evaluation, MS. idit.YER shall provide the chemical dependency professional with a copy of this Addendurn, the July 2004 Notice and the .ianuary 2005 Consent Agreement. Further, MS. FRYER shall execute releases to permit the chemical dependency professional to obtain any information deemed appropriate and necessary for the evaluation. The chemical dependency professional shall submit a written opinion to the Board that incltides diagnoses, recommendations for treatment and monitoring, any additional restrictions to be placed on MS. FRYER's license to practice, and stating whether MS. PRYER is capable of practicing nursing according to acceptable and prevailing standards of safe nursing care. (e) MS, FRYER shall provide the Board with satisfactory documentation of compliance with all aspects of the treatment plan developed by the chemical dependency professional described above until released. Further, MS. FRYER agrees that the Board may utilize the prOfessional's recommendations and conclusions from the evaluation as a basis for additional terms, conditions, and limitations on MS. FRYER's license and that the terms, conditions, and limitations shall be incorporated in an addendum to this Consent Agreement (d) MS. FRYER shall obey all federal, state, and local laws, and all laws and rules governing the practice of nursing in Ohio. (e) MS. FRYER shall appear in person for interviews before the, full Board or its designated representative as requested by the Board. (f) M.S. FRYER shall abstain completely from the personal use or possession of drugs, except those prescribed, administered, or dispensed to her by another so authorkzed by law who has full knowledge of MS. FRYER's history of chemical use and recovery status. MS. FRYER shall self-administer the prescribed drugs only in the manner prescribed.

Kiinb y Page 4

ne ryes,

(g)MS.

FRYER shall abstain completety from the use of alcohol add/or substances containing alcohol.

(h) MS. FRYER shall continue to attend a minimum of one (1) meeting per week of a support or peer group meeting approved in advance by the Board, or a Twelve Step program, and licensee shall provide satisfactory documentation of such attendance to the Board prior to reinstatement. 4 (1)

MS. FRYER shall continue to submit, at her expense and on the day selected, blood or urine specimens for drug and/or alcohol analysis at a collection site specified by the Board at such times as the Board may request. Refusal to submit such specimen, or failure to submit such specimen on the day she is selected, or in such a manner as the Board may request, shall constitute a violation of a restriction placed on a license for purposes of Section 4723.28(B), ORC. This screening shall require a daily call-in process. The specimens submitted by MS. FRYER shall be negative, except for substances prescribed, administered, or dispensed to her by another so authorized by law who has full knowledge of MS. FRYER's history of chemical dependency and recovery status,

(j) MS, FRYER shall cause all treating practitioners to complete a medication prescription report that is to be mailed by the practitioner directly to the Board. The medication report is to be completed for any and all substances prescribed, administered, or dispensed to MS. FRYER (k) MS. FRYER shall report to the Board in writing, any violation of this Consent Agreement within thirty (30) days of the occurrence of the violation. (1) MS. FRYER shall sign release of information forms allowing health professionals and other organizations to submit requested documentation or information directly to the Board. (m)MS, FRYER shall submit any and all information that the Board may request regarding her ability to practice according to acceptable and prevailing standards of safe nursing practice. (n) MS. FRYER shall not submit or cause to be submitted any false, misleading, or deceptive statements, information, or documentation to the Board or to employers or potential employers. (a) M. FRYER shall submit the reports and documentation required by this Consent Agreement on forms specified by the Board. All reporting and communications required by this Consent Agreement shall be made to the Compliance Unit of the Board,

Page 5 (p) MS. FRYER shall submit the reports and documentation required by this Consent Agreement to the attention of the Compliance Unit, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, OH 43215-7410. (q) MS. FRYER shall verify that the reports and documentation required by this Consent Agreement are'received in the Board office. (r) MS. FRY4R shall inform the Board within three (3) business days, in writing, of any change in address and/or telephone number. (s) The Board may only alter the indefinite suspension imposed if: (1) MS. FRYER submits a written request for reinstatement; (2) the Board determines that S. FRYER has complied with all conditions of reinstatement; (3) and the Board determines that MS. FRYER is able to practice according to acceptable and prevailing standards of safe nursing care based upon an interview with MS. FRYER arid review of the documentation specified in this Consent Agreement. 2) Following reinstatement, MS. FRYER shall be subject to the following probationary terms, conditions, and limitations for at least THREE (3) years: (a) MS. FRYER shall obey all federal, state, and local laws, and all laws and ruieS governing the practice of nursing in Ohio.

(b)MS. FRYER shall appear in person for interviews before the full Board or its
designated representative as requested by the Board. (c) MS. FRYER shall abstain completely from the personal use or possession of drugs, except those prescribed, administered, or dispensed to her by another so authorized by law who has full knowledge of MS. FRYER'S history of chemical dependency and recovery status. MS. FRYER shall self-administer the prescribed drugs only in the manner prescribed. (d) MS. FRYER shall abstain completely from the use of alcohol and/or substances containing alcohol. (e) MS. FRYER shall continue to submit, at her expense and on the day selected, blood or urine specimens for drug and/or alcohol analysis at a collection site specified by the Board at such times as the Board may request. Refusal to submit such specimen, or failure to submit such specimen on the day she is selected, or in such a manner as the Board may request, shall constitute a violation of a restriction placed on a license for purposes of Section 4723.28(B), ORC. This screening shall require a daily call-in process. The specimens submitted by IVIS FRYER shall be negative, except for substances prescribed, administered, or dispensed to her by another so authorized by law

KirribEily-Aiiii6-Fryer, R.N. who has full knowledge of MS. FRYER's history of chemical dependency and recovery status. (f) MS. FRYER shall continue to attend a minimum of one (1) meeting per week of a support or peer group meeting approved in advance by the Board, or a Twelve Step program, and licensee shall provide satisfactory documentation of such attendance to the Board every aft (6) months. (g) Within thirty (30) days of reinstatement of her nursing license, MS. IIRYER shall provide a copy of this Consent Agreement to all treating practitioners and shall provide to the Board a list of all treating practitioners, including addresses and telephone numbers. Further, MS. FRYER shall be under a continuing duty to provide a copy of this Consent Agreement, prior to initiating treatment, to additional treating practitioners, and to update the list of treating practitioners with the Board within forty-eight (48) hours of being treated by another practitioner. (h) MS. FRYER shall cause all treating practitioners to complete a medication prescription report that is to be. mailed by the practitioner directly to the Board. The medication report is to be completed for any and all substances prescribed, administered, or dispensed to MS. FRYER throughout the duration of this Consent Agreement, (i) Within twenty-four (24) hours of release from hospitalization or medical treatment, MS. FRYER shall notify the Board of any and all medication(s) or prescription(s) received. (I) Prior to accepting employment as a nurse, each time with every employer, MS. FRYER shall notify the Board. (k) Upon reinstatement of her nursing license, MS. FRYER shall have her ernployer(s), if working in a position where a nursing license is required, submit written reports regarding job performance on a quarterly basis. MS. FRYER shall provide her employer(s) with a copy of this Consent Agreement, the July 2004 Notice and the January 2005 Consent Agreement. MS. FRYER shall have her employer(s) send documentation to the Board, along with the first employer report, of receipt of a copy of this Consent Agreement, the July 2004 Notice and the January 2005 Consent Agreement. Further, MS. FRYER is under a continuing duty to provide a copy of this Consent Agreement, the July 2004 Notice and the January 2005 Consent Agreement to any new employer prior to accepting employment. (I) MS. FRYER shall report to the Board in writing, any violation of this Consent Agreement within thirty (30) days of the occurrence of the violation.

b e .fiy Anne FrTETRPage 7 (m)MS. FRYER shall sign release of information forms allowing health . professionals and other organizations to submit the. requested documentation directly to the Board. (a) MS. FRYER shall submit any and all information that the Board may request regarding her ability to practice according to acceptable and prevailing standards of safe nursing practice (o) MS. FRYER shall not submit or cause to be submitted any false, misleading, or deceptive statements, information, or documentation to the Board or to employers or potential employers. (p) It4S. FRYER shall submit the reports and documentation required by this Consent Agreement on forms specified by the Board. All reporting and communications required by this Consent Agreement shalt be made to the Compliance Unit of the Board.

(q)MS. FRYER shall submit the reports and documentation required by this
Consent Agreement or any other documents required by the Board to the attention of the Compliance Unit; Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, OH 43215-7410. (r) MS. FRYER shall verify that the reports and documentation required by this Consent Agreement are received in the Board office. (s) MS. FRYER shall inform the Board within five (5) business days, in writing, of any change in employment status or of any change in residential or home address or telephone number. Temporar Narcotic Restriction MS. FRYER knowingly and voluntarily agrees with the Board to the following TEMPORARY LICENSURE RESTRICTIONS: Upon reinstatement of her nursing license, MS. FRYER shall not administer, have access to, or possess (except as prescribed for MS. FRYER's use by another so authorized by law who has full knowledge of MS. FRYER's history of chemical dependency) any narcotics, other controlled substances, or mood altering drugs for a minimum of twelve (12) months in which MS. FRYER is working in a position that requires a nursing license, At any time after the twelve (12) months period previously described, MS. FRYER may submit a written request to the Board to have this restriction re-evaluated. In addition, MS. FRYER shall not possess or carry any work keys for locked medication carts, cabinets, drawers, or containers; shall not count narcotics; and shall not call in orders for prescriptions or prescription refills.

larTeTTCINT-eage is Permanent Practice Restrictions MS. FRYER further knowingly and voluntarily agrees with the Board to the following PERMANENT LICENSEIRE RESTRICTIONS: Unless otherwise approved in advance by the Board or its designee, MS. FRYER shall not practice nursing as a registered nurse (1) for agencies providing home care in the patient's residence; (2) for hospice care programs providing hospice care in the patient's residence; (3) as a nurse for staffing agencies or pools; (4) as an independent provider where the nurse provides nursing care and is reimbursed for services by the State of Ohio through State agencies or agents of the State; or (5) for an individual or group of individuals who directly engage MS. FRYER to provide nursing services for fees, compensation, or other consideration or as a volunteer. Un.less otherwise approved in advance by the Board or its designee, MS. FRYER shall not function in a position or employment where the job duties or requirements involve management of nursing and nursing responsibilities, or supervising and evaluating nursing practice. Such positions include but are not limited to the following: Director of Nursing, Assistant Director of Nursing, Nurse Manager, Vice President of Nursing. FAILURE TO COMPLY MS. FRYER agrees that her license to practice nursing as a registered nurse will be automatically suspended if it appears to the Board that MS. FRYER has violated or breached any terms or conditions of the Consent Agreement. Following the automatic suspension, the Board shall notify MS. FRYER via certified mail of the specific nature of the charges and automatic suspension of her license. Upon receipt of this notice, MS. FRYER may request a hearing regarding the charges, The above described terms and conditions shall constitute "restrictions placed on a license" for purposes of Section 4723.28(B), ORC. If, in the discretion of the Board, MS. FRYER appears to have violated or breached any terms or conditions of this Consent Agreement, the Board reserves the right to institute formal disciplinary proceedings for any and all possible violations or breaches, including, but not limited to, alleged violations of the laws of Ohio occurring before the effective date of this Consent Agreement. DURATION/MODDICATION, OF TERMS The terms, limitations, and conditions of this Consent Agreement, other than the permanent licensure restrictions, may be modified or terminated in writing at any time upon the agreement of both MS. FRYER and the Board. The Board may only alter the probationary period imposed by this Consent Agreement if: (I) the Board determines that MS FRYER has compiled with all aspects of this Consent Agreement; and (2) the. Board determines that MS. FRYER is able to practice according to acceptable and , prevailing standards of safe nursing care without Board monitoring, based upon an interview with MS. FRYER and review of the reports as required herein. Any period during which MS.

Page 9 FRYER does not work in a position for which a nursing license is required shall not count toward fulfilling the probationary period imposed by this Consent Agreement. 1 ,LE11 .__,..:_g_gagab,Bileilyni3ELF,A3F, ,___C__2, A gl1Q3,7 S. FRYER acknowledges that she has had an opportunity to ask questions concerning the terms. of this Consent Agreement and that all questions asked have been answered in a satisfactory manner. S. FRYER waives all of her rights under Chapter 119, ORC, as they relate to matters that are the subject of this Consent Agreement MS, FRYER waives any and all claims or causes of action she may have against the Board, and its members, officers, employees and/or agents arising out of matters that are the subject of this Consent Agreement, This Consent Agreement is not an adjudication order within the meaning of Section 119.01(D), ORC. Any action initiated by the Board based on alleged violations of this Consent Agreement shall comply with the Administrative Procedures Act, Chapter 119, ORC. This Consent Agreement shall be considered a public record as that term is used in Section 149,43, ORC. The information contained herein may be reported to appropriate organizations, data banks and governmental bodies.

EFFErTIVE DATE.
S. 'R ER understands that this Consent Agreement is subject to ratification by the Board prior to signature by the Board President and shall become effective upon the last date of signature below.

(zziDATE

/4210,2
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XitAtati, insA)
CYNTHIA A..l UEGER, Praident Ohio Board of Nursing DATE

7 al 67

dkid

f Nursing

www.mirsing.ohio.gov

17 South High Street, Suite 400 t Columbus, Ohio 43215-74.10 t (614) 466-3947

CONSENT A_GREEMENT BETWEEN TKIMBERI_,Y ANNE FRYER, R.N. AND (Tam BOARD OF NURSING
This Consent Agreement is entered into by and between KIMBERLY ANNE FRYER, R.N. (MS. FRYER) and the Ohio Board of Nursing (Board), the state agency charged with enforcing Chapter 4123. or the Ohio Revised Code (ORC), and all administrative rules promulgated thereunder. MS. FRYER voluntarily enters into this Consent Agreement being folly informed of her rights under Chapter 119, ORC, including the right to represeniatiou by legal counsel and the right to a formal adjudicative bearing on the issues considered herein. the entire agreement between the parties, there being This ConSent Agreement no other agreement of any any kind, verbal or otherwise, which varies the terms of this Consent Agreement.

BASIS FOR ACTION

This Consent Agreement is entered into on the basis of the following stipulations, admissions and understandings; A, The Board is empowered by Section 4723.28, ORC, to deny, permanently revoke, revoke, suspend, or place restrictions on any license issued by the Board; reprimand or otherwise discipline a licensee; or impose a fine of five hundred dollars ($500.00) or less per violation. Section 472328(B)(4), ORC, authorizes the Board to discipline a licensee for a conviction of, plea of guilty to, a judicial finding of guilt of, a judicial finding of guilt resulting from a plea of no contest to, or a judicial finding of eligibility for intervention in hen of conviction for, any felony. Section 4723.28(B)(5), ORC, authorizes the Board to discipline a licensee for a conviction of, plea of guilty to, a judicial finding of guilt of, a judicial finding of guilt resulting from a plea of no contest to, or a judicial finding of eligibility for intervention in lieu of conviction for, any municipal, state, county or federal drug law, Section 4723.28(B)(8), ORC, authorizes the Board to discipline a licensee for self-administering or otherwise taking into the body any dangerous drug, as defined in

Kimberly Anne Fryer, R.N. Page 2 section 4729.01 of the Revised Code, in any way not in accordance with a legal, valid prescription issued for that individual. B. M. FRYER's license to practice nursing as a registered nurse, RN228090, in the State of Ohio, is currently suspended pursuant to a Notice of Immediate Suspension and Opportunity for Hearing issued to her on July 16, 2004 (July 2004 POtice), a copy of which is attached hereto and incorporated herein. MS, FRYER knowingly and voluntarily admits to the legal and factual allegations set forth in her July 2004 Notice.. S. FRYER. has completed and complied with all of the terms of her Treatment in Lieu of Conviction program, which was granted by the Court in Montgomery County Court of Common Pleas Case No, 2003 CR 03314. As such, on or about July 23, 2004, MS . FRYER's criminal case was dismissed, MS. PRYER has not worked as a nurse since the events referenced in her July 2004 Notice, P. MS. FRYER has contacted the Board and has reported that she would like to settle the issues set forth in her July 2004 Notice and is willing to cooperate with the Board,

C,

AGIE.FaeUNDELIOES.
Wherefore, in consideration of the foregoing and mutual promises hereinafter set forth, and in lieu of any formal proceedings at this time, MS. FRYER knowingly and voluntarily agrees with the Board to the following terms, conditions, and limitations: MS. FRYER's license to practice nursing as a registered nurse is hereby suspended indefinitely. Such suspension is hereby stayed, subject to the following PROBATIONARY terms, conditions, and limitations until at least JANUARY 2008: 1, 2. MS. FRYER shall obey all federal, state, and local laws, and all laws and rules governing the practice of nursing in Ohio, S. FRYER shall appear in person for interviews before the full Board or its designated representative on a quarterly basis or as otherwise requested by the Board. MS. Y R. shall submit, on a quarterly basis, beginning MARCH 1, 2005, or as otherwise requested by the Board, satisfactory personal statements to the Board regarding progresstin recovery, her employment,

3.

Kimberly Anne Fryer, R,N. Page 3 if working in a position for which a nursing license is required, and whether MS. FRYER has complied with all of the provisions of -this Consent Agreement. 4, MS. FRYER shall, in addition to the requirements of licensare renewal, successfully complete and submit satisfactory documentation of successful completion of the following continuing education by 4ANCIARY 1, 2006: two (2) hours of Ohio nursing law and rules; eight (8) hours of chemical dependency.

Monitoring of Rehabilltadon and Treatment 5. MS. FRYER shall abstain completely from the personal use or possession of drugs, except those prescribed, administered, or dispensed to her by another so authorized by law who has full knowledge of MS, FRYER's history of chemical dependency and recovery status. MS. FRYER, shall self-administer prescribed drugs only in the manner prescribed. MS. FRYER shall abstain completely from the use of alcohol. MS. FRYER shall submit, at her expense and on the day selected, blood or urine specimens for drug and/or alcohol analysis at a collection site specified by the Board at such times as the Board may request. Refusal to submit such specimen, or failure to submit such specimen on the day she is selected, or in such a manner as the Board may request, shall constitute a violation of a restriction placed on a license for purposes of Section 4723,28(B), ORC, This screening shall require a daily call-in process. The specimens submitted by MS, FRYER shall be negative, except for substances prescribed, administered, or dispensed to her by another so authorized by law who has full knowledge of MS, FRYER's history of chemical dependency and recovery status. MS. FRYER shall attend a minimum of one (1) meeting per week of a support or peer group meeting approved in advance by the Board, or a Twelve Step program, and licensee shall provide satisfactory documentation of such attendance to the Board on a quarterly basis beginning MARCH 17 2005. Within NINETY (90) DAYS following the effective date of this Consent Agreement, MS, FRYER shall, at her own expense, seek a chemical dependency evaluation by a Board approved chemical dependency professional and shall provide the Board with complete documentation of this evaluation, Prior to the evaluation, MS. X;RYER shall provide the chemical dependency professional with a copy of this Consent Agreement, Further, MS. FRYER shall execute releases to permit the chemical

6. 7,

8,

9,

Kimberly Anne Fryer, R,N. Page 4 dependency professional to obtain any information deemed appropriate and necessary for the evaluation. The professional, shall submit a written opinion to the Board that includes diagnoses, recommendations for treatment and monitoring, any additional restrictions that should be placed on MS. FRYER'S license to practice, and stating whether S. FLYER is capable of practicing nursing according to acceptable and prevailing ( standards of safe nursing care. 10. S. FRYER shall provide the Board with satisfactory documentation of compliance with all aspects of the treannent plan developed by the chemical dependency professional described above until released. Further, MS, FRYER agrees that the Board may utilize the professional's recommendations and conclusions from the evaluation as a basis for additional terms, conditions, limitations on MS. FRYER's license and that the terms, conditions, and limitations shall be Incorporated in an addendum to this Consent Agreement,

Treating Practitioners and Reporting 11. Within sixty (60) days of the execution of this Consent Agreement, S. FRYER shall provide a copy of this Consent Agreement to all treating practitioners and ghat' provide to the Board a list of all treating practitioners, including addresses and telephone numbers, Farther, MS. FRYER shall be under a continuing duty to provide a copy of this Consent Agreement, prior to initiating treatment, to additional treating practitioners, and to update the list of treating practitioners with the Board within forty-eight (48) hours of being treated by another practitioner. MS. FRYER shall cause all treating practitioners to complete a medication prescription report that is to be mailed by the practitioner directly to the Board, The medication report is to be completed for any and all substances prescribed, administered, or dispensed to MS. FRYER throughout the duration of this Consent AgreementWithin twenty-four (24) hours of release from hospitalization or medical treatment, MS. FRYER shall notify the Board of any and all medication(s) or prescription(s) received_

12.

13.

Employment Conditions 14. 15. Prior to accepting employment as a nurse, each time with every employer, MS. il'KYER shall notify the Board. MS. FRYER shall not practice nursing as a registered nurse (1) for agencies providing borne care in the patient's residnce; (2) for hospice

Kimberly Anne Fryer, R.N. Page 5 care programs providing hospice care in the patient's residence., (3) as a nurse for staffing agencies or pools., (4) as an independent provider where the nurse provides nursing care and is reimbursed for services by the State of Ohio through State agencies or agents of the Stare; or (5) for an individual or group of individuals who directly engage MS, FRYER to provide nursing services for fees, compensation, or other consideration or as a volunteer, 16, When working as a nurse, ikiM PRYER shall only work in settings in which a registered nurse supervisor is present on-site at all times and shall not function as a supervisor while working in a position for which a nursing license is required. MS FRYER shall have a work site registered nurse (Contact Nurse) who supervises MS. FRYER and agrees to monitor 1 ,14& FRYER'S work performance and progress and to be In contact with the Board. MS. FRYER shall have the Contact Nurse talk with the Board prior to MS, FRYER working:- as a nurse, MS. FRYER shall have the Contact Nurse maintain contact with the Board. In the event that the Contact Nurse becomes unable 01 unwilling to serve in this capacity, MS. leitYER must immediately notify the Board in writing and make arrangements acceptable to the Board for another Contact Nurse to monitor progress and status as soon as practicable. MS, RYER shall have her employer(s), if working In a position where a nursing license is required, submit written reports regarding Job performance on a quarterly basis beginning MARCH 1 2005. FRYER shall provide her employer(s) with a copy of this Consent Agreement and shall have her employer(s) send documentation to the Board, along with the first employer report, of receipt of a copy of this Consent Agreement. Further, MS. FRYER is under a continuing duty to provide a copy of this Consent Agreement to any new employer prior to accepting employment.

17.

L.

Reporting Requirements of Licensee 19. MS. FRYER shall sign release of information forms allowing health professionals and other organizations to submit the requested documentation directly to the Board. MS. FRYER shall submit any and all information that the Board may request regarding her ability to practice according to acceptable and prevailing standards of safe nursing practice.

20.

Kimberly Anne Flyer, R.N. Page 6 21. MS. FRYER shall not submit or cause to be submitted any false, misleading, or deceptive statements, information, or documentation to the Board or to employers or potential employers, ISIS. FRYER shall submit the reports and documentation required by this Consent Agreement on forms specified by the Board- All reporting and communications required by this Consent Agreement shill be made to the Monitoring Unit of the Board, M.S. FRYER shall submit the reports and documentation required by this Consent Agreement or any other documents required by the Board to the attention of the Monitoring Unit, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, OH 43215-3413, MS. FRYER shall verify that the reports and documentation required by this Consent Agreement are received in the Board office. MS. FRYER shall inform the Board within five (5) business days, in. writing, of any change in 'employment status or of any change in residential or home address or telephone number.

22,

23,

24. 25,

Temporary Narcotic Restriction MS. MYER further knowingly and voluntarily agrees with the Board to the following teraporaxy licensore restrictions: 26. Upon reinstatement, MS. FRYER shall not administer, have access to, or possess (except as prescribed for MS. FRYER's use by another so authorized by law who has full knowledge of MS, FRYER's history of chemical dependency) any narcotics, other controlled substances, or mood altering drugs for a minimum of ONE (1) YEAR in which MS. FRYER is working in a position that requires a nursing license. At any time after the ONE (1) YEAR previously described, MS, +RYER may submit a written request to the Board to have this restriction re-evaluated. In addition, MS. FRYER shall not possess or carry any work keys for locked medication carts, cabinets, drawers, or containers, MS. FRYER shall not count narcotics. FAILVRlE TO COMPLY MS. FRYER agrees that her license to practice nursing as a registered nurse will be automatically suspended if it appears to the Board that MS. FRYER has violated or breached any terms or conditions of the Consent Agreement, Following the automatic suspension, the Board shall. notify MS. FRYER via certified mail of the speciBc nature 1

Kimberly Anne Fryer, R.N. Page 7 of the charges and automatic suspension of her license, Upon receipt of this notice, 1-1S. FRYER may request a hearing regarding the charges. The above described terms and conditions shall constitute "restrictions placed on a license" for purposes of Section 472,28(B), CRC, lf, in the discretion of the Board, MS. FRYER appears to have violated or breached any terms or conditions of this Consent Agreement, the Board reserves the right to institute formal disciplinary proceedings for any and all possible violations or breaches: including-, but not limited to, alleged violations of the laws of Ohio occurring before the effective date of this Consent Agreement DIJRATI Nada= A T I ON_QE.1 ERMS The terms, limitations, and conditions of this Consent Agreement may be modified or terminated in writing at any time upon the agreement of both S. FRYER and the Board, The Board may only alter the probationary period imposed by this Consent Agreement (1) the Board determines that MS. FRYER has complied with all aspects of this Consent Agreement; and (2.) the Board determines that MS. FRYER Is able to practice according to acceptable and prevailing standards of safe nursing care without Board monitoring, based upon an interview with MS. FRYER and review of the reports as required herein. Any period during which. MS. FRYER does not work in a position for which a nursing license is required shall not count toward fulfilling the probationary period imposed by this Consent Agreement.

AMCqELG ) MISTEILIA13 _1021K RELEASE

MS. FRYER acknowledges that she has had an opportunity to risk questions concerning the terms of this Consent Agreement and that all questions asked have been answered in a satisfactory manner, MS. l?RYER waives all of her rights under Chapter 119, O.RC, as they relate to matters that are the subject of this Consent Agreement. MS, FRYER waives any and all claims or causes of action she may have against the Board, and its members, officers, employees and/or agents arising out of matters that are the subject of this Consent Agreement, This Consent Agreement is not an adjudication order within the meaning of Section 119,01(D), OR.C, Any action initiated by the Board based on alleged violations of this Consent Agreement shall comply with the Administrative Procedures Act, Chapter 119, CRC,

Kimberly Anne Fryer, P.M. Page 8 This Consent Agreement shall be considered a public record as that term is used in Section 149.43, ORC, The information contained herein may be reported to appropriate organizations, data banks and gove.unnent21 bodies. RIVECTTVE DATE

4 KS. FRYER understands that this Consent Agreement is subject to ratification by the Board prior to signature by the Board President and shall become effective upon, the lust date of signature below.

LW' . Eny Ai\

/cr/v/ez/ &Axe*.ifirj1/ 0/

3o
DATE

YVONNE SMITH, Preident Ohio Board of Nursing

Qi
D A.TE

haiirtilaVirgt Nursing

rwvv nursing.ohio.gov

17 South High Street, Suite 400 , Columbus, Ohio 437.15-7410 (614) 466-3947

Ally 16, 2004

NOTICE OF iMMEDIATE SUSPENSION AND OPPORTUNITY FOR HEARING

Kimberly Anne Fryer, R.N. 6419 Tantamount Lane Dayton, Ohio 45449 Dear Ms. Fryer: In accordance with Sections 2929.24 and/or 371912 of the Ohio Revised Code (hereinafter "ORC"), the Ohio Board of Nursing (hereinafter "Board") has been notified that, on or about December 15, 2003, in Montgomery County Court of Common Pleas Case No. 2003 CR 03314, you pled guilty to two (2) felony counts of Theft of Drugs, in violation of Section 2913.02(A)(2), ORC, and two (2) felony counts of Illegal Processing of Drug Documents, in violation of Section 2925.23(A), ORC, and were found eligible for Intervention in Lieu of Conviction, Section 3719.121(C), ORC, states in pertinent part as follows: (C) On receiving notification pursuant to Section 2929.24 or 3719.12 of the Revised Code, the board under which a person has been issued a license, certificate or evidence of registration immediately shall suspend the license, certificate, or registration of that person on a plea of guilty to, a finding by a jury or,cotirt of the person's guilt of, or conviction Of a felony drug abuse offense; a finding by a court of the person's eligibility for treatment in lieu of conviction; a plea of guilty to, or a finding by a jury or court of the person's guilt of, or the person's conviction of an offense in another jurisdiction that is essentially the same as a felony drug abuse offense; or a finding by a court of the person's eligibility for treatment in lieu of conviction in another jurisdiction,

WHEREFORE, PURSUANT TO SECTION 3719.121(C), ORC, YOU ARE HEREBY NOTIFIED THAT YOUR LICENSE TO PRACTICE NURSING AS A REGISTERED NURSE IS HEREBY SUSPENDED. Continued practice after receipt of this notice of suspension shall be considered engaging in the practice of nursing without a current, valid
It

Kimberly Anne Fryer, RN. Page 2 license, which is a violation of Section 4723.03(A), ORC. You are hereby ordered to surrender your Ohio license to practice nursing as a registered nurse, RN-228090, to the Board within ten (10) days of receipt of this notice. You are further notified that in accordance with Chapter 119, ORC, the Board proposes under authority of Section 4723.28, ORC, to deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: 1. On or about December 15, 2003, in Montgomery County Court of Common Pleas Case No. 2003 CR 03314, you pled guilty to two (2) felony counts of Theft of Drugs, in violation of Section 2913.02(A)(2), ORC, and two (2) felony counts of Illegal Processing of Drug Documents, in violation of Section 2925.23(A), ORC, and were found eligible for Intervention in Lieu of Conviction. The acts underlying your guilty plea and the finding of eligibility for Intervention in Lieu of Conviction involve you, on or about August 4, 2003, while working as a registered nurse at Kettering Medical Center in Kettering, Ohio, obtaining Meperidine (Demerol) for your personal use from the PYXIS under patients' names. Upon meeting with Kettering Medical Center security and the Clinical Nurse Manager about discrepancies in your withdrawal of medications from PYXIS, you indicated that you had a drug problem and had been obtaining medications, primarily Demerol, from the PYXIS for approximately two years, On September 9, 2003, you admitted to an Ohio State Board of Pharmacy Compliance Agent that you had taken drugs from PYXIS for your personal use on two occasions on August 4, 2003. Section 4723.28(B)(4), ORC, authorizes the Board to discipline a licensee for conviction of, a plea of guilty to, a judicial finding of guilt of, a judicial finding of guilt resulting from a plea of no contest to, or a judicial finding of eligibility for intervention in lieu of conviction for, any felony. Section 4723.28(B)(5), ORC, authorizes the Board to discipline a licensee for conviction of, a plea of guilty to, a judicial finding of guilt of, a judicial finding of guilt resulting from a plea of no contest to, or a judicial finding of eligibility for intervention in lien of conviction for, violating any municipal, state, county, or federal drug law. Accordingly, the Board is authorized to impose one or more of the sanctions as cited in Section 4723.28, ORC. In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing in this matter. If you wish to request such hearing, the request must be made in writing and must be received in the Board office within thirty (30) days of the time of mailing of this notice.

Kimberly Anne Fryer, R.N. Page 3

You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Bdard, or you may present your position, arguments, or contentions in writing. At the hearing you may also present evidence and examine witnesses appearing for and against you_ Should you choose to request a hetaring, please mail or deliver the request, in addition to any other correspondence regarding this matter, to: Lisa Ferguson-Ramos, Compliance Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, Ohio 43215-3413. if the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Immediate Suspension arid Opportunity for Hearing, deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely, r

80/0
Bertha Lovelace, RN., BA., C.R.k,A. Supervising Member

Certified Mail Receipt No. 7003 3110 0005 0231 2406 cc: Katherine Bockbrader, Assistant Attorney General Holly Fischer, Assistant Attorney General

Case #13-000628

Ohio Board of Nursing'

17 South High Street, Suite 400
Columbus,

www.nursing.ohio.gov

Ohio 4p215-74.10 m (61.4).466-3947

March 22, 2013

NOTICE OF OPPORTUNITY FOR HEARING.

Kimberly Rose Gates, L.P.N. 1045 Parkside Avenue Alliance, Ohio /I/1601 Dear Ms. Gates: In accordance with Chapter 119. of the Ohio Revised Code (ORC), you are hereby notified that the Ohio Board of Nursing (Board) proposes under the authority of Section 4723.28, ORC, to deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: 1. On or about June 1, 2012, in Alliance Municipal Court Case No. 2012CRB-00679, you were convicted of one (1) count of Possession of Drug Paraphernalia, a misdemeanor of the fourth degree, in violation of 2925.14 (C)(1), ORC; and one (1) count of Possession of Drugs, a minor misdemeanor, in violation of 2925.11(A), ORC. The events underlying your conviction occurred on or about April 25, 2012, in Alliance, Ohio, and involve you being found in possession of marijuana and a glass pipe. Section 4723 .28(B)(5) [as in effect prior to March 20, 2013], ORC, authorizes the Board to discipline a licensee for conviction of, a plea of guilty to, a judicial finding of guilt of, a judicial finding of guilt resulting from a plea of no contest to, or a judicial finding of eligibility for intervention in lieu of conviction for, violating any municipal, state, county, or federal drug law. Accordingly, the Board is authorized to impose one or more of the sanctions as cited in Section 4723.28 ORC.
)

You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in writing. At the hearing you may also present evidence and examine witnesses appearing for and against you.

Kimberly Rose Gates, L.P.N. Page 2 Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to: Lisa Ferguson-Ramos, Compliance) Unit Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, OH 43215-7410, or to the email address, hearin_g@nursin If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Opportunity for Hearing, deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely,

HA/
Rhonda S. Barkheimer, C.N.P. Supervising Board Member Certified Mail Receipt No. 7012 2210 0000 6272 3384 cc: Henry G. Appel, Senior Assistant Attorney General

Case #12-004738

Ohio Board of Nursing

www.nursing.ohio.gov
e

17 South High Street, Suite 400 -0 Columbus, Ohio 43215-74.10

(614) 466-3947

March 22, 2013

NOTICE OF OPPORTUNITY FOR HEARING

Maragene Marie Graham, L.P.N. 9810 Bradner Road Risingsun, Ohio 43457 Dear Ms. Graham: In accordance with Chapter 119. of the Ohio Revised Code (ORC), you are hereby notified,that the Ohio Board of Nursing (Board) proposes under the authority of Section 4723.28, ORC, to deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: 1. On or about June 6, 2011, in Wood County Court of Common Pleas Case No. 2009-CR-0298, you pled no contest to, and were found guilty of, one (1) amended count of Attempted Arson, a fifth-degree felony, in violation of Sections 2909.03(A)(2) & 2923.02(A), ORC. The events underlying your conviction occurred on or about April 18, 2008, in Fostoria, Ohio. Section 4723.28(B)(4) [as in effect prior to March 20,2013.1, ORC authorizes the Board to discipline a licensee for conviction of, a plea of guilty to, a judicial finding of guilt of, a judicial finding of guilt resulting from a plea of no contest to, or a judicial finding of eligibility for intervention in lieu of conviction for, any felony. Accordingly, the Board is authorized to impose one or more of the sanctions as cited in Section 4723.28 ORC. You are hereby further informed that, if you timely request a hearing, you are entitled to appear at, such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Bdard, or you may present your position, arguments, or contentions in writing. At the hearing you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to: Lisa Ferguson-Ramos, Compliance Unit Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, OH 43215-7410, or to the email address, hearin @nursin .obio.' ov.

Maragene Marie Graham, L.P.N. Page 2

if the Board fails to receive a request for a hearing within thirty (NO) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Opportunity for Hearing, deny,. permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely, At z Rhonda S. Barkheimer, R.N., C.N.P. Supervising Board. Member Certified Mail Receipt No. 7012 2210 0000 6272 3360 cc: Henry G. Appel, Senior Assistant Attorney General

Case # 11-000670

'Ohio Ro:ard ,.of Nursing

www.nursing.ohio.gov
a

17 South High Street, Suite 400 0: Columbus, Ohio 43215-7410 6 (614) 466-3947

March 22, 2013

NOTICE OF OPPO*TUNITY FOR HEARING

Jacquelyn Ann Grate, L.P.N. 406 Grate Road Patriot, Ohio 45658 Dear Ms. Grate: In Accordance with Chapter 119, Ohio Revised Code (ORC), you are hereby notified that the Ohio Board of Nursing (Board) proposes under authority of Section 4723.28 ORC, to deny, revoke, permanently revoke, suspend or place restrictions on your license to practice nursing as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: 1. On or about March 21, 2011, in Gallia County Court of Common Pleas Case No. 10 CR 299, you pled guilty to two (2) counts of Assault of a Peace Officer, both fourth-degree felonies in violation of Section 2903.13(A), ORC. You were subsequently sentenced to two (2) years community control sanctions, including but not limited to completion of an Anger Management Program. The acts underlying your conviction occurred on or about November 30, 2010 in Gallia County, Ohio and involve knowingly causing or attempting to cause physical harm to a Gallipolis Police Department officer and a Gallia County Sheriff's Office officer. Section 4723.28(B)(4) [as in effect prior to March 20, 2013] ORC, authorizes the Board to discipline a licensee for conviction of, a plea of guilty to, a judicial finding of guilt of, a judicial finding of guilt resulting from a plea of no contest to, or a judicial finding of eligibility for intervention in lieu of conviction for, any felony or of any crime involving gross immorality or moral turpitude. 2. On or about May 4; 2011, the Ohio Department of Job and Family Services terminated your Medicaid Provider Agreement No. 3022124, thereby prohibiting you from providing care to Medicaid consumers. Section 4723.28(B)(1) [as in effect prior to March 20, 2013], ORC, authorizes the Board to discipline a license for denial, revocation, suspension, or restriction of authority to practice a health care occupation, including nursing, for any reason other than a failure to renew, in Ohio or another state or jurisdiction.

Jacquelyn Ann Grate, L.P.N. Page 2

Accordingly, the Board is authorized to impose one or more of the sanctions cited in Section 4723.28, ORC. In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing in this matter. If you wish to request such hearing, the request must be made in writing and must be received in the Board office within thirty (30) days of the time of mailing of this notice. You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in writing. At the hearing, you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to Lisa Ferguson-Ramos, Compliance Unit Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, Ohio 432157410 or to the email address, hearing@nursing.ohio.gov. If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Opportunity for Hearing, deny, revoke, permanently revoke, suspend, or place restrictions on your license to practice nursing as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely, -74.2..2777,z,,-0 ,/g:It.,zr4 Rhonda S. Barkheimer, R.N., C.N.P. Supervising Board Member Certified Mail Receipt No. 7012 2210 0000 6272 3629 cc: Henry G. Appel, Senior Assistant Attorney General A/

Case #12-007231 & 13-000050

Ohio Board of Nursing

17 South High Street, Suite 400 March 22; 2013

www.nurs. rig ol-ti.o.gov

(614) 466-3947

Columbus, Ohio 43215-7410

NOTICE OF AUTOMATIC SUSPENSION AND PPO TUNITY FOR HEARING

Michelle Caryl Gumbert, R.N. 1400 Pebble Court Cincinnati, Ohio 45255 Dear Ms. Gumbert: You are hereby notified that, on or about March 20, 2009, you entered into a Consent Agreement (March 2009 Consent Agreement) with the Ohio Board of Nursing (Board), a copy of which is attached hereto and incorporated herein, in which you agreed with the Board that your license to practice nursing as a registered nurse in the State of Ohio would be suspended indefinitely and that such suspension would be stayed subject to probationary terms, conditions, and limitations for a minimum period of three (3) years. Attached to an incorporated within the March 2009 Consent Agreement is a May 16, 2008 Notice of Opportunity for Hearing. A. Item 12. of the March 2009 Consent Agreement states, "Beginning sixty (60) days from the effective date of this Agreement and throughout the probationary period, MS. GUMBERT shall submit, at her expense and on the day selected, blood or urine specimens for drug and/or alcohol analysis at a collection site specified by the Board at such times as the Board may request. Upon and after MS. GUMBERT's initiation of drug screening, refusal to submit such specimen, or failure to submit such specimen on the day she is selected, or in such a manner as the Board may request, shall constitute a violation of a restriction placed on a license for purposes of Section 4723.28(B), ORC. This screening shall require a daily call-in process. The specimens submitted by MS. GUMBERT shall be negative, except for substances prescribed, administered, or dispensed to her by another so authorized by law who has full knowledge of MS. GUM ERT's history of chemical dependency and recovery status." Despite this provision, on the dates set forth in Attachment A, attached hereto and incorporatid herein, you failed to call Firstlab, the Board's random drug/alcohol screen program administrator, to determine if you had been selected to provide a specimen for analysis. Furthermore, on the following dates, you were selected to provide a specimen for analysis and failed to do so: December 3, 2012; December 6, 2012; and January 2, 2013.

Michelle Caryl Gumbert, R.N. Page 2 Section 4723.28(B)(17), Ohio Revised Code, ORC, authorizes the Board to discipline a licensee for violation of any restrictions placed on a nursing licefise by the Board. In accordance with the paragraph under "FAILURE TO COMPLY" of the March 2009 Consent Agreement, you are hereby notified that it appears to the Board that you have violated. Item 12. of the March 2009 Consent Agreement. 1 YOU ARE FURTHER NOTIFIED THAT YOUR LICENSE TO PRACTICE NURSING AS A REGISTERED NURSE, RN-288385, IS HEREBY AUTOMATICALLY SUSPENDED. Continued practice after receipt of this notice of suspension shall be considered engaging in the practice of nursing as a registered nurse without a current, valid license, which is a violation of Section 4723.03(A), ORC. You are further notified that in accordance with Chapter 119, ORC, the Board proposes under authority of Section 4723.28, ORC, to deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: 1. On or about March 20, 2009, you entered into a Consent Agreement (March 2009 Consent Agreement) with the Ohio Board of Nursing (Board), a copy of which is attached hereto and incorporated herein, in which you agreed with the Board that your license to practice nursing as a registered nurse in the State of Ohio would be suspended indefinitely and that such suspension would be stayed subject to probationary terms, conditions, and limitations for a minimum period of three (3) years. Attached to an incorporated within the March 2009 Consent Agreement is a May 16, 2008 Notice of Opportunity for Hearing. 2. Item 12. of the March 2009 Consent Agreement states, "Beginning sixty (60) days from the effective date of this Agreement and throughout the probationary period, IVIS GUMBERT shall submit, at her expense and on the day selected, blood or urine specimens for drug and/or alcohol analysis at a collection site specified by the Board at such times as the Board may request. Upon and after MS. GUMBERT's initiation of drug screening, refusal to submit such specimen, or failure to submit such specimen on the day she is selected, or in such a manner as the Board may request, shall constitute a violation of a restriction placed on a license for purposes of Section 4723.28(B), ORC. This screening shall require a daily c 11 in process. The specimens submitted by MS. GUMBERT shall be negative, except for substances prescribed, administered, or dispensed to her by another so authorized by law who has full knowledge of MS. GUMBERT's history of chemical dependency and recovery status." Despite this provision, on the dates set forth in Attachment A, attached hereto and incorporated herein, you failed to call Firstlab, the Board's random

Michelle Caryl Gurnbert, R.N. Page 3 drug/alcohol screen program administrator, to determine if you had been selected to provide a specimen for analysis. Furthermore, on the following dates, you were selected to provide a specimen for analysis and failed to do so: December 3, 2012; December 6, 2012; and January 2, 20)13. Section 4723.28(B)(17), Ohio Revised Code, ORC, authorizes the Board to discipline a licensee for violation of any restrictions placed on a nursing license by the Board. Accordingly, the Board is authorized to impose one or more of the sanctions as cited in Section 4723.28, ORC. In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing in this matter. If you wish to request such hearing, the request must be made in writing and must be received in the Board office within thirty (30) days of the time of mailing of this notice. You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in writing. At the hearing you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to: Lisa Ferguson-Ramos, Compliance Unit Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, Ohio 432157410, or to the e-mail address, hearing@nursing.ohio.gov. If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Automatic Suspension and Opportunity for Hearing, deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars (S500.00) per violation. Sincerely, ;d, C.N.P. Rhonda S. Barkheimer, Supervising Board Member Certified Mail Receipt No. 7012 2210 0000 6272 3773 Attorney Certified Mail Receipt No. 7012 2210 0000 6272 3889 cc: Henry G. Appel, Senior Assistant Attorney General Latonia Denise Wright, Esq.

Case # 084515; 07-38I3 z 07-3504

Ohio oar of Nursing

17 &:iuth High- Str=, Suite 400

www.norsing.ohia,gov
i64) 456-3947

Cdumbus, Ohio 4'3215.7410

cpNSENT AGREEMMT
BETWEEN MICHELLE GUMBERTt AND 0E10 130ARD OF NURSING This Consent Agreement is entered iota by and between MICZELLE GOIVIBERT,11,N. (M,S. GITfrigER.T) arid the Ohio Board of i.lui-sing (Board), the state agency charged with enforcing Chapter 4723, of the Ohio Revised Code (ORC), and all administrative rules promulgated thereunder. MS. GUMMI' vohnatadiy enters late this Consent Agreement being fully informed of her rights under Chapter 119, ORC, including the right to representation by legal maim' and the right to a formal adjudicative hoaxing on the issues considered herein. This Consent Agreement contains the entire agreement between the parties, there being no ether agreement of any kind, verbal or otherwise, which varies the terms (if this Consent Agtooment.

DAsISFOR.ACTICO
This Consent Agreement is entered into on the basis of the following stipulations, admissions and understandings: A. Tice Board is empowered by Section 4723.28, ORC, to deny, permanently mvoke, rovoRe, suspend, or place restrictions on any Ilcensts issued by the Board; reprimand or otherwise discipline a licence; or impose a fine of five hundred dollars ($500.0D) or less per violalion. Section 472128(8)(ft ORC, authorizes the Board to discipline a licensee for litilure to practice accordance with acceptable and prevailing standards of safl nursing care. Section 4723.20)(20, ORC, authorizes the Batted to dinipI,We a licensee for, in the case of a registered nurse, engaging in activities that exceed the practice of musing as a registered nurse. Section 4123_28(B)(16), ORC, authorizes the Board to discipline a licensee for violation of Chapter 4723, CRC, or any rules adopted under it, Specifically, Rule 47211406M, Ohio Administrative Code, states that a licensed nurse shall in a complete, accurate, and tirnoty rmwer, report and do not nursing assessments or observations, the care provided by the nurse for the client, and the client's response to that care. Rule 4723-4-46(1-1) Ohio Administrative Code, states that a licensed nurse shall implement measures to promote a safe erwirOiltuea for each client. Rule 4723-4.06(F), Ohio Ariralnistrative Cods, states that a ticemsed num shall, ilk art accurate and timely manner, It-port to the

Michelle Ournbart, Page 2 appropriates praotitioner aaors in or deviations :from the =ant valid orider. Rtde 412-4-06(P), Ohio Adtnissisixattve Codes states that a lioertscd nurse shall not submit or mere t be submitted any false, atislcadiug, or deceptive staterdents, infori,4.011# or doctuntmtation to the Board, to wait employers, or to any future employers for positioas requiring s. aurginglicnse, B. MS. GrRi410a's license to practice nuxsing4 as a registemd nurse in the State of Ohio, RN-288385, was initially issued! on January 2,6, 200Q. MS. GINRERT was 4censed_ to practice nuttirtg in the State of Indiana in )uly 2008. MS 0t, OR placed her Ohio nursing license on insc6va status on October 2, 2008. On, May 16, 2008, the Board ixsuect a Actiaa of Oppomtity far Rang (May 2008 Notice) against MS, GrihraElart lioense, A nue and accurate copy of the May 2008 Notice it attached he.reto and imorporateAi here& MS, GilltetERT knowingly and voinntarily admits to the faatlifil and legal aliegatiens set Oat in the May 2008 Notice.

C.

I).MS. GOMM' states she resigned from her employment with Mercy Hospital. MS. GUM BERT also states that she did, inform Bethesda North of her employment at Sowiat Hospital at the time alter in-person interview although she did not include, this information in her employment application and forms completed and submitted online. R. Between April 2008 and June 2008 while employed at Bethesda North Hospital, NIS, 0-1D.WCBERT failed to withdraw medications, according to physician's orders, inconsistmtly documented medication waste, and failed to consisteutly and accurately document the administration of controlled medications. MS. GUMBERT explains at the dis%.eponeies delineated in the May 2008 Notice ate a result of her lax documentation practices. denies that she is chemically dependent. XvM. GUMBERT, MS. GUM 3J through eounscl, submitted an Alcohol and Dreg Assessment of MS. GUMBERT completed on November 29, 2007 indicating that MS. Akti, MS. GUMBERT did not appear alcohol or drug dependent, GUMMY submitted a negative drug screen dated November 27, 2007 required by MS. GU1@'BER1",s employer. MS. GITIVLBEIZT states that site is willing to cooperate with tha Board_

F.

lwlitrireiie Clinsabert, P-I4',

Page 3

ArEEP.XLCIODEUM
Wherefcre, in consideration of the foregoing and mutual promises hereinafter set lore sad, br iieo of ar(y formal proceedings at this time, MS, GUiViariatT latovringly end voluntatily ads with the Board to the following tams, carnations, and limitations: MS, GUNUREritrs license to practice nursing as a registered nurse shall be suspended indefinitely. After inmcessitifiy completing the mgairernents and conditions of tiiis Consent Agrwment and upon prior approval by the Guard or its ctesignce, such anapension shall be stayed, subject to the following term, conditions, and limitations for a tainknwa period of d=e, Yezn: I. MB. GUMBERT slezll obey all federal., svire, cart lor.s1 laws, ail laws and. zi&E; go\vaning the practice of nursing in Ohio, 21. MS. OUP' T shall appear in person for interviews tefonc the Pa&t Board or i desi*,ated representative as requested by the Board or its desigilee. 3, MS, GUMBERT ,shall not work as 0 nurse b the State of Gluon 4nti/ after 31, 2009, and MS, GOACKERT obtains prior approval by the Bowl or its designee and is in Nil compliance with this Consent Agreement. 4, MS. GTIMBERT agrees that she will submit a request to the Bureau of Criminal Identification and Investigation (CU) to conduct a criminal, records check of MS. GUMBERT, including a check of Federal )3ateau of Investigation (FliI) records, and request Bell to submit MS. GUMBERrs criminal records check reports to the Board. MS. GUMBERT completed criminal records check, including the FBI check, must be received by the Board prier to requesting approval to work as a nurse ba the State of Ohio. Bducationni Needs Assessment and Learning Plan 5, Prior to requesting approval to work as a mine in the State of Male, MS. GUIVERERT shall establish contact with a naming educator approved by the Board who has no leas than a master's degree and who is affiliated with a nursing educational program and MS. GUMS I' shall have the educator provide the Board with a written Tr-port of an assessment of MS. GUM BERT, which identifies MS, GUMBERT'a Jcnowledgetpractiec deficiencies and remedial educational needs. Prior to the assessment, MS. GUMBElla shall provide the nursing educator with a copy of this Consent Agreement and the tittahnaants and shall submit to any nursing skills or knowledge assessments required by the educator. M. GrUMBYRT shall also =cute releases prior to the assessment to permit the educator to obtain any information deemed appropriate and necessary for the assessment including information from S. GUIVLBERT's employer(s), former employers, and Board staff. Following the assessment, MS. GUMBERT shall have the Educator :poovide the Bowl with a copy of a learning plan developed by the educator for MS, GUMIIERT and shall obtain approval of the learning plan by the Board or Its designee, The leaning plan shall identify specific reinediation that MS. GtiMnirr shall complete to address any knowledgepreetiee deficiencies and remedial educational needs identified by the educator and shall identify the time frame during which MS. GOMBERT shall complete such learning plan. Prior to

lvitchelle Gutchert, Page 4 ceotesattg approval in work as a nurse by e &tutt or u-s &atm, Mg, GI:linlarr gall successfully ecimplete and submit satisfactory doenineutaiion of sucess)N completion of the learning plan within the time frame specified in the learning piagh 0.unam. T that( be msponsillie for all coas assoeiatecl with obtain" mquiretneuts of the teaming plan. and meeting the

fez MS. GITMERT lire succesdatly complorad the teort(thrg Om and prior 6e MS. pawreatiog, approval to wort an a mane by the luazia or its acsigneo, the shall provide the Board with azt assessment and any recornanendatioas for additional remedial education anther restrictions that should be placed on MS. GUlt?i E1.Vs li.C41U0 practice. Furthermore, the educator shall provide to the Board a written opinion stating whether M.S. GOMM is capable of practicing nursing according to acceptabie and prevailing standards of see pursing care. The Board may Oft the odoetor's recommendations and conchtsioas from the assessment as a bmis for additional terms, conditions, and limitatiOns on MS, GUMEtz ra 8. the avant Sing the educator's reetbnIllaentlations require MS, G.b:_lii,CMERT to have at nave nursing license, the Board may allow IteYS., GUMERT to work wider the learning plan with an active license as a registered nurse that is restricted to the limited use and sal; purpose of completing the educator's recommendations. For all other uses and purposes, GYJMBERT's license shall remain suspended.

9. MS, GUMMI' agrees that she shall not gain or attempt to gain employment as a registered nurse in the State of Ohio until she has completed the requirements rtd conditions set forth in this Agreement. Monitoring of Rehabilitation and Treatment i 10.Witt six (6) mouths of the ellactive date of AA Agreetalent, MS. GUMMI' all, at her own expense, seek, a chemical dependency evaluation by a Board approved chemical dependency professional and shall provide the Board with complete documeptAtion of this evaluation. Prior to the evaluation, MS. GM/13MT shall provide the chemical dependency professional with a copy of this Consent Agreement with the May 2008 Motive. nuttier, MS, GUMMI' shall execute releases to permit the chemical dapendencY professional to obtain any information deemed appropriate and necessary for the evaaratioa, 'rho chemical dependency professional shall submit a written opinion to the Board that includes diagnoses, recommendations for treatnent and monitoring, and any information deemed appropriate and necessary for the evaluation, The chemical dependency professional. shall submit a written opinion to the Boar' that includes any additional restrictions to be placed on MS. GIUMBERT's license to practice, and stating whether MS, GT.ThIBERT is capable of practicing nursing according to acceptable and prevailing standards of safe nursing care. Ekr shall provide the Board with satisfactory decurrontation of compliance 31. MS. 4.~ with all aspects of the treattnerlt Pitt developed by the chemical dependency profeit,sional described above until released. Further, M GTIMBERT agrees that tbc Board may native 4

Oumbe.rt, Page the professional's rwommenclations and conclusions fr<rtn the eyaination as a basis for additional terms, conditions, and limitations on M. GUMMER.ro license and that the tzrms acadions, and limitations shall be incorporated in an addendum. te this Consent greement. g (60)'ova from the effective date a we . iikutamalitt and aimightrat the probadonary period, 1W-S. GEIMBERT shall submit, at her expanse end on the day selected, blood or Uritigi specimens for drug and/or alcohol analysis at a collectka site specified by the Boat'd at such times as the Board may request. Upon, and efte VA. GIIMMItre initiation of drug saraming, pausal to submit such rpecirmrt, or failure to gain-nit such specimen on the day she is selected, or in suoh a manner as the Board may request, shall Miattute a violation of 8 restriction placed on a license ;Fier purposes of Section 4123.28(1 ), CRC. This screening shall require a daily csil-ia prt:coss. The specimens submitted by MS. GUMBERT shall be negative, except for Babstaano9 presMbed, administered, or diSperised to her by anotbet so authorized by law who has fa Rnowlodg of M&. GTWinatra history. of chemieal dependency and recovery status. a. Within thirty (SO) days prior to MS. GMVE4318RT initiating drag screoning, M. GUMBERT shall provide a copy of this Consent Agreement and the May 2008 Notice to all treating practitioners and shall provide to the Board a list of all treating practitioners, ineinding addresses and telephone timbers. and cause all treating practitioners to complete a medication prescription report that is to be mailed by the practitioner directly to the Board. The medication report is to be completed for any and all substances prescribed, administered, or dispensed to MS, (UMBERT. b. After initiating drug =ming, MS. GIIMSERT shell bc under a cc:dinning duty to provide a copy of this Consent Agreement and the May 2008 iklotice, prior to initiating treatment, to additional treating practitioners, and to update the list of treating practitioners with the Board within forty-eight (48) hours of being treated by another practitioner. Father, MS. GUMIUIRT shall notify the Board of any and all reedication(s) or prescription(s) received within twenty-four (24) hours of release from hospitalization cr medical tmattnont. Xmplayer *ezA,rtit-fi i3. Prior to accepting employment as a aurae in the State of Ohio, each time and with every employer, MS, GUIABLMIC shall notify and obtain approval from the Board or its designee. 14. IdWar receiving approval to work as a reuse MS. GUMMI', if working in a position in which a nursing license is required, shall provide her emploYer(s) with a copy of this Cangallt Agreement and the May 2008 Notice, Further, MS. GUMIMMT is under a continuing duty to provide a copy of this Consent Agreement with attachments to any new employer prior to accepting onviament, lam. OXYMBERT shall have her employer(s), if work* in a position where a nursing license is required, submit written reports regarding job Nrforrnallt0 on a quarterly basis., MS. OLIMBERT vhail have her empioyot(s) send

Michelle Garribee, R.N. Pne 6 docuittnmtion. to .the lam, along With the fimt employer report, of receipt of a copy of to Consent Agreement and the May 2008 Notice, imolitding the date they ware received, Report:L:1g Reriokennenta of Ueen'M 15, MS. GUll. )1RT shah report to the Board, in wiling, any violation Agreenamt within thisty (30) days of the ocouti.ence of the violaton.,

or this Consent

16.MS. GUMBEMT shad si release of information forms allowing h.4altix profeesionals nnd other organizations to submit the requested documentation directly to the BOWL. 17.la. GUMS" ERT still submit any and all information that the Board may request regardin,g her ability to pr ti according to acceptable and prevailing staridards of see nurs1ng pzuctiee. .T shall not submit or cause to be submitted any false, ivialeading, car 13, MS, (I deceptive statements, information, or doom-mutation to the rieerd as to employers or potential employers, 19,14S. GUKBERT shall submit the reports and documentation required by this Consent Agreement on forma specified by the Bowl, All reporting and communications required by this Consent Agreement shall be made to the Compliance Unit of the Board, 20, MS. GUMBERT shall aubmit the imports and doennaontation regained by this Consent, Agreement or any other documents required by the Board to the attention of the. Compliance Unit, Ohio Board of Nursing, Vi South High Street, Suite 400, Columbus, Ohio 43215,7410. 2L MS, GU/VIBERT ahatl verify that the reports and documentation required by this Consent Agreement are received la the Board office, 22. MS, GUMBERT shall, inform the Board within five (5) business diva, in writing, of any change in employment status or of any change in residential or home address or telephone number. keLltiacrartittlggitignaim MS. GUMBERT further knowingly and voluntarily agrees with the '.card to the following PERMANENT LICENSURE RPSTRICTIONSz Unleas otherwhe approved in admanse by the Board or its deateee MS, GUMBERT shall not practice .nursing as a rang taxed nurse (1) for agoticies providing home care in the patient's residonee; (2) for hospice, care programs providing hospice care in, the patient's re,sidencci (3) for staffing agencies or pools; (4) as an, independent provider where the taurse provides nursing care and is mirthursed for services by the state of Ohio through State agencies or kgaltS of the State; er (5) for an individual or group of individuals who directly engage MS,

KirinIle Gumbert, R.N. E'age 7 GUMERT fo prosidu nursing services. fog fees, componsgion, or other consideration, or as a voinnteer, M& Useless otherwise approved in tielvEmem by the Bid ar ita dies GtIl'OMT shall not function in a position or emplomeat wheyp.i the job duties or nsquiretnenta involve maongemant of nursing and naming responsibilities, or supervising and evaluating nursing practice. Such positions 'include, but are not limited to, the foLlowing; Director of, Nursing, Assistant Director of Nursing, Nurse Manager, Vice Pinsirlent Nunt14,

Zolimmam.t.bigmft,E
MS. GUMBMT shad not adminisint, have aCCaRS to, or possess (except as prescribed fur S. GUIVilIERT's Imo by another 6o arrthorized by law who ba.9 ' fall knowledge of MS. GUMBERT's history) any XIIIMcstis, other controlled substances., or mood Ong drugs for a minimum of six (6) mwthszu which, MS. OUIViltiERT is working in a position that requires a twain license, At any time after the six (6) mouth period previously described, MS, 011.MUER.T may submit a mitten =pest to the Board to have this restriction xv-evalttated, addition, MS. GTIVIBERT shall not, possess or carry any work keys for lacked medication carts, cabinets, drawers, or containers. MS. GYJMIBERT shall not connt narcotics. MS. GUMBEIRT shall not call in or order 7,nescriptions or prescription refills for BELIVOtiOg, other controlled substances, or mood altering drugs.

2AUMFL-T.,QCONCELX
GUMBERT 0,9xees that upon /3oard approval to return to the practice of nursing her license to practice nursing as a registered nurse will be automatically suspended if it appears .to the Board that M. GUMMIrlf has violated or breached any terms or cortditions of the Consent Agreement, Following the automatic suspension, the b'oar'd shalt notify MS. GUM:BURT via certified mail of the specific nature of the charges and automatic suspension of her licease. Upon receipt of this notice, MS. GUAM= may request a hearing regarding the charges.

The above described terms and conditions shall constitute 'restrictions placed on a license" for purposes of Section 4723.23(B), ORC. If, in the discretion of the Bead, MS. GUMBERT appears to have violated or breached any terms or conditions of this Consent Agreement, the Board reserves the right to institute formal disciplinary proceedings for any ad all possible violations or breaches, Including, bur not limited to, alleged violations of the laws of Ohio ccoutriug before the effective date of this Consent Agreement. AUX-633.0-MLODIXICAnalSarnaS The terms, limitations, and conditions of this Consent Agrtemeat, other than the permanent lint sune =striations, may be modified or terminated, in writing, at any time upon the niVerttent of both MS. GUMBERT and the Board-

Citunhert, RN. Page 8 'The Board nnty only alter the probationary period imposed by this Colts :t AD'eereent L (1) the MI' has complied with ail tweets of this Cortsett Bartel determines that 10. GUM Agreement; and (2) the Beard detemines that MS,. Gt.11.08R,T is able K.% prantice according to acaeptable and prevailing standards a safe nutsing care without 13oard monitoring, based upon tn interview with IBS. GO/vtitERT Eta, MY161Y of the -eparts as retttOod herein, Any period during which MS. QtifvflMT does not work In a position for which a nursing lieertge is Mtzired shall not count toward fulfilling rite probationary period imposed by this Conseut A gmarnont, "'
-1 0 1 .

GUKEIFAT acknowledges that she has had sal oppormity to ask questions concerning the terms c this Consent Agreement and that all questios asked, have been answered in a satisfactory manner. MS. GUMBERT waives all of her rights under Chapter 1.0, ORC, as they relate to inatters.that are the subject this COMErilt Agfnerflellt.

MS. GU PT waives any and all claims or causes of action she may have against the Board. Rid its members, officers, employees and/or agents arising out of matters, which are the subject of this Consent Agreement. This Consent Agreement shall be considered a public record as that term is used in Section 14943, ORC. The infonnation contained herein may be mperted to appropriate organizations, data banks, and governmental bodies. This Consent Agreement is not an adjudication order as discussed in Chapter 119, ORC. Any notion initiated by the Bead based on alleged violation of this Consent Agreement shall coati* vigil the AdalinigratiVO PtOcedlIttS Act, Chapter 10, ORC.

Micballe Culbert, RN,

7:giv . CikaPAIS

- MS, GETNEBEIZT trac.le,rttaT4e that this Cw.samt Agraornart k subject to Meiettti= by the Plonrd ttpon tho last data pf priox f,3: signatvit 153r tli. ":80avi PrePtidmt F3_ml shalt 1.v=me effecttveti Apattira below. ,J, MLR GUMBERTy

I 1

aLi

7 DENISE wmturr Camase1 tax. Miaaefie (lambert, LN.

Case #07-3504 ez 07-3813 No4,4>

Ohio oard of Nursing

www,pursing.ohio.gov

17 South High Street, Suite 400 . Columbus, Ohio 43215-7410 <, (614) 466-3947

May 16, 2008

NOTICE OF OPPORTUNITY FOR HEARING

Michelle Gumbert, R.N. 2 Otter Court Amelia, Ohio 45102 And 742 Wilfert Drive Cincinnati, Oho 45245 Dear Ms. Gunthert: In accordance with Chapter 119. of the Ohio Revised Code (ORC), you are hereby notified that the Ohio Board of Nursing (Board) proposes under the authority of Section 4723.28, ORC, to deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: A. While working as a nurse in the Emergency Department of Mercy Anderson Hospital in Cincinnati, Ohio, you acted in the following manner: 1. You withdrew Hydromorphone (Dilaudid) and Phenergan for Patient #1 on October 11, 2007, at 13:02,- although the patient did not have a physician's order for either medication. (All patients are identified on. the Patient Key, which is confidential and to be withheld from public disclosure). You did not document administration or waste of the Dilaudid and Phenergan you withdrew. You withdrew Phenergan for Patient #2 on October 11, 2007 at 15:43. Patient #2 did not have a physician's order for Phenergan. You did not document administration or waste of the Phenergan. You withdrew Dilaudid 1mg for Patient #2 on October 11, 2007 at 15:43 and 17:29 for a total of 2mg. Patient #2 had a physician's order for a single dose of Dilaudid ling, which you documented administering at 15:50, You did not document administration or . waste of the remaining Dilaudid 1mg,

2.

3.

Michelle Gumbert, Page 2 4. You withdrew Lorazepam 2mg for Patient #3 on September 19, 2007 at 09:24, although you were not assigned to care for this patient. Patient #3 had a physician's order for a single dose of Ativan (Lorazepam) 0.5mg, which another nurse documented . administering at 09:45. You did not document administration or waste of the Lorazepam you withdrew. You withdrew 2 Hydrocodone tablets for Patient #4 an October 5, 2007 at 12:39, although the patient did not have a physician's order for the medication. You did. not document administration or waste of the Hydrocodone you withdrew. You withdrew Phenergan for Patient #5 on October 5, 2007 at 17:15, although the patient did not have a physician's order for the medication. You did not document administration or waste of the Phertergan. You withdrew Dilaudid 2rng for Patient #5 on October 5, 2007 at 17:15 and 17:41 for a total of 4mg. Patient #5 had a physician's order for a single dose of Dilaudid Img, which you. documented administering at 17:17. You did not document administration or. waste of the remaining Dilaudid 3mg. You withdrew Phenergan for Patient #6 on October 6, 2007 at 07:54, although the patient did not have a physician's order for the medication, You did not document administration or waste of the Phenergan. You withdrew Dilaudid 2ing for Patient #6 on October 6, 2007 at 07:52 and 09:02 for a total of 4mg. Patient #6 had a physician's order for a single dose of Dilaudid Irrig, which you documented administering at 08:17. You did not document administration or waste of the remaining Dilaudid 3mg. You withdrew Phenergan for Patient #7 on October 6, 2007 at 10:58 and 13:34, although the patient did not have a physician's order for the medication. You did not document administration or waste of the Phenergan. You withdrew Dilaudid Img for Patient #7 on October 6, 2007 at 10:58 and 13:34 for a total of 2trig. Patient #7 had a physician's order for a single dose of Dilaudid 1mg, which you documented administering at 10:46. You did not document administration(or waste of the remaining Dilaudid Img.

5.

6.

7.

8.

9.

10.

11.

Michelle Gurnbert, R.N. Page 3 12, You withdrew Phenergan for Patient #8 on October 10, 2007 at 07:24 and 8:50, although the patient did not have a physician's order for the medication and was discharged to the operating room at '08:30. You documented administration of Phenergan 12.5mg at 8:29, although there is no physician's signature or indication of a verbal or telephOne order for this dose. You did not document administration or waste of the remaining Phenergan. You withdrew Dilaudid lmg at 07:23 and Dilaudid 2mg at 08:50 for Patient #8 on October 10, 2007, although the patient did not have a physician's order for the medication. You documented administering Dilaudid 2mg at 08:30, although there is no physician's signature or indication of a verbal or telephone order for this dose. You did not document administration or waste of the remaining Img. You withdrew Lorazeparn 2mg for Patient #9 on October 10, 2007. at 9:50, Patient #9 had a physician's order for' a single dose of Ativan (Lorazepam) 1mg, which you documented administering at 9:44. You did not document administration or waste of the remaining ling. You withdrew Dilaudid 2mg for Patient #10 on October 6, 2007 at 09:02, 11:42, and 13:41 for a total of 6mg. Patient #10 did not have a physician's order for Dilaudid. You did not document administration or waste of the Dilaudid. You withdrew Phenergan for Patient #10 on October 6, 2007 at 09:02 'and 13:41, although the patient did not have a physician's order for the medication. You did not document administration or waste of the Phenergan. You withdrew Morphine Zang for Patient #10 on October 6, .2007 at 11:42, although the patient did not have a physician's order for the medication at the time. You did not document administration or waste of the Morphine. You withdrew Morphine 4ing at 13:41, and documented administration at 14:03 when Patient #10 had a physician's order for a single dose of Morphine 10mg.

13.

14.

15.

16.

17.

Section 4723.28(B)(19), ORC, authorizes the Board to discipline a licensee for failure to practice in accordance with acceptable and prevailing standards of safe nursing care. Section 4723.28(B)(20), ORC, authorizes the Board to discipline a licensee for, in the case of a registered. nurse, engaging in adtivities that exceed the practice of nursing as a registered nurse. Section 4723.28(B)(16), ORC, authorizes the Board to discipline a licensee for violation of Chapter 4723, ORC, or any rules adopted under it. Specifically, Rule 47234-06(4 Ohio Administrative Code, states that a licensed nurse shall, in a complete, accurate, and timely

Michelle Gumbert, RN. Page 4 manner, report and document nursing assessments or observations, the care provided by the nurse for the client, and the client's response to that care. Rule 4723-4-06(), Ohio Administrative Code, states that a licensed nurse shall implement measures to promote a safe environment for each client. Rule 4723-4-06(F), Ohio Administrative Code, states that a licensed nurse shall, in an accurate and timely manner, report to the appropriate practitioner errors in or deviations from the current valid order.

B.

While working as a nurse at Jewish Hospital in Cincinnati, Ohio, you - acted in the following manner: 1. You withdrew Prometha.zine (Phenergan) for Patient #11 on November 26, 2007 at 18:59 and did not document Administration or waste. You withdrew Hydromorphone (Dilaudid) 2mg for Patient #11 on November 26, 2007 at 18:59. Patient #11 had a physician's order for Dilaudid 2mg every three hours as needed for pain (PRN). You did not document administration or waste. You documented administering Demerol 50mg for Patient #12 on October 28. 2007 at 11:30, although you acknowledged the discontinuation of the physician's order for Demerol at approximately 11:00. You did not Withdraw two syringes of Demerol 25mg until over two hours later at 14:01. You withdrew Phenergan 25rng on November 2, 2007 at 14:07 for Patient #13 who had a physician's order for 12.5ing every six hours PRN. You documented administration of Phenergan 12.5mg at 12:00, approximately two hours before your withdrawal. You did not document administration or waste of the remaining 12.5mg. You withdrew one Oxycodone 5mg tablet on November 2, 2007 at 14:06 for Patient #13 who had a physician's order for one Sing tablet every three hours PRN. You documented administration at 12:00, approximately two hours before your 'withdrawal.

2.

3.

4.

5.

Section 4723.28(B)(19), ORC, authorizes the Board to discipline a licensee for failure to practice in accordance with acceptable and prevailing standards of safe nursing care. Section 4723.28(B)(16), ORC, authorizes the Board to discipline a licensee for violation of Chapter 4723, ORC, or any. rules adopted under it. Specifically, Rule 4723-4-06(B), Ohio Administrative Code, states that a licensed nurse shall, in a complete, accurate, and timely manner, report and. document nursing assessments or observations, the care provided by the nurse for the client, and the client's response to that care. Rule 4723-4-06(H), Ohio Administrative Code, states that a licensed nurse shall implement measures to promote a safe environment for each client.

Michelle Gumbert, R.N, Page 5

Accordingly, the Board is authorized to impose one or more of the sanctions as cited in Section 4723.28, ORC. In accordance with Chapter 119, CRC, you are hereby informed that you are entitled to a hearing in this matter. If you wish to request such hearing, the request must be made in writing and must be received in the Board office within thirty (30) days of the time of mailing of this notice. You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in writing. At the hearing you may also present evidence and examine witnesses appearing for and. against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding.this matter, to: Lisa Ferguson-Ramos, Compliance Manager,. Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, Ohio 43215-7410. If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Opportunity for Hearing, deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation.

Sincerely, 042,41

1 4, d424044:1

Debra A. Broadnax, M.S.N., R.N., C.N.S. Supervising Board Member Certified Mail Receipt No. 7006 0810 0004 4840 8262 7006 0810 0004 4840 8279 cc: LaTonia Denise Wright Law Office of LaTonia Denise Wright, L.L.C. 11427 Reed Hartman Highway Suite 205 Cincinnati, Ohio 45241

Attorney Certified Mail Receipt No. 7006 0810 0004 4840 8286 cc: Leah O'Carroll, Assistant Attorney General

ATTACHMENT A

Michelle Gurnbert.

Missed Cali History: Oate 01/0712012 05/19/2012 06/02/2012 10/07/2012 11/04/2012 12/01/2012 12104/2012 12/05/2012 12/06/2012 12/07/2012 12/08/2012 12/09/2012 Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Misseg,Call Missed Call Missed Call Missed Call Details

12/10/2012 12/11/2012 12/12/2012 12/13/2012 12/14/2012 12/15/2012 12/16/2012 12/17/2012 12/18/2012 12/19/2012 12/20/2012 12/21/2012 12/22/2012 12/23/2012 12/24/2012 12/25/2012 12/26/2012 12/27/2012 12/28/2012 12/29/2012 12/30/2012 12/31/2012 01/01/2013 01/02/2013 01/03/2013 01/04/2013

Missed Call Missed Call Missed Call Missed Call Missed Call Missed Calf Missed,Calf Missed Call Missed Call Missed Call Missed Call Missed Cali Missed Call Missed Call Missed Call Missed Calf Missed Call Missed Call Missed Call Missed Call Missed Calf Missed Call Missed Call Missed Call Missed Call Missed Call

01105/2013 01/06/2013 01/07/2013 01/08/2013 01/09/2013 01110/2013 01/11/2013 01/12/2013 01/13/2013 01/14/2013 01/15/2013 01/16/2013 01/17/2013 01/18/2013 01/19/2013 01/20/2013 01/21/2013 01/22/2013 01/23/2013 01/24/2013 01/25/2013 01/26/2013 01/27/2013 01/28/2013 01/29/2013 01/30/2013

Missed Call Missed Call Missed Call Missed Call Missed Call Missed Cail Missed Call Missed Cail Missed Call Missed Cal! Missed Call Missed Call Missed Call Missed Call Missed Call Missed Cali Missed Call Missed Call Missed Cali Missed Call Missed Call Missed Cali Missed Call Missed Call Missed Call Missed Call

01/31/2013 'Missed Call 02/01/2013 Missed Call Row Count: 66

Case #13-000372

Ohio Board of Nursing

17 South High Street, Suite 400 March 22, 2013

www.nursing.oh.i.o.gov

Columbus, Ohio 43215-7410 e (614) 466-3947

NOTICE OF OPPORTUNITY FOR HEARING

Courtney Renee Hammons 201 Main Street PO Box 267 College Corner, Ohio 45003 Dear Ms. Hammons: On or about February 6, 2013, the Ohio Board of Nursing (Board) issued to you a Notice of Immediate Suspension and Opportunity for Hearing, a copy of which is attached hereto and incorporated herein. You are notified that in accordance with Chapter 119, ORC, the Board proposes under authority of Section 472328 of the Ohio Revised Code, ORC, to deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: 1. On or about July 24, 2012, in Hamilton County Court of Common Pleas Case Number )31201096, you pled guilty to one (1) count of Possession of Heroin, a felony of the fifth degree, in violation of Section 2925.11(A), ORC. On or about November 16, 2012, you were sentence to two (2) years of Community Control. The acts underlying this case occurred on or about February 13, 2012, and involve you obtaining, possessing, or using Heroin. Section 4723 .28(B)(4) [as in effect prior to March 20, 2013], ORC, authorizes the Board to discipline a licensee for conviction of, a plea of guilty to, a judicial finding of guilt of, a judicial finding of guilt resulting from a plea of no contest to, or a judicial finding of eligibility for intervention in lieu of conviction for, any felony. Section 4723.28(B)(5) [as in effect prior to March 20, 2013] , ORC, authorizes the Board to discipline a licensee for conviction of, a plea of guilty to, a judicial finding of guilt of, a judicial finding of guilt resulting from a plea of no contest to, or a judicial finding of eligibility for intervention in lieu of conviction for, violating any municipal, state, county, or federal drug law. Accordingly, the Board is authorized to impose one or more of the sanctions as cited in Section 4723.28, ORC.

Courtney Renee Hammons Page 2

In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing in this matter. If you wish to request such hearing, the request must be made in writing and must be received in the Board office within thirty (30) days of the time of mailing of this notice. You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in writing. At the hearing you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to: Lisa Ferguson-Ramos, Compliance Unit Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus OH 43215-7410, or to the email address, hearing(Ouirsing.ohio.gov. If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Opportunity for Hearing, deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely,

Rhonda S. Barkheimer, R.N., C.N.P. Supervising Board Member Certified Mail Receipt No. 7012 2210 0000 6272 3872 cc: Henry G. Appel, Senior Assistant Attorney General

Case #13-000372

Ohio Board of Nursing

17 South High Street, Suite 400 February 6, 2013

www.nursing.ohiogov
(614) 466-3947

Columbus, Ohio 43215-7410

NOTICE OF IMMEDIATE SUSPENSION AND OPPORTUNITY FOR HEARING

Courtney Renee Hammons, L.P.N. 201 Main Street PO Box 267 College Corner, Ohio 45003 Dear Ms. Harnrnons: In accordance with Sections 2929.42 and/or 3719.12 of the Ohio Revised Code (ORC), the Ohio Board of Nursing (Board) has been notified that, on or about July 24, 2012, in Hamilton County Court of Common Pleas Case Number B1201096, you pled guilty to one (1) count of Possession of Heroin, a felony of the fifth degree, in violation of Section 2925.11(A), ORC. On or about November 16, 2012, you were sentence to two (2) years of Community Control. Section 3719.121(C), ORC, states in pertinent part as follows: On receiving notification pursuant to Section 2929.42 or 3719.12 of the Revised Code; the board under which a person has been issued a license, certificate or evidence of registration immediately shall suspend the license, certificate, or registration of that person on a plea of guilty to, a finding by a jury or court of the person's guilt of, or conviction of a felony drug abuse offense; a finding by a court of the person's eligibility for intervention in lieu of conviction; a plea of guilty to, or a finding by a jury or court of the person's guilt of, or the person's conviction of an offense in another jurisdiction that is essentially the same as a felony drug abuse offense; or a finding by a court of the person's eligibility for treatment or intervention in lieu of conviction in another jurisdiction. Possession of Heroin, a felony of the fifth degree, in violation of Section 2925.11(A), ORC, constitutes a "felony drug abuse offense" as defined in Section 2925.01, ORC. WHEREFORE, PURSUANT TO SECTION 3719.121(C), ORC, YOU ARE HEREBY NOTIFIED THAT YOUR LICENSE TO PRACTICE NURSING AS A LICENSED PRACTICAL NURSE, PN-135610, IS HEREBY SUSPENDED. Continued practice after receipt of this notice of suspension shall be considered engaging in the practice of nursing without a current, valid license, which is a violation of Section 4723.03(8), ORC.

Courtney Renee Hammons, L.P.N. Page 2 In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing in this imatter. If you wish to request such hearing, the request must be made in writing and must be received in the Board office within thirty (30) days of the time of mailing of this notice. As required by Section 3719.121(C), ORC, the suspension ordered herein shall remain in effect until this hearing is held. You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in writing. At the hearing you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to: Lisa Ferguson-Ramos, Compliance Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, Ohio 43215-7410, or to the e-mail address, hearing@nursing.ohio.gov. If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Immediate Suspension and Opportunity for Hearing, deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely,

Rhonda S. Barkheimer, R.N., C.N.P. Supervising Board Member

Certified Mail Receipt No. 7012 2210 0000 6272 1526

cc:

Henry G. Appel, Senior Assistant Attorney General

Cases #2012-005243

Ohio Board of Nursing

17 South High Street, Suite 400

www.nursing.ohio.gov

Columbus, Ohio 43215-7410 (614) 466-3947

March 22, 2013

NOTICE OF OPPORTUNITY FOR HEARING

Carol Lee Harper, L.P.N. P.O. Box 94 Waterloo, Ohio 45688 Dear Ms. Harper: In accordance with Chapter 119, Ohio Revised Code (ORC), you are hereby notified that the Ohio Board of Nursing (Board) proposes under authority of Section 4723.28 ORC, to deny, revoke, permanently revoke, suspend or place restrictions on your license to practice nursing as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: 1. Beginning in or about 2012, and through at least in or around August 16, 2012, while employed by Primary Care Nursing Services, Inc., in Dublin, Ohio, you provided home nursing services to Patient #1, a minor child [See Attached Patient Key to Remain Confidential and Not Subject to Public Disclosure]. During a November 8, 2012, meeting with a Board Compliance Agent, (November 2012 meeting) and in a written statement you provided to the Board on that date (Statement), you admitted that, during the course of your employment as a nurse in the home of Patient #1, you brought your son with you to Patient #1's home you while you were on duty. You admitted to the Board Compliance Agent that bringing your son to the home was "wrong" and in the Statement you stated that you exercised "poor judgment." Section 4723.28(B)(31), ORC, authorizes the Board to discipline a licensee for failure to establish and maintain professional boundaries with a patient, as specified in rules adopted under section 4723.07, ORC. 2. During the November 2012 meeting and in your Statement you admitted self-administration of medication for which you did not have a legal, valid prescription. a. During the November 2012 meeting you reported that you had been taking Vicodin that you obtained from your mother and for which you did not have a legal, valid prescription. In your Statement, you wrote

Carol Lee Harper, L.P.N. Page 2 that, "Over the last few years, I have taken Lortab (Vicodin) that my mother has given tine. I do not have a prescription for it. I had taken them almost daily to allev[iate] general aches and pains." b. During the November 2012 meeting you reported that when you were employed as a nurse at Sunsett Nursing Center, in Ironton, Ohio (Sunset Nursing), and were asked to provide a specimen for drug testing on or around September 2, 2011, you refused because you had previously self-administered Ambien that you obtained from your mother and that was not prescribed to you. In your Statement, you reported that when you were asked by your employer at Sunset Nursing to provide a specimen for drug testing [on or around September 2, 2011], you told your supervisor, Rhonda Howard, R.N., that you had previously self-administered a sleeping pill that was not prescribed to you. Section 4723.28 (B)(8), ORC, authorizes the Board to discipline a licensee for self-administering or otherwise taking into the body any dangerous drug, as defined in Section 4729.01, ORC, in any way not in accordance with a legal, valid prescription issued for that individual, or selfadministering or otherwise taking into the body any drug that is a schedule I controlled substance. Section 4723.28(B)(8), ORC [as in effect prior to June 8, 2012], authorizes the Board to discipline a licensee for self-administering or otherwise taking into the body any dangerous drug, as defined in Section 4729.01, ORC, in any way not in accordance with a legal, valid prescription issued for that individual. Accordingly, the Board is authorized to impose one or more of the sanctions cited in Section 4723.28, ORC. In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing in this matter. If you wish to request such hearing, the request must be made in writing and must be received in the Board office within thirty (30) days of the time of mailing of this notice. You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice be-fore the Board, or you may present your position, arguments, or contentions in writing. At the hearing, you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or)deliver the request, in addition to any other correspondence regarding this matter, to Lisa Ferguson-Ramos, Compliance Unit Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, Ohio 432157410 or to the email address, hearing@nursing.ohio.gov. If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Opportunity for Hearing, deny or permanently deny your

Carol Lee Harper, L.P.N. Page 3 request for reinstatement, revoke, permanently revoke, suspend, or place restrictions on your license to practice nursing as a licensed practical nurse; reprimand or otherwise disciplin0 you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely,

Rhonda S. Barkheimer, RN., C.N.P. Supervising Board Member Certified Mail Receipt No. 7012 2210 0000 6272 3490 cc: Henry G. Appel, Senior Assistant Attorney General

Case # 12-005838

Ohio Board of Nursing

17 South High Street, Suite 400

www.nursing.ohio.gov (614) 466-3947 Columbus, Ghia 43215-7410

March 22, 2013

1PORTUNITY FOR HEARING NOTICE OF 01

Monica S. Haymaker, L.P.N. 624 Harvest Drive Ravenna, Ohio 'M266 And 657 Mill Rd. Ravenna, OH 44266 Dear Ms. Haymaker: In accordance with Chapter 119, Ohio Revised Code (ORC), you are hereby notified that the Ohio Board of Nursing (Board) proposes under authority of Section 4723.28 ORC, to deny, revoke, permanently revoke, suspend or place restrictions on your license to practice nursing as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: 1. On or about September 20, 2012, you admitted in a written statement to the Brimfield Police Department that, while working as a nurse with Altercare (Post-Acute Rehabilitation Center in Kent, Ohio), you "took approximately 70 - 80 [Oxycodone] pills" over a period of three (3) to six (6) months and sold the pills for help with "a bill and groceries." Section 4723 .28(B)(13) [as in effect prior to March 20, 2013], ORC, authorizes the Board to discipline a licensee for obtaining or attempting to obtain money or anything of value by intentional misrepresentation or material deception in the course of practice. Section 4723.28(B)(5) [as in effect prior to March 20, 2013], ORC, authorizes the Board to discipline a licensee for selling, giving away, or administering drugs or therapeutic devices for other than legal and legitimate therapeutic purposes. Accordingly, the Board is authorized to impose one or more of the sanctions cited in Section 4723.28, ORC. In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing in this matter. If you wish to request such hearing, the request must be made in writing and must be received in the Board office within thirty (30) days of the time of mailing of this notice.

Monica S . Haymaker, L.P.N. Page 2 You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in writing. At the hearing, you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to Lisa Ferguson-Ramos, Compliance Unit Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, Ohio 432157410 or to the email address, hearing@nursing.ohio.gov. If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegationS" set forth in this Notice of Opportunity for Hearing, deny, revoke, permanently revoke, suspend, or place restrictions on your license to practice nursing as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely,
A -7 /V

Rhonda

Barkheimer, R.N., C.N.P. Supervising Board Member Certified Mail Receipt No. 7012 2210 0000 6272 3391 Second Address Certified Mail Receipt No. 7012 2210 0000 6272 3407 cc: Henry G. Appel, Senior Assistant Attorney General

Case #2013-000077

Ohio Board of Nursing.

17 South High Street, Suite 400 March 22, 2013

www..m rSing.ohio.gov (614) 466! -3947

Columbus, Ohio 43215-7410

N TICE OF OPPORTUNITY FOR HEA LING

Jessica R. Holder, L.P.N. 5109 E KY 8 Vanceburg, KY 41179 Dear Ms. Holder: In accordance with Chapter 119. of the Ohio Revised Code (ORC), you are hereby notified that the Ohio Board of Nursing (Board) proposes under the authority of Section 4723.28, ORC, to deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: 1. On or about December 20, 2012, in Case #2011-41, the Kentucky Board of Nursing issued a letter to you in which you were subjected to a civil penalty of $1,200,00, denied licensure for a two (2) year period, and terminated from the KARE Program for non-compliance (Kentucky Board 2012 Letter). A certified copy of the. Kentucky Board 2012 Letter is attached hereto and incorporated herein.

Section 4723.28(B)(1) [as in effect prior to March 20, 2013], ORC, authorizes the Board to discipline a license for denial, revocation, suspension, or restriction of authority to practice a health care occupation, including nursing, for any reason other than a failure to renew, in Ohio or another state or jurisdiction. Accordingly, the Board is authorized to impose one or more of the sanctions as cited in Section 4723.28 ORC. You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in writing. At the hearing you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to: Lisa Ferguson-Ramos, Compliance Unit Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, OH 432157410, or to the email address, hearing@nursing.ohio.gov. If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal

Jessica R. Holder, L.P.N.

Page 2

allegations set forth in this Notice of Opportunity for Hearing, deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely,

Rhonda. S. Barkheimer, R.N., C.N.P. Supervising Board Member Certified Mail Receipt No. 7012 2210 0000 6272 3155 cc: Henry G. Appel, Senior Assistant Attorney General

KENTUCKY BOARD OF NUR IN

Steven L. Beshear Govemor Via Certified Mail December 20, 2012 312 Whittington Parkway, Suite 300 Kentmig t 40222-5172 1113
k- erransw-xx.nwnsmaxmMoemmliendiwo....1

JESSICA RACHEL HOLDER 1500 PARKSIDE DR BOWLING GREEN KY 42101

certify this to be a true coPV 0f the records) on file with .the Kentucky Arsing r...)ard

Phone: (502) 429-3300 (800) 305-2042 Fax: (502) 429-3311 www,kbn,ky,gov

RE:

TERMINATION OF KARE FOR NURSES PROGRAM CASE # 201141 DENIED LICENSURE

Dear Ms. Holder: You are hereby given official Notice by the Kentucky Board of Nursing of your termination from the KARE for Nurses. Program for noncompliance with the KARE for Nurses Program Agreement signed by you on July 26, 2011. (Copy Enclosed) Pursuant to 201 KAR 20:450 Alternative program Section 3 (1)(a).and (b), you agreed to comply with the terms and conditions of the KARE for Nurses Program Agreement upon admission to the Program on July 26, 2011. Further, 201 KAR 20:450 Section 5 states .that:a Participant may be terminated from the Program'for non-compliance with any aspect of the Program Agreement. The following information 'indicates that you are non-compliant with Provision # 4, 9, 15, 19, 25, 27, 31, 32, 34 and 38 of the KARE for Nurses Program Agreement: You failed to obtain a nursing license in the Commonwealth of Kentucky, or another compact state, within six (6) months of your.admission to the KARE for Nurses Program. Documentation from Affinity Online Services (Affinity), the drug testing company utilized by the Board, indicates that you have failed to contact Affinity on a daily basis, as required, on the following dates: July 28, 2011; August 25, 2011; October 7, 30 and 31, 2011; November 8 and 17, 2011; January 18 and 31, 2012; February 13 and 17, 2012; March 24 and 31, 2012; April 8, 2012; May 13, 2012; June 9, 2012; July 7 and 21, 2012; September 2, 15, 22, 29 and 30, 2012; October 7, 22 and 27, 2012; November 6 - 30, 2012; December 1 - 19, 2012 o Documentation from Affinity indicates that you were randomly selected for drug testing IE and failed to provide a specimen on the following date: November 6, 2012; December 6, 2012.

KentuckyUnbridieriSpitit,corn

aituckyts-UNORIDI,E0 Sprair

An Equal Opportunity Employer M/FID

Jessica Rachel Holder Termination of KARE for Nurses Program Case # 2011-41 Denied Lippnsure Page 2 of 3 You have failed to submit Monthly Meeting Report forms documenting attendance at three (3) twelve (12) step meetings per week for the following months: July, September and October 2012)( The reports are to be submitted to the Program by the tenth (10a) day of the following month. You have failed to submit written verification of at least twice weekly contact with your twelve (12) step sponsor for the following months: July, September and October 2012. The reports are to be submitted to the Program by the tenth (10th) day of the following month.

O You have failed to submit Monthly Self Report forms for the following months: July, September and October 2012. The reports are to be submitted to the Program by the tenth (10th) day of the following month.
a

You failed to submit Counselor Evaluation Report forms, completed by your counselor/primary therapist, verifying compliance with ongoing therapeutic counseling and treatment for the month of October 2012. Documentation has been received from Haven4Change, Inc., indicating that, although you successfully completed and moved out of the facility on August 12, 2012, you have failed to attend aftercare sessions and you have not made contact with them since leaving the facility.

A letter was mailed to your address of record on November 2, 2012, informing you of various Issues of non-compliance; however, you have not responded to the notice of noncompliance with any rebuttal or lawful justification.

Provision *40 of the KARE for Nurses Program Agreement states that: The Participant understands that she shall be terminated from the Program for any cause as set out in 201 KAR 20:450. Termination from the Program by reason of that provision shall result in the immediate suspension (or denial of reinstatement if the nursing license has lapsed, expired, been surrendered or invalidated, or has been denied a nursing license in a compact state) of the nursing license, with notification by mail. The suspension/denial of reinstatement will begin on the date of the notification letter and will continue for a period of at least two (2) years. Implementation of the suspension/denial of reinstatement will result in a civil penalty of one-thousand two hundred dollars ($1,200). The Participant understands that that this action is public information and can be disseminated according to the regulations of the Board, the Kentucky Open Records Act, and any other state or federal law as required. Reinstatement of the nursing license after such a suspension/denial of reinstatement will be in accordance with the Board's Guidelines for Reinstatement that may include, but not be limited to, similar terms and conditions as set out in the Program Agreement. Pursuant to this notice, you are hereby DENIED LICENSURE and you are prohibited from engaging in the practice of nursing within the Commonwealth of Kentucky and from obtaining a

Jessica Rachel Holder Termination of KARE for Nurses Program Case 4 2011-41 Denied Licensure Page 3 of 3 nursing license within the Commonwealth of Kentucky for a period of at least two (2) years. Further, you are required to pay a civil penalty in the amount of one-thousand two-hundred dollars ($1,200,00) to the Kentucky Board of Nursing. Any continued practice of nursing on your part will be in violation of KRS 314.031(1) which is punishable by criminal sanctions tinder KRS 314,991, Be advised that this action is public information and can be disseminated according to the regulations of the Board, the Kentucky Open Records Act and any other state or federal law as required.

,k/JCL' --E.1 1 otta-Paula S. Schenk MPH, RN Executive Director

Enclosure (1) cc: File jmc

Case #12-002664

Ohio Board of Nursing

www.nursing.ohio.gov

17 South High Street, Suite 400 Columbus, Ohio 43215-7410 s (614) 466-3947

January 30, 2013

NOTICE OF AUTOMATIC SUSPENSION AND OPPORTUNITY FOR HEARING

Kevin Eugene Hughley, L.P.N. 11710 Cromwell Down Cleveland, Ohio 44120 And Inmate #A632682 Madison Correctional Institution P. O. Box 740 1851 State Route 56 London, Ohio 43140 Dear Mr. Hughley: The Ohio Board of Nursing has received notification that, on or about September 6, 2012, in Cuyahoga County Court of Common Pleas Case No. CR-12-558688-A, you pled guilty to one (1) amended count of Sexual Battery, a third-degree felony in violation of Section 2907.03 A(1), Ohio Revised Code (ORC). You were subsequently classified as a Tier 3 Sex Offender, and sentenced to three (3) years in prison. Section 4723.281 (C), ORC, states in pertinent part as follows: (C) The license or certificate issued to an individual under this chapter is automatically suspended on that individuals conviction of plea of guilty to, or judicial finding with regard to any of the following: aggravated murder, murder, voluntary manslaughter, felonious assault, kidnapping; rape, sexual battery, gross sexual imposition, aggravated arson, aggravated robbery, or aggravated burglary. The suspension shall remain in effect from the date of the conviction, plea, or finding until an adjudication is held under Chapter 119. of the Revised Code. If the board has knowledge that an automatic suspension has occurred, it shall notify the individual subject to the suspension. If the individual is notified and either fails to request an adjudication within the time periods established by Chapter 119. Of the Revised Code or fails to participate in the adjudication, the board shall enter a final order permanently revoking the persons license or certificate.

Kevin Eugene Hughley, L.P.N. Page 2 WHEREFORE, PURSUANT TO SECTION 4723.281(C), ORC, YOU ARE HEREBY NOTIFIED THAT YOUR LICENSE TO PRACTICE NURSING AS A LICENSED PRACTICAL NURSE, PN-100498 IS AUTOMATICALLY SUSPENDED, EFFECTIVE JANUARY 30, 2013. Continued practice after receipt of this notice of suspension shall be considered engaging in the practice of nursing without a current, valid license, which is a violation of Section 4723.03(B), ORC. You are further notified that in accordance with Chapter 119, ORC, the Board proposes under authority of Section 4723.28, ORC, to deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: 1. On or about September 6, 2012, in Cuyahoga County Court of Common Pleas Case No. CR-12-558688-A, you pled guilty to one (1) amended count of Abduction, with sexual motivation specification, a third-degree felony in violation of 2905.02 A(2), ORC; and one (1) amended count of Sexual Battery, a third-degree felony in violation of Section 2907.03 A(1), ORC. You were subsequently classified as a Tier 3 Sex Offender, and sentenced to three (3) years in prison. The acts underlying your conviction occurred on or about August 29, 2011 in Cuyahoga County, Ohio, and involve a female victim. Section 4723.28(B)(4), ORC, authorizes the Board to discipline a licensee for conviction of, a plea of guilty to, a judicial finding of guilt of, a judicial finding of guilt resulting from a plea of no contest to, or a judicial finding of eligibility for intervention in lieu of conviction for, any felony or of any crime involving gross immorality or moral turpitude. Accordingly, the Board is authorized to impose one or more of the sanctions as cited in Section 4723.28, ORC. In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing on this matter. If you wish to request such hearing, the request must be made in writing and must be received in the Board office within thirty (30) days of the time of mailing this notice. You are hereby further informed that if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present you position, argument, or contentions in writing. At the hearing you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter to: Lisa Ferguson-Ramos, Compliance Manager, 17 South High Street, Suite 400, Columbus, OH 43215-7410, or to the email address, hearing@nursing.ohio.gov.

Kevin Eugene Hughley, L.P.N. Page 3 If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in the Notice of Automatic Suspension and Opportunity for Hearing, deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely,

Rhonda S. Barkheimer, R.N., C.N.P. Supervising Board Member Certified Mail Receipt No. 7008 0150 0003 3672 8598 Second Address Certified Mail Receipt No. 7012 2210 0000 6270 6455 cc: Henry G. Appel, Senior Assistant Attorney General

Case #11-005027

Ohio Board of Nursing

17 South High Street, Suite 400
4

www.nursing.ohio.gov
(614) 466-3947

Columbus, Ohio 43215-7410

March 22, 2013

NOTICE OF OPPORTUNITY FOR HEARING

Alexandria Ann Kaminski, L.P.N. 4113 Thornton Toledo, Ohio 43613 And 2609 Oak Grove Place Toledo, OH 43613 Dear Ms. Kaminski: In accordance with Chapter 119, Ohio Revised Code (ORC), you are hereby notified that the Ohio Board of Nursing (Board) proposes under authority of Section 4723.28 ORC, to deny, revoke, permanently revoke, suspend or place restrictions on your license to practice nursing as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: 1. While working as a nurse for Maxim Healthcare Services, Inc. (Maxim), you were assigned to provide nursing services to Patient #1 [See attached Patient Key to remain confidential and not subject to public disclosure] from on or about January 2011 to October 2011. You submitted a signed, written statement to the Board in which you admit to forging the initials of Patient #1's mother on your timesheet. You also admitted to Maxim that you made false entries on your timesheet, which did not accurately reflect the length of time you provided nursing services to Patient #1. Section 4723.28(B)(16), ORC, authorizes the Board to discipline a, licensee for violation of Chapter 4723, ORC, or any rules adopted under it. Specifically, Rule 4723-4-06(G), Ohio Administrative Code (OAC), states that a licensed nurse shall not falsify any client record or any other document prepared or utilized in the course of, or in conjunctionwith, nursing practice. This includes, but is not limited to, case management documents or reports or time records, reports, and other documents related to billing for nursing services. Accordingly, the Board is authorized to impose one or more of the sanctions cited in Section 4723.28, ORC.

Alexandria Am) Kaminski, L.P.N. Page 2 In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing in this matter. If you wish to request such, hearing, the request must be made in writing and must be received in the Board office within thirty. (30) days of the time of mailing of this notice. You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in writing. At the hearing, you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to Lisa Ferguson-Ramos, Compliance Unit Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, Ohio 432157410 or to the email address, hearing@ nursing .ohio .gov. If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Opportunity for Hearing, deny, revoke, permanently revoke, suspend, or place restrictions on your license to practice nursing as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely, X. A/ Rhonda S. Barkheimer, R.N., C.N.P. Supervising Board Member Certified Mail Receipt No. 7012 2210 0000 6272 3476 Second Address Certified Mail Receipt No. 7012 2210 0000 6272 3483 cc: Henry G. Appel, Senior Assistant Attorney General

Case # 12-000792

Ohio Board of Nursing

www.nursing.ohio.gov

17 South High Street, Suite 400 .o Columbus, Ohio 43215-7410 4 (614) 466-3947

March 22, 2013

NOTICE OF OPPORTUNITY FOR HEARING

Renee Joy Kantner, L.P.N. 306 Decatur Street Toledo, Ohio 43609 Dear Ms. Kanter: In accordance with Chapter 119, Ohio Revised Code (ORC), you are hereby notified that the Ohio Board of Nursing (Board) proposes under authority of Section 4723.28 ORC, to deny, revoke, permanently revoke, suspend or place restrictions on your license to practice nursing as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: 1. In a written statement dated June 7, 2012, you admitted that on February 4, 2012, while working as a home healthcare nurse for Maxim Healthcare Services and caring for Patient #1 [see attached Patient Key to Remain Confidential and Not Subject to Public Disclosure], an infant with 24-hour per day ventilator orders, you sat on the couch "charting and working on the computer" and could not see the child. Further, you admitted that you could not hear the child crying because of the "trach" and your charting times "may have been off' because you "charted later that morning and not immediately after care." Section 4723.28(B)(19), ORC, authorizes the Board to discipline a licensee for failure to practice in accordance with acceptable and prevailing standards of safe nursing care. Section 4723.28(B)(16), ORC, authorizes the Board to discipline a licensee for violation of Chapter 4723, ORC, or any rules adopted under it. Specifically, Rule 4723-4-06(H), OAC, states that a licensed nurse shall implement measures to promote a safe environment for each client. Accordingly, the Board is authorized to impose one or more of the sanctions cited in Section 4723.28, ORC. In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing in this matter. If you wish to request such hearing, the request must be made in writing and must be received in the Board office within thirty (30) days of the time of mailing of this notice. You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in

Renee Joy Kantner, L.P.N. Page 2 writing. At the hearing, you may also present evidence and examine witnesses appearing for and against you.

Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to Lisa Ferguson-Ramos, Compliance Unit Manager,'Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, Ohio 432157410 or to the email address, beayi nursirlg,ohio,ggy. If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Opportunity for Hearing, deny, revoke, permanently revoke, suspend, or place restrictions on your license to practice nursing as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely, ic,--/-4.es( .4t, Rhonda S. Barkheimer, R.N., G.N.P. Supervising Board Member Certified Mail Receipt No. 7012 2210 0000 6272 3438 cc: Henry G. Appel, Senior Assistant Attorney General , A7,</z

Case 12-007487

Ohio Board of Nursing

wwwnursing.ohio,gov

17 South High Street, Suite 400 . Columbus, Ohio 43215-7410 6 (614) 466-3947

March 22, 2013

NOTICE OF OPPORTUNITY FOR HEARfNG

Michelle Lynn Keeper 5279-B Franklyn Blvd. Willoughby, Ohio 094 Dear Ms. Keeper: In accordance with Chapter 119, Ohio Revised Code (ORC), you are hereby notified that the Ohio Board of Nursing (Board) proposes under authority of Section 4723.28, ORC, to deny or permanently deny reinstatement of your license to practice nursing as a registered nurse; permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: 1. On or about September 23, 2011, you. entered into a Consent Agreement (September 2011 Consent Agreement) with the Ohio Board of Nursing (Board), a copy of which is attached hereto and incorporated herein, in which you agreed with the Board that your license to practice nursing as a registered nurse in the State of Ohio would be suspended indefinitely, with conditions for reinstatement. Attached to and incorporated within the September 2011 Consent Agreement is a May 20, 2011 Notice of Immediate Suspension and Opportunity for Hearing. Documents are redacted according to Section 2953.32, ORC. On December 27, 2012, you provided a specimen for analysis to Firstlab, the Board's random drug/alcohol screen program administrator, that tested positive for Oxycodone. You did not have a valid, legal prescription for Oxycodone. Section 4723.28 (B)(8), ORC, authorizes the Board to discipline a licensee for self-administering or otherwise taking into the body any dangerous drug, as defined in Section 4729.01, ORC, in any way not in accordance with a legal, valid prescription issued for that individual, . or selfadministering or otherwise taking into the body any drug that is a schedule I controlled substance. Accordingly, the Board is authorized to impose one or more of the sanctions cited in Section 4723.28, ORC.

Michelle Lynn Keeper Page 2 In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing ih this matter. If you wish to request such hearing, the request must be made in writing and must be received in the Board office within thirty (30) days of the time of mailing of this notice. You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in writing. At the hearing, you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to Lisa Ferguson-Ramos, Compliance Unit Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, Ohio 432157410 or to the email address, hearing@nursing.ohio.gov. If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Opportunity for Hearing, deny or permanently deny reinstatement of your license to practice nursing as a registered nurse; permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely,

Rhonda S. Barkheimer, C.N.P. Supervising Board Member Certified Mail Receipt No. 7012 2210 0000 6272 3520 cc: Henry G. Appel, Senior Assistant Attorney General

Ohio Board of Nursing

17 South High Street, Suite 400

wwvw,nursing.ohio,gov
(614) 466-3947

Columbus, Ohio 43215-7410

To Whom It May Concetn:

You recently requested records regarding Michelle Lynn Keeper, R.N. #309618. Enclosed are records in response to your request. Information has been redacted, per Section 2953.32 of the Ohio Revised Code. If you have any further questions or concerns, please contact the Compliance Unit Manager or a Supervising Attorney.

Thank you. Compliance Unit Ohio Board of Nursing

Case #10-0246; 10-2631

Ohio- Board of Nursing www.nursin g.ohio.gov

17 South High Street, Suite 400 g Columbus, Ohio 43215-7410 9 (614) 466-3947

CONSENT AGREEMENT BETWEEN MICHELLE LYNN KEEPER, R.N. AND OHIO BOARD OF NURSING
This Consent Agreement is entered into by and between MICHELLE LYNN KEEPER, R.N. (MS. KEEPER) and the Ohio Board of Nursing (Board), the state agency charged with enforcing Chapter 4723. of the Ohio Revised Code (ORC), and all administrative rules promulgated thereunder. For purposes of this Agreement, "Consent Agreement" shall be defined as this Agreement, and the following documents, that is attached hereto and incorporated herein: Notice of Immediate Suspension and Opportunity for Hearing dated May 20, 2011 (May 2011 Notice). This Consent Agreement contains the entire agreement between the parties, there being no other agreement of any kind, verbal or otherwise, which varies the terms of this Consent Agreement. BASIS FOR ACTION This Consent Agreement is entered into on the basis of the following stipulations, admissions and understandings: A. The Board is empowered by Section 4723.28, ORC, to. deny, permanently revoke, revoke, suspend, or place restrictions on any lieense issued by the Board; reprimand or otherwise discipline a licensee; or impose a fine of five hundred dollars ($500.00) or less per violation. Section 4723.2$(B)(4), ORC,.authorizes the Board to discipline a licensee for conviction of, a plea of guilty to, a judicial finding of guilt of, a judicial finding of guilt resulting from a plea of no contest to, or a judicial finding of eligibility for . intervention in lieu of conviction for, any felony, Section 4723.28(B)(5), ORC, authorizes the Board to discipline- a licensee for conviction of, a plea - of guilty to, a judicial finding of guilt of, a judicial finding of guilt resulting from a plea of no contest to, or -a judicial finding of eligibility for intervention in lieu of conviction for, violating any municipal, state,-county, . or federal drug law, Section 4723.28(B)(8), ORC, authorizes the Board to

Michelle Lynn Keeper, R.N. Page 2

discipline a licensee for self-administering or otherwise taking into the body any dangerous drug, as defined in Section 4729.01, ORC, in any way not in. accordance with a legal, valid prescription issued for that individual. Section 4723.28(B)(13), ORC, authorizes the Board to discipline a licensee for obtaining or attempting to obtain money or anything of value by intentional rnisrepresentationi or material deception in the course of practice. Section 4723.28(B)(20), ORC, authorizes the Board to discipline a licensee for, in the case of a registered nurse, engaging in activities that exceed the practice of nursing as a registered nurse, Section 4723.28(B)(16), ORC, authorizes the Board to discipline a licensee for violation of Chapter 4723, ORC, or any rules adopted under it. Specifically, Rule 4723-4-03(A), Ohio Administrative Code, states that a registered nurse shall provide nursing care within the scope of practice of nursing for a registered nurse as set forth in division (B) of Section 4723.01, ORC, and the rules of the board. B. MS. KEEPER's license to practice nursing as a registered nurse, RN309618, in the State of Ohio, was initially issued in January 2004. MS. KEEPER has been suspended since May 2011. MS. KEEPER knowingly and voluntarily admits to the factual and legal allegations set forth in the May 2011 Notice. MS. KEEPER knoWingly and voluntarily admits to the following: 1. MS. KEEPER states that she was receiving pain management treatment from a pain management specialist for herniated disks and was prescribed Percocet, Flexeril, and Motrin. MS. KEEPER states that also at the time, she was working through a stressful divorce.

C.

D,

AGREED CONDITIONS Wherefore, in consideration of the foregoing and mutual promises hereinafter set forth, and in lieu of any formal proceedings at this time, MS. KEEPER knowingly and voluntarily agrees with the Board to the following terms, conditions, and limitations:

Michelle Lynn Keeper, R.N. Page 3

SUSPENSION OF LICENSE 1. MS. KEEPER'S license to practice nursing as aregistered nurse is hereby indefinitely suspended for not less than sixteen (16) months from the date of the May 2011 MS. KEEPER may submit a written request for reinstatement after Notice. September 1, 2012, if the conditions for reinstatement are met,

CONDITIONS FOR REINSTATEMENT 2. MS. KEEPER shall obey all federal, state, and local laws, and all laws and rules :overrun:, the 'tactic rant in Ohio;

3,

MS. KEEPER shall appear in person for interviews before the full Board or its designated representative as requested by the Board or its designee. Prior to reinstatement, MS. KEEPER shall enter into a Consent Agreement with the Board for probationary terms, conditions, and limitations determined by the Board for a minimum period of three (3) years following reinstatement. Within six (6) months immediately prior to requesting reinstatement, MS. KEEPER agrees that she will submit a request to the Bureau of Criminal Identification and Investigation (BCII) to conduct a criminal records check of MS. KEEPER, including a check of Federal Bureau of Investigation (FBI) records, and shall cause BCH to submit MS. KEEPER's criminal records check reports to the Board. MS. KEEPER agrees that a request for reinstatement will not be considered by the Board until the completed criminal records check, including the FBI check, has been received by the Board.

4.

Educational Requirement 6. Prior to requesting reinstatement, MS. KEEPER shall, in addition to the requirements of 1 icensure renewal, successfully complete and submit satisfactory documentation of successful completion of the following continuing nursing education, or another comparable course approved in advance by the Board or its designee, taken subsequent to the effective date of this Consent Agreement: fifteen (15) hours of Chemical dependency and five (5) hours of Professionalism.

Monitoring of Rehabilitation and Treatment 7, MS. KEEPER shall abstain completely from the personal use or possession of drugs, except those prescribed, administered, or dispensed to her by another so authorized by law who has received a complete copy of this Consent Agreement prior to prescribing

Michelle Lynn Keeper, R.N. Page 4

for MS. KEEPER. MS. KEEPER shall self-administer the prescribed drugs only in the manner prescribed. 8. MS, KEEPER shall abstain completely from the use of alcohol or products containing alcohol. t Within three (3) months immediately prior to requesting reinstatement, MS. KEEPER shall, at her expense, obtain a chemical dependency evaluation by a Board approved chemical dependency professional and shall provide the Board with complete documentation of this evaluation. Prior to the evaluation, MS. KEEPER shall provide the chemical dependency professional with a copy of this Consent Agreement. Further, MS. KEEPER shall execute releases to permit the chemical dependency professional to obtain any information deemed appropriate and necessary for the evaluation. The professional shall submit a written opinion to the Board that includes diagnoses, recommendations for treatment and monitoring, any additional restrictions that should be placed on MS. KEEPER's license to practice, and stating whether MS. KEEPER is capable of practicing nursing according to acceptable and prevailing standards of safe nursing care. MS. KEEPER shall provide the Board with satisfactory documentation of compliance with all aspects of the treatment plan developed by the chemical dependency professional described above until released. Further, MS. KEEPER agrees that the Board may utilize the professional's recommendations and conclusions from the evaluation as a basis for additional terms, conditions, and limitations on MS. KEEPER's license and that the terms, conditions, and limitations may be incorporated in an addendum to this Consent Agreement or in a reinstatement consent agreement. For a minimum, continuous period of twelve (12) months immediately prior to requesting reinstatement, MS. KEEPER shall submit, at her expense and on the day selected, blood, breath, hair, or urine specimens for drug and/or alcohol analysis at a collection site specified by the Board at such times as the Board may request. Upon and after MS. KEEPER's initiation of drug screening, refusal to submit such specimen, or failure to submit such specimen on the day she is selected, or in such a manner as the Board may request, shall constitute a violation of a restriction placed on a license- for purposes of Section 4723.28(B), ORC. This screening shall require a daily call-in process. The specimens submitted by M.S. KEEPER shall be negative, except for substances prescribed, administered, or dispensed to her by another so authorized by law who has received a complete copy of this Consent Agreement priorto prescribing for MS. KEEPER, a. Prior to MS. KEEPER initiating drug 6oreening, MS. KEEPER shall provide a copy of this Consent Agreement to all treating practitioners and shall provide to the Board a list of all treating practitioners, including addresses and telephone numbers and cause all treating practitioners to complete a

9.

10.

11.

Michelle Lynn Keeper, R.N. Page 5

medication prescription report that is to be mailed by the practitioner directly to the Board. The medication report is to be completed for any and all substances prescribed, administered, or dispensed to MS. KEEPER. b. After initiating drug screening, MS. KEEPER shall be under a continuing duty to provide a copy of this Consent Agreement, prior to initiating treatment, to additional treating practitioners, and to update the list of treating .practitioners with the Board within forty-eight (48) hours of being treated by another practitioner, Further, MS. KEEPER shall notify the Board of any and all medication(s) or preseription(s) received within twenty-four (24) hours of release from hospitalization or medical treatment. 12. For a minimum, continuous period of twelve (12) months immediately prior to requesting reinstatement, MS. KEEPER shall attend a minimum of one (1) meeting per week of a support or peer group meeting approved in advance by the Board, or a Twelve Step program, and MS. KEEPER shall provide satisfactory documentation of such attendance to the Board prior to requesting reinstatement. .

Reporting Requirements of Licensee 13. MS. KEEPER shall report to the Board, in writing, any violation of this Consent Agreement within thirty (30) days of the occurrence of the violation. MS. KEEPER shall sign release of information forms allowing health professionals and other organizations to submit requested documentation or information directly to the Board. MS. KEEPER shall submit any and all information that the Board may request regarding her ability to practice according to acceptable and prevailing standards of safe nursing practice. MS. KEEPER shall not submit or cause to be submitted any false, misleading, or deceptive statements, information, or documentation to the Board or to employers or potential employers. MS. KEEPER shall submit the reports and documentation required by this Consent Agreement on forms specified by the Board. All reporting and communications required by this Consent Agreement shall be made to the Compliance Unit of the Board, MS. KEEPER shall submit the reports and documentation required by this Consent Agreement to the attention of the Compliance Unit, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, O.H. 43215-7410.

14.

15.

16.

17.

18.

Michelle Lynn Keeper, R.N. Page 6

19.

MS. KEEPER shall verify that the reports and documentation required by this Consent Agreement are received in the Board office. MS. KEEPER shall inform the Board within five (5) business days, in writing, of any change in residential or home address or telephone number.

20.

Nursing Refresher Course Upon request of the Board or its designee, MS. KEEPER shall, prior to. working in a position where a nursing license is required, complete and submit satisfactory documentation of completion of a nursing refresher course or an extensive orientation approve in advance by the Board or its designee, Temporary Narcotic Restriction MS. KEEPER shall not administer, have access to, or possess (except as prescribed for MS. KEEPER's use by another so authorized by law who. has received a complete copy of this Consent Agreement prior to prescribing. for MS. KEEPER) any narcotics, other controlled substances, or mood altering drugs far a minimum of TWELVE (12) Months in which MS. KEEPER is working in a position that requires a nursing license. At any time after the twelve (12) months period previously described, MS. KEEPER, may submit a written request to the Board to have this restriction re-evaluated. In addition, MS. KEEPER shall not possess or carry any work keys for locked medicatiOn carts, cabinets, drawers, or containers. MS. KEEPER shall not count narcotics. MS. KEEPER shall not call in or order prescriptions or prescription refills for narcotics, other controlled substances, or mood altering drugs. Permanent Practice Restrictions MS. KEEPER further knowingly and voluntarily agrees with the Board to the following PERMANENT LICENSURE RESTRICTIONS: MS. KEEPER shall not practice nursing as a registered nurse (1) for agencies providing home care in the patient's residence; (2) for hospice care programs providing hospice care in the patient's residence; (3) for staffing agencies or pools; (4) as an independent provider where the nurse provides nursing care and is reimbursed for services by the State of Ohio through State agencies or agents of the State; or (5) for an individual or group of individuals who directly engage MS. KEEPER to provide nursing services for fees, compensation, or other consideration or who engage MS. KEEPER as a volunteer. MS. KEEPER shall not function in a position or employment where the job duties or requirements involve management of nursing and nursing responsibilities, or supervising and evaluating nursing practice. Such positions include, but are pot liniited to, the following: Director of Nursing, Assistant Director of Nursing, Nurse Manager, Vice President of Nursing.

Michelle Lynn Keeper, R.N. Page 7

FAILURE TO COMPLY The above described terms and conditions shall constitute "restrictions placed on a license" for purposes of Section 4723.28(B), ORC. If, in the discretion of the Board, MS. KEEPER appears to have violated or breached any terms or conditions of this Consent Agreement, the Board resres the right to initiate disciplinary proceedings for any and all possible violations or breaches; including, but not limited to, alleged violations of the laws of Ohio occurring before the effective date of this Consent Agreement. DURATION/MODIFICATION OF TERMS The terms, limitations, and conditions of this Consent Agreement, other than the permanent licensuxe restrictions, may be modified or terminated, in writing, at any time upon the agreement of both MS KEEPER and the Board. The Board. may only alter the indefinite suspension imposed if: (1) MS. KEEPER submits a written request for reinstatement; (2) the Board determines that MS. KEEPER has complied with all conditions of reinstatement; (3) the Board determines that MS. KEEPER is able to practice .according to acceptable and prevailing standards of safe nursing care based upon an interview with MS. KEEPER and review of the documentation specified in this Consent Agreement; and (4) -MS. KEEPER has entered into a Consent Agreement with the Board for probationary terms, conditions, and limitations determined by- the Board for a minimum period . of three (3) years following reinstatement. ACKNOWLEDGMENTS/LIABILITY RELEASE MS. KEEPER acknowledges that she has had an opportunity to ask questions . concerning the terms of this Consent Agreement and that all questions asked . have been answered in a satisfactory manner. MS. KEEPER waives all of her rights under Chapter 119, ORC, as they relate to matters that are the subject of this Consent Agreement. MS. KEEPER waives any and all claims or causes of action she may have against the Board, and its members, officers, employees and/or agents arising out of matters that are the subject of this Consent Agreement: This Consent Agreement is not an adjudication order as discussed in Chapter 119, ORC. Any action initiated by the Board based on alleged violations of this Consent Agreement shall comply with the Administrative Procedures Act, Chapter 119, ORC. This Con*nt Agreement shall be considered a public record as that term is used in Section 149.43, ORC. The information contained herein may be reported to appropriate organizations, data banks and goVernmental bodies.

 Michelle Lynn Keeper, R.N. Page 8 EFFECTIVE DAT.N MS. KEEPER understands that this Consent Agreement is subject to rtitifleation by the Board prior to signature by the hoard President and shall become affee1 upon the last date of signature below.

MICHELLE LYNN

E EPER, R.N.

9
DATE

c)\
DATE Attorney for Michelle Lynn Keeper, R.N,

8190,06- Rd
BERTHA LOVELACE, President Ohio Board of Nursing

q
DATE

cP0(1

Case #10-0246 & 10-2631

Ohio Board of Nursing

May 20, 2011

www.nursing;ollio.gov 17 South High Street, Suite 400 4' Columbus, Ohio 43215-7410. 0 (614) 466-3947

NOTICE OF IMMEDIATE SUSPENSION AND OPPORTUNITY FOR HEARING

Michelle Lynn Keeper, R.N. 5279-B Franklyn Blvd Willoughby, OH 41094 Dear Ms. Keeper: In accordance with Sections 2929,42 and/or 3719.12 of the Ohio Revised Code (ORC), the Ohio. Board of Nursin ("Board") has

Section 3719,121(C), ORC, states in pertinent part as follows: On receiving notification pursuant to Section 2929.42 or 3719.12 of the Revised Code, the board under which a person has been issued .a license, certificate or evidence of registration immediately shall suspend the license, certificate, or registration of that person on a plea of guilty to, a finding by a jury or court of the person's guilt of, or conviction of a felony drug abuse offense; a finding by a court of the person's eligibility for intervention in lieu of conviction; a plea of guilty to, or a finding by a jury or court of the person's guilt of, or the person's conviction of an offense in another jurisdiction that is essentially the same as a felony drug abuse offense; or a finding by a court of the person's eligibility for treatment or intervention in lieu of conviction in another jurisdiction.

WHEREFORE, PURSUANT TO SECTION 3719.121(C), ORC, YOU ARE HEREBY NOTIFIED TH4.T YOUR LICENSE TO PRACTICE NURSING AS A REGISTERED NURSE, RN-309618, IS HEREBY SUSPENDED. Continued practice after receipt of this notice of suspension shall be considered engaging in the practice of nursing without a current, valid license, which is a violation of Section 4723.03(A), ORC,

Michelle Lynn Keeper, R.N. Page 2

You are further notified that in accordance with Chapter 119, ORC, the Board proposes under authority of Section 472328, ORC, to deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons:

Section 4723.28(B)(4), ORC, authorizes the Board to discipline a licensee for conviction of, a plea of guilty to, a judicial finding of guilt of, a judicial finding of guilt resulting from a plea of no contest to, or a judicial finding of eligibility for intervention in lieu of conviction for, any felony. Section 4723.28(B)(5), ORC, authorizes the Board to discipline a licensee for conviction of, a plea of guilty to, a judicial finding of guilt of, a judicial finding of guilt resulting from a plea of no contest to, or a judicial finding of eligibility for intervention in lieu of conviction for, violating any municipal, state, county, or federal drug law 2. On or about June 18, 2010, you admitted to Lake Health employees that you have a drug problem, You admitted that you diverted Diluadid and Demerol and self-administered the drugs IM in your right hip/thigh. In a written statement you wrote, "I am sorry for stealing from the hospital and compromising patient care." On or about July 1, 2010, you admitted to a Board Compliance Agent that you were dependent on drugs and that you stole from Lakewest while working there as a nurse. You admitted to using 1-2mg of Diluadid and up to 30mg of Demerol at a time and while working as a nurse, Section 4723.28(13)(8), ORC, authorizes the Board to discipline a licensee for selfadministering or otherwise taking into the body any dangerous drug, as defined in Section 4729.01, ORC, in any way not in accordance with a legal, valid prescription issued for that individual. Section 4723.28(B)(13), ORC, authorizes the Board to discipline a licensee for obtaining or attempting to obtain money or anything of value by intentional misrepresentation or material deception in the course of practice,

Michelle Lynn Keeper, R.N. Page 3

3.

On or about April 7, 2010, you admitted to a Board Compliance Agent that while employed as a nurse at University. Hospitals of Cleveland, you administered, without a valid order or prescription, Zofran to an ill co-worker.

Section 4723.28(B)(20), ORC, authorizes the Board to discipline a licensee for, in the case of a registered nurse, engaging in activities that exceed the practice of nursing as a registered nurse. Section 4723.28(B)(16), ORC, authorizes the Board to discipline a licensee for violation of Chapter 4723, ORC, or any rules adopted under it. Specifically, Rule 4723-403(A), Ohio Administrative Code, states that a registered nurse shall provide nursing care within the scope of practice of nursing for a registered nurse as set forth in division (B) of Section 4723.01, ORC, and the rules of the board. Accordingly, the Board is authorized to impose one or more of the sanctions as cited in Section 4723.28, ORC. In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing in this matter. If you wish to request such hearing, the request must be made in writing and must be received in the Board office within thirty (30) days of the time of mailing of this notice. As required by Section 3719.121(C), ORC, the suspension ordered herein shall remain in effect until this hearing is held. You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in writing. At the hearing you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to: Lisa Ferguson-Ramos, Compliance Unit Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus OH . 432154410, or to the email address, hearing@i If the Board fails to receive a request for a hearing within thirty (30) days of the time of Mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Immediate Suspension and Opportunity for Hearing, deny, permanently revoke, revoke, suspend or place restrictions on your license to

Michelle Lynn Keeper, RN. Page 4

practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely,

ce.,,, -,4e
Judith A. Church, RN., C.N.P. Supervising Board Member

Certified Mail Receipt No. 7011 0110 0001 5992 7815 cc:

Melissa L. Wilburn, Assistant Attorney General

Case# 12-006492

Ohio Board of Nursing

www.nursing.ohio.gov

17 South High Street, Suite 400 -4' Columbus, Ohio 43215-7410 4, (614) 466-3947

March 22, 2013

NOTICE OF AUTOMATIC SUSPENSION AND OPPORTUNITY FOR HEARING

Jami S. Kerston, R.N. 5779 Plank Drive Hilliard, Ohio 43026 Dear Ms. Kerston: You are hereby notified that, on or about September 21, 2012, you entered into a Consent Agreement (September 2012 Consent Agreement) with the Ohio Board of Nursing (Board), a copy of which is attached hereto and incorporated herein, in which you agreed with the Board that your license to practice nursing as a registered nurse in the State of Ohio would be suspended indefinitely and that such suspension would be stayed subject to probationary terms, conditions, and limitations for a minimum period of two (2) years. A. Item 2. of the September 2012 Consent Agreement states, "MS. KERSTON shall appear in person for interviews before the full Board or its designated representative as requested by the Board or its designee." Despite this provision, you failed to appear in person for a scheduled interview with a Board Monitoring Agent on December 17, 2012. B. Item 7. of the September 2012 Consent Agreement states, "Within forty-five (45) days of the effective date of this Consent Agreement and continuing throughout the probationary period, MS. KERSTON shall submit, at her expense and on the day selected, blood, breath, hair, or urine specimens for drug and/or alcohol analysis at a collection site specified by the Board at such times as the Board may request. Refusal to submit such specimen, or failure to submit such specimen on the day she is selected, or in such a manner as the Board may request, shall constitute a violation of a restriction placed on a license for purposes of Section 4723.28(B), ORC. This screening shall require a daily call-in process. The specimens submitted by MS. KERSTON shall be negative, except for substances prescribed, administered, or dispensed to her by another so authorized by law who has received a complete copy of this Consent Agreement prior to prescribing for MS. KERSTON."

Jami S. Kerston, R.N. Page 2 Despite this provision, on the dates set forth in Attachment A, attached hereto and incorporated herein, you failed /to call Firstlab, the Board's random drug/alcohol screen program administrator, to determine if you had been selected to provide a specimen for analysis. Furthermore, on the following dates, you were selected to provide a specimen for analysis and failed to do so: November 27, 2012; December 19, 2012; January 8, 2013; and January 30, 2013. Section 4723 .28(B)(17), Ohio Revised Code, ORC, authorizes the Board to discipline a licensee for violation of any restrictions placed on ,a nursing license by the Board. In accordance with the paragraph under "FAILURE TO COMPLY" of the September 2012 Consent Agreement, you are hereby notified that it appears to the Board that you have violated Items 2. and 7. of the September 2012 Consent Agreement. YOU ARE FURTHER NOTIFIED THAT YOUR LICENSE TO PRACTICE NURSING AS A REGISTERED NURSE, RN-179196, IS HEREBY AUTOMATICALLY SUSPENDED. Continued practice after receipt of this notice of suspension shall be considered engaging in the practice of nursing as a registered nurse without a current, valid license, which is a violation of Section 4723.03(A), ORC. You are further notified that in accordance with Chapter 119, ORC, the Board proposes under authority of Section 4723.28, ORC, to deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: 1. On or about September 21, 2012, you entered into a Consent Agreement (September 2012 Consent Agreement) with the Ohio Board of Nursing (Board), a copy of which is attached hereto and incorporated herein, in which you agreed with the Board that your license to practice nursing as a registered nurse in the State of Ohio would be suspended indefinitely and that such suspension would be stayed subject to probationary terms, conditions, and limitations for a minimum period of two (2) years. 2. Item 2. of the September 2012 Consent Agreement -states, "MS. KERSTON shall appear in person for interviews before the full Board or its designated representative as requested by the Board or its designee.' Despite this provision, you failed to appear in person for a scheduled interview with a Board Monitoring Agent on December 1'7, 2012. 3. Item 7. of the September 2012 Consent Agreement states, "Within forty-five (45) days of the effective date of this Consent Agreement and continuing throughout the probationary period, MS. KERSTON shall submit, at her

Jami S. Kerston, R.N. Page 3 expense and on the day selected, blood, breath, hair, or urine specimens for drug and/or alcohol analysis at a collection site specified by the Board at such times as the Board may request. Refusal to submit such specimen, or failure to submit such specimen on the day she is selected, or in such a manner as the Board may request, shall constitute a violation of a restriction placed on a license for purposes of Section 4723.28(B), ORC. This screening shall require a daily call-in process. The specimens submitted by MS. KERSTON shall be negative, except for substances prescribed, administered, or dispensed to her by another so authorized by law who has received a complete copy of this Consent Agreement prior to prescribing for MS. KERSTON." Despite this provision, on the dates set forth in Attachment A, attached hereto and incorporated herein, you failed to call Firstlab, the Board's random drug/alcohol screen program administrator, to determine if you had been selected to provide a specimen for analysis. Furthermore, on the following dates, you were selected to provide a specimen for analysis and failed to do so: November 27, 2012; December 19, 2012; January 8, 2013; and January 30, 2013. Section 4723 .28(B)(17), Ohio Revised Code, ORC, authorizes the Board to discipline a licensee for violation of any restrictions placed on a nursing license by the Board. AccOrdingly, the Board is authorized to impose one or more of the sanctions as cited in Section 4723.28, ORC. In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing in this matter. If you wish to request such hearing, the request must be made in writing and must be received in the Board office within thirty (30) days of the time of mailing of this notice. You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in writing. At the hearing you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to: Lisa Ferguson-Ramos, Compliance Unit Manage-, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, Ohio 432157410, or to the e-mail address, hearing@nursing.ohio.gov. If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Automatic Suspension and Opportunity for Hearing, deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a

Jami S. Kerston, R.N. Page 4 registered nurse; reprimand or otherwise discipline you; or impose a fine of not ore than ive hundred dollars ($500.00) per violation.* Sincerely,

"Pc"--"teezz., J, ,i,2.4/1-,(--g

,t) KA/

-,A.4;:

Rhonda S. Barkheimer, C.N.P. Supervising Board Member Certified Mail Receipt No. 7012 2210 0000 6272 3735 cc: Henry G. Appel, Senior Assistant Attorney General

Cases #12-001836

Ohio Board of Nursing

CONSENT AGREEMENT BETWEEN JAM! S. KERSTON, R.N. AND OHIO BOARD OF NURSING

www.nursing.ohio.gov
(614) 466-3947

17 South High Street, Suite 400 6, Columbus, Ohio 43215-7410

This Consent Agreement is entered into by and between JAMI S. KERSTON, R.N. (MS. KERSTON) and the Ohio Board of Nursing (Board), the state agency charged with enforcing Chapter 4723, of the Ohio Revised Code (ORC), and all administrative rules promulgated thereunder. This Consent Agreement contains the entire agreement between the parties, there being no other agreement of any kind, verbal or otherwise, which varies the terms of this Consent Agreement. BASIS FOR ACTION This Consent Agreenient is entered into on the basis of the following stipulations, admissions and understandings: A. The Board is empowered by Section 4723.28, ORC, to deny, permanently revoke, revoke, suspend, or place restrictions on any license issued by the Board; reprimand or otherwise discipline a licensee; or impose a fine of five hundred dollars ($500.00) or less per violation. Section 4723.28(3)(9), ORC, authorizes the Board to deny a license or otherwise discipline a licensee for habitual indulgence in the use of controlled substances, other habit-forming drugs, or alcohol or other chemical substances to an extent that impairs ability to practice. Section 472828(B)(19), ORC, authorizes the Board to discipline a licensee for failure to practice in accordance with acceptable and prevailing standards of safe nursing care. MS. KERSTON was initially licensed as a licensed practical nurse, PN065400, in the State of Ohio in November 1981. MS. KERSTON's license as a licensed practical nurse lapsed on September 1, 1986. MS. KERSTON has an active license to practice nursing as a registered nurse, RN-179196, in the State of Ohio. MS. KERSTON was licensed as a registered nurse in September 1982. MS. KERSTON self-reported to the Board that on or about May" 3, 2012, prior to starting her shift as a nurse at Nationwide Children's Hospital in Columbus, Ohio, she was confronted about the odor of Alcohol on her breath. MS. KERSTON submitted a reasonable suspicion drug screen that

B.

C.

Jami S. Kerston, R.N. Page 2

tested positive for Alcohol. MS. KERSTON was subsequently terminated from Nationwide Children's Hospital after thirty years of employment as a nurse with no prior practice problems or concerns. D. MS. KERSTON admits that she has an Alcohol problem and states that she had been drinking wine the night before she tested positive. MS. KERSTON entered and completed twenty-four days of inpatient and partial inpatient treatment at The Woods of Parkside in Columbus, Ohio. MS. KERSTON subsequently completed Intensive Outpatient Treatment at Neil Kennedy Recovery Clinic in Dublin, Ohio. MS. KERSTON continues to attend weekly 12-Step meetings. F. MS. KERSTON is willing to cooperate with the Board in order to maintain her nursing license. AGREED CONDITIONS Wherefore, in consideration of the foregoing and mutual promises hereinafter set forth, and in lieu of any formal proceedings at this time, MS. KERSTON knowingly and voluntarily agrees with the Board to the following terms, conditions, and limitations: MS. KERSTON's license to practice nursing as a registered nurse shall be suspended indefinitely. Such suspension shall be stayed, subject to the following PROBATIONARY terms, conditions, and limitations for a minimum of two (2) years: 1. MS. KERSTON shall obey all federal, state, and local laws, and all laws and rules governing the practice of nursing in Ohio. MS. KERSTON shall appear in person for interviews before the full Board or its designated representative as requested by the Board or its designee. MS. KERSTON agrees that she will submit a request to the Bureau of Criminal Identification and Investigation (BCH) to conduct a criminal records check of MS. KERSTON, including a check of Federal Bureau of Investigation (FBI) records, and shall cause BCII to submit MS. KERSTON's criminal records check reports to the Board. MS. KERSTON completed criminal records check, including the FBI check, must be received by the Board within six (6) months of the effective date of this Consent Agreement.

2,

3.

Educational Requirement 4. Within (6) months of the effective date of this Consent Agreement., MS. KERSTON shall, in addition to the requirements of licensure renewal, successfully complete and submit satisfactory documentation of successful completion of the following continuing nursing education, or another

Sarni S. Kerston, R.N. Page 3

comparable course approved in advance by the Board or its designee, all taken subsequent to the effective date of this Consent Agreement: eight (8) hours of Substance Abuse; and two (2) hours of Laws and Rules Governing the Practice of Nursing in Ohio. Monitoring of Rehabilitation and Treatment 5. MS. KERSTON shall abstain completely from the personal use or possession of drugs, except those prescribed, administered, or dispensed to her by another so authorized by law who has received a complete copy of this Consent Agreement prior to prescribing for MS. KERSTON, MS. KERSTON shall self-administer the prescribed drugs only in the manner prescribed. MS. KERSTON shall abstain completely from the use of alcohol and any products containing alcohol. Within forty-five (45) days of the effective date of this Consent Agreement and continuing throughout the probationary period, MS. KERSTON shall submit, at her expense and on the day selected, blood, breath, hair, or urine specimens for drug and/or alcohol analysis at a collection site specified by the Board at such times as the Board may request. Refusal to submit such specimen, or failure to submit such specimen on the day she is selected, or in such a manner as the Board may request, shall constitute a violation of a restriction placed on a license for purposes of Section 4723.28(B), ORC. This screening shall require a daily call-in process. The specimens submitted by MS. KERSTON shall be negative, except for substances prescribed, administered, or dispensed to her by another so authorized by law who has received a complete copy of this Consent Agreement prior to prescribing for MS. KERSTON. a. Prior to initiating screening, MS. KERSTON shall provide a copy of this Consent Agreement to all treating practitioners and shall provide to the Board a list of all treating practitioners, including addresses and telephone numbers and cause all treating practitioners to complete a medication prescription report that is to be mailed by the practitioner directly to the Board. The medication report is to be completed for any and all substances prescribed, administered, or dispensed to MS. KERSTON. After initiating screening, MS. KERSTON shall be under a continuing duty to provide a copy of this Consent Agreement, prior to initiating treatment, to additional treating practitioners, and to update the list of treating practitioners with, the Board within forty-eight (48) hours cif being treated by another practitioner. Further, MS. KERSTON shall notify the Board of any and all medication(s) or prescription(s) received within

6.

7.

b.

Jami S. Kerston, R.N. Page 4

twenty-four (24) hours of release from hospitalization or medical treatment, 8. Upon request by the Board or its designee and within sixty (60) days of such a request, MS. KERSTON shall, at her expense, obtain a chemical dependency evaluation by a Board approved chemical dependency professional and shall provide they Board with complete documentation of this evaluation. Prior to the evaluation, MS. KERSTON shall provide the chemical dependency professional with a copy of this Consent Agreement and any relevant treatment records from The Woods at Parkside and Neil Kennedy Recovery Clinic. Further, MS. KERSTON shall execute releases to perinit the chemical dependency professional to obtain any information deemed appropriate and necessary for the evaluation. The professional shall submit a written opinion to the Board that includes diagnoses, recommendations for treatment and monitoring, any additional restrictions that should be placed on MS. KERSTON's license to practice, and stating whether MS. KERSTON is capable of practicing nursing according to acceptable and prevailing standards of safe nursing care. If a chemical dependency evaluation is requested, MS. KERSTON shall provide the Board with satisfactory documentation of compliance with all aspects of the treatment plan developed by the chemical dependency professional described above until released. Further, MS. KERSTON agrees that the Board may utilize the professionaPs recommendations and conclusions from the evaluation as a basis for additional terms, conditions, and limitations on MS. KERSTON's license and that the terms, conditions, and limitations may be incorporated in an addendum to this Consent Agreement. Within thirty (30) days of the effective date of this Consent Agreement, MS. KERSTON shall attend a minimum of one (1) meeting per week of a support or peer group meeting approved in advance by the Board, or a Twelve Step program, and licensee shall provide satisfactory documentation of such attendance to the. Board every six (6) months beginning within sixty (60) days of the effective date of this Consent Agreement.

9.

10.

Employment Conditions 11. If working in a position hi which a nursing license is required, MS. KERSTON shall notify the Board, in writing, of the name and address of any current employer within thirty (30) days following the effective date of this Consent Agreement, or any new employer prior to accepting employment. MS. KERSTON within fifteen (15) days of the effective date of the Consent Agreement, if working in a position in which a nursing license is required, shall provide her employer(s) with a copy of this Consent Agreement. Further, MS. KERSTON is under a continuing duty to provide a copy of this Consent

12,

fami' S. Kerston, R.N. Page 5

Agreement to any new employer prior to accepting employment as a nurse. MS. KERSTON shall have her employer(s), if working in a position where a nursing license is required, submit written reports regarding job performance on a quarterly basis beginning within thirty (30) days of the effective date of this Consent Agreement and/or within thirty (30) .of accepting employment as a nurse. MS, KERSTON shall have her employer(s) send documentation to the Board, along with the first employer report, of receipt of a copy of this Cot sent Agreement, including the date it was received. Reporting Requirements of Licensee 13. MS. KERSTON shall report to the Board, in writing, any violation of this Consent Agreement within thirty (30) days of the occurrence of the violation. MS. KERSTON shall sign release of information forms allowing health professionals and other organizations to submit requested documentation or information directly to the Board. MS. KERSTON shall submit any and all information that the Board may request regarding her ability to practice according to acceptable and prevailing standards of safe nursing practice. MS. KERSTON shall not submit or cause to be submitted any false, misleading, or deceptive statements, information, or documentation to the Board or to employers or potential employers. MS. KERSTON shall submit the reports and documentation required by this Consent Agreement on forms specified by the Board. All reporting and communications required by this Consent Agreement shall be made to the Compliance Unit of the Board. MS. KERSTON shall submit the reports and documentation required by this Consent Agreement to the attention of the Compliance Unit, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, OH 43215-7410. MS. KERSTON shall verify that the reports and documentation required by this Consent Agreement are received in the Board office. MS. KERSTON shall inform the Board within five (5) business days, writing, of any change in employment status or of any change in residential or home address or telephone number.

14.

15.

16.

17.

18.

19.

20.

Jami S. Kerston, R.N. Page 6 Nursing 0 efresher Course or Orientation Upon request by the Board or its designee, MS. KERSTON shall, prior to working in a position where a nursing license is required, complete and submit satisfactory documentation of completion of a refresher course or an extensive orientation to be approved in advance by the Board or its designee. Temporary Practice Restrictions Unless otherwise approved in advance, in writing, by the Board or its designee, MS. KERSTON shall not practice nursing as a registered nurse (1) for agencies providing home care in the patient's residence; (2) for hospice care programs providing hospice care in the patient's residence; (3) for staffing agencies or pools; (4) as an independent provider where the nurse provides nursing care and is reimbursed for services by the State of Ohio through State agencies or agents of the State; or (5) for an individual or group of individuals who directly engage MS. KERSTON to provide nursing services for fees, compensation, or other consideration or as a volunteer. Unless otherwise approved in advance, in writing, by the Board or its designee, MS. KERSTON shall not function in a position or employment where the job duties or requirements involve management of nursing and nursing responsibilities, or supervising and evaluating nursing practice. Such positions include but are not limited to the following: Director of Nursing, Assistant Director of Nursing, Nurse Manager, and Vice President of Nursing. FAILURE TO COMPLY MS. KERSTON agrees that her license to practice nursing as a registered nurse will be automatically suspended if it appears to the Board that MS. KERSTON has violated or breached any terms or conditions of the Consent Agreement. Following the automatic suspension, the Board shall notify MS. KERSTON via certified mail of the specific nature of the charges and automatic suspension of her license. Upon receipt of this notice, MS. KERSTON may request a hearing regarding the charges. The above described terms and conditions shall constitute "restrictions placed on a license" for purposes of Section 4723.28(B), ORC. lf, in the discretion of the Board, MS. KERSTON appears to have violated or breached any terms or conditions of this Consent Agreement, the Board reserves the right to institute formal disciplinary proceedings for any and all possible violations or breaches, including, but not limited to, alleged violations of the laws of Ohio occurring before the effective date of this Consent Agreement.

Jami S. Kerston , R .N. Page 7

DURATION/MODIFICATION OF TERMS The terms, limitations, and conditions of this Consent Agreement, may be modified or terminated, in writing, at any time upon the agreement of both MS. KERSTI N and the Board. The Board may only alter the probationary period imposed by this Consent Agreement if: (1) the Board determines that MS. KERSTON has complied with all aspects of this Consent Agreement; and (2) the Board determines that MS. KERSTON is able to practice according to acceptable-and prevailing standards of safe nursing care without Board monitoring, based upon an interview with MS. KERSTON and review of the reports as required herein. Any period during which MS. KERSTON does not work in a position for which a nursing license is required shall not count toward fulfilling the probationary period imposed by this Consent Agreement. ACKNOWLEDGMENTS/LIABILITY RELEASE MS. KERSTON acknowledges that she has had an opportunity to ask questions concerning the terms of this Consent Agreement and that all questions asked have been answered in a satisfactory manner. MS. KERSTON waives all of her rights under Chapter 119, ORC, as they relate to matters that are the subject of this Consent Agreement. MS. KERSTON waives any and all claims or causes of action she may have against the Board, and its members, officers, employees and/or agents arising out of matters that are the subject of this Consent Agreement. This Consent Agreement shall be considered a public record as that term is used in Section 149.43, ORC. The information contained herein may be reported to appropriate organizations, data banks and governmental bodies. This Consent Agreement is not an adjudication order as discussed in Chapter 119, ORC. Any action initiated by the Board based on alleged violations of this Consent Agreement shall comply with the Administrative Procedures Act, Chapter 119, ORC.

Jami S. Kerston, R.N. Page 8 EFFECTIVE DATE MS. KERSTON understands that this Consent Agreement is subject to ratification by the Board prior to signature by the Board President and shall become effective upon the last date of signature below,

/.IAMI S. KERSTON, R.N.

DAT

Z..t I torr-BERTHA LOVELACE, President Ohio Board of Nursing DATE

ATTACHMENT A
11/05/2012 - 01/31/2013 Jami S Kerston

Missed Call History: Oath 11/09/2012 11123/2012 11/25/2012 11/27/2012 11/28/2012 11/29/2012 11/30/2012 12/01/2012 12/0212012 12/03/2012 12/04/2012 12/05/2012 Missed Call Missed Call Missed. Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Oetails .:

12/0612012 12/07/2012 12/08/2012 12/09/2012 12/10/2012 12/11/2012 12/12/2012 12/13/2012 12/14/2012 12/15/2012 12/16/2012 12/17/2012 12/18/2012 12/19/2012 12/20/2012 12/21/2012 12/22/2012 12/23/2012 12/2412012 12/25/2012 12/26/2012 12/27/2012 12/28/2012 12/29/2012 12/30/2012 12/31/2012

Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed-Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call

ATTACHMENT A
11/06/2012 - 01/31/2013 Jami S Kerston

Missed Call History:

Data

Details Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call

11/09/2012 11/23/2012 11/25/2012 11/27/2012 11/28/2012 11/29/2012 11/30/2012 12/01/2012 12/02/2012 12/03/2012 12/04/2012 12/05/2012

12/0612012 12/07/2012 12/08/2012 12/09/2012 12/10/2012 12/11/2012 12/12/2012 12/13/2012 12/14/2012 12/15/2012 12/16/2012 12/17/2012 12/18/2012 12/19/2012 12/20/2012 12/21/2012 12/22/2012 12/23/2012 12/2412012 12/25/2012 12/26/2012 12/27/2012 12/28/2012 12/29/2012 12/30/2012 12/31/2012

Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed-Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call

01/0112013 01/02/2013 01/03/2013 01/04/2013 ...... 01/05/2013 01/06/2013 01/07/2013 01/08/2013 01/09/2013 01/10/2013 01/11/2013 01/12/2013 01/13/2013 01/14/2013 01/15/2013 01/16/2013 01/17/2013 01/18/2013 01/19/2013 01/20/2013 01/21/2013 01/22/2013 01/23/2013 01/24/2013 01/25/2013 01/26/2013

Missed Cali Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Cali Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call

01/27/2013 01/29/2013 01/30/2013 01/31/2013 Row Count 69

Missed Call Missed Call Missed Call Missed Call

01/28/2013 Missed Call

Case # 11-000126

Ohio Board of Nursing

www.nursing.ohio.gov

17 South High Street, Suite 400 0; Columbus, Ohio 43215-7410 6 (614) 466-3947

March 22, 2013

NOTICE OF OPPORTUNITY FOR HEARING

Marquetta Lynn Kimbrough, L.P.N. 2808 Vienna View Court SW Canton, Ohio 44706 Dear Ms. Kimbrough: In accordance with Chapter 119, Ohio Revised Code (ORC), you are hereby notified that the Ohio Board of Nursing (Board) proposes under authority of Section 4723.28 ORC, to deny, revoke, permanently revoke, suspend or place restrictions on your license to practice nursing as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: 1. On or about December 30, 2010, you submitted a pre-employment urine specimen that tested poSitive for Marijuana. On or about October 25, 2012 you reported to a Board Compliance Agent that you had attended a party in late December 2010 where a "hookah pipe" was present. You stated: "When I arrived at the party I found a hookah pipe sitting on the floor . . . I was told by friends at the party that the hookah contained a synthetic substance that was like tobacco. I was specifically advised it did not contain marijuana or any other illegal substance and that the 'tobacco' that was in the pipe was not illegal to smoke. I naively believed what I was told and took a few smokes off of one of the pipes." Section 4723.28(B)(8), ORC [as in effect prior to June 8, 2012], authorizes the Board to discipline a licensee for self-administering or otherwise taking into the body any dangerous drug, as defined in Section 4729.01, OK, in any way not in accordance with a legal, valid prescription issued for that individual. Accordingly, the Board is authorized to impose one or more of the sanctions cited in Section 4723.28, ORC. In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing in this matter. If you wish to request such hearing, the request must be made in writing and must be received in the Board office within thirty (30) days of the time of mailing of this notice. You are hereby further informed that, if you timely, request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to

Marquetta Lynn Kimbrough, L.P.N. Page 2 practice before the Board, or you may present your position, arguments, or contentions in writing. At the hearing, you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to Lisa Ferguson-Ramos, Compliance Unit Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, Ohio 432157410 or to the email address, hearittg@nursing.ohio.o.ov. If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Opportunity for Hearing, deny, revoke, permanently revoke, suspend, or place restrictions on your license to practice nursing as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ( 500.00) per violation. Sincerely,

Rhonda S. Barkheimer, C.N.P. Supervising Board Member

Certified Mail Receipt No. 7012 2210 0000 6272 3933 Attorney Certified Mail Receipt No. 7012 2210 0000 6272 3926

cc: Henry G. Appel, Senior Assistant Attorney General Elizabeth Y. Collis, Esq.

Case # 11-003404

Ohiooard of Nursing
17 South High Street, Suite 400

www.nursing.ohid.gov

Columbus, Ohio 43215-7410 - 0, (614) 466-3947

March 22,2013

NOTICE OF OPPO TUT\ !TY FOR HEARING

Lisa Renee Leasure, L.P.N. 7528 Lake Road Madison, Ohio 44057 Dear Ms. Leasu In accordance with Chapter 119, Ohio Revised Code (ORC), you are hereby notified that the Ohio Board of Nursing (Board) proposes under authority of Section 4723.28 ORC, to deny, revoke, permanently revoke, suspend or place restrictions on your license to practice nursing as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: On or about August 11, 2011, while working as a nurse at the Broadfield Care Center, in Madison, Ohio, your employer requested that you submit a urine specimen for drug testing. The urine specimen you submitted tested positive for Marijuana. On or about August 11, 2011,you reported to your employer that you had smoked "pot" recently, more than once, and that you smoked it to relax. Section 4723.28(B)(8), ORC [as in effect prior to June 8, 2012], authorizes the Board to discipline a licensee for self-administering or otherwise taking into the body any dangerous drug, as defined in Section 4729,01, ORC, in any way not in accordance with a legal, valid prescription issued for that individual. Accordingly, the Board is authorized to impose one or more of the sanctions cited in Section 4723.28, ORC. In accordance with Chapter 119, CRC, you are hereby informed that you are entitled to a hearing in this matter. If you wish to request such hearing, the request must be made in writing and must be received in the Board office within thirty (30) days of the time of mailing of this notice. You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in writing. At the hearing, you may also present evidence and examine witnesses appearing for and against you.

Lisa Renee Leasure, L.P.N. Page 2 Should you choose to request a hearing, please mail or deliver the request, in addition to any Pother correspondence regarding this matter, to Lisa Ferguson-Ramos, Compliance Unit Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, Ohio 432157410 or to the email address, hearing@nursiug.ohio.gov. If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Opportunity for Rearing, deny, revoke, permanently revoke, suspend, or place restrictions on your license to practice nursing as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars 0500.00) per violation. Sincerely,
;. / c<fv.z4V -4t.,

X At

Rhonda S. Barkheimer, R.N., C.N.P. Supervising Board Member Certified Mail Receipt No. 7012 2210 0000 6272 3193 cc: Henry G. Appel, Senior Assistant Attorney General

Case #2012-005873

Ohio Boarci of Nursing

17 South High Street, Suite 400

www.nursing.oh.i.o.gov (614) 466-3947

Columbus, Ohio 43215-7410

March 22, 2013

NOTICE OF OPPORTUNITY FO HEARING

Lucas Norman Mackesy, L.P.N., R.N. 4354 N. 82'd Street 264 Scottsdale, Arizona 85251 Dear Mr. Mackesy: In accordance with Chapter 119. of the Ohio Revised Code (ORC), you are hereby notified that the Ohio Board of Nursing (Board) proposes under the authority of Section 4723.28, ORC, to deny, permanently revoke, revoke, suspend or place restrictions on your licenses to practice nursing as a licensed practical nurse and as a registered nurse in Ohio; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: On or about August 3, 2012, the Board of Registered Nursing, Department of Consumer Affairs, State of California issued a letter in which your application for licensure to practice nursing as a registered nurse in California was denied (California Board 2012 Denial Letter). You were provided the opportunity to be given a hearing by filing an appeal no later than October 3, 2012. You did not request a hearing. A certified copy of the California Board 2012 Denial Letter is attached hereto and incorporated herein. Section 4723.28(B)(1) [as in effect prior to March 20, 2013], ORC, authorizes the Board to discipline a license for denial, revocation, suspension, or restriction of authority to practice a health care occupation, including nursing, for any reason other than a failure to renew, in Ohio or another state or jurisdiction. Accordingly, the Board is authorized to impose one or more of the sanctions as cited in Section 4723.28 ORC. You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in writing. At the hearing you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to: Lisa Ferguson-Ramos, Compliance Unit Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, OH 43215. 7410, or to the email address, hearing@nursin

Lucas Norman Mackesy, L.P.N ., R.N. Page 2

If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Opportunity for Hearing, to deny, permanently deny, permanently revoke, revoke, suspend or place restrictions on your licenses to practice nursing as a licensed practical nurse and as a registered nurse in Ohio; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely, ,/,/ Rhonda S. Barkheimer, R.N., C.N.P. Supervising Board Member Certified Mail Receipt No. 7012 2210 0000 6272 3100 cc: Henry G. Appel, Senior Assistant Attorney General

IJ

A'reTO OP 0.41.1 ,0PINI1k

STAIT .44.40 col57ilvi214 SaPlvicE AoenIcr envtallom =mut.= Z. BLOWN JR,

OZAMPAENTOF cOmsuignA0FAins

BOARD OF REGISTERED NURSING PO Box 944210, Sacramento, CA 94244-2100 P (916) 322-3350 F (916) 574-8637 1 www.m.oa.00v Louise R. Bailey, M. Ed, RN, Executive Officer 04,0r Tloprhyfi,,
I

lfy
y

August 3, 2012 LUCAS MACKESY 4354 N 821\10 ST. 264 SCOTTSDALE, AZ 85251 Dear MR. MACKESY:

B00f the doc office, RD r. ci ft fi lrD yP Pt: E n 'a T ahRei P i :t. E :g6 G . jn6 h : (1 6 tolrP R
of,e4Y. .* rked, i:OUiaU'R.BdeV, 'ED... RN pecotiVe Officer

4ar>. : " '4 1:; 17 P: "C 5 14 .;0 i 1:

"

The California Board of Registered Nursing (Board) is denying your application for licensure as a registered nurse pursuant to Sections 480(a)(1), 480(a)(3), 2761(a), 2761(f), 2762(b), and 2762(c) of the Business and Professions Code. This denial is based upon your prior criminal convictions. You used alcohol to the extent or in.-a manner dangerous or injurious to yourself, any other person, or the public. These acts are considered to be substantially related to the practice of nursing and would constitute grounds for revocation or suspension of a license if done by a licensed nurse. You have the right to appeal this decision and to have a formal hearing under the provisions of Section 485 (b) of the Business and Professions Code. Such an appeal must be submitted in writing to this office within 60 days of this notice,. no later than 5:00 p.m, on October 8, 2012; otherwise your right to a hearing is' waived, If you do not appeal this denial, the earliest date you can reapply for licensure is one year from the date of this letter. Should you appeal and the denial is upheld, the earliest date you can reapply would be one year from the date of the decision. At such time reapplication is made, all competent evidence of rehabilitation will be considered. (Enclosed is a copy of the Board's criteria for rehabilitation.) Your appeal will be sent to the California Attorney General's Office (AG). Once the appeal has been transmitted to the AG, your application for licensure cannot be withdrawn. The AG will prepare a Statement of Issues and request a hearing date. As an alternative to a formal hearing, it may be possible to reach an agreement with the Board. A representative of the AG's office would work with you and Board staff to draft a proposed stipulated agreement, which would then be

subject to approval by the Board. If you appeal the denial, you may state your interest in pursuing a stipulation as an alternative to a formal hearin. You will be contacted by a representative from the AG's office by mail and all communication will be with the attorney assigned to your case. Sincerely,

'\-

7e

Louise R. Bailey, NI.Ed, RN Executive Officer End. Form 1445 (a) LB:yn

Case #12-006248

Ohio Board of Nursing

www.nursing.ohio.gov
(614) 466-3947

17 South High Street, Suite 400 o Columbus. Ohio 43215-7410

March 22, 2013

NOTICE OF OPPORTUNITY FOR HEARING

Brent Donovan Mathews, R.N. 2201 Rockbrook Dr. #433 Lewisville, TX 75067 Dear Mr. Mathews: In accordance with Chapter 119. of the Ohio Revised Code (ORC), you are hereby notified that the Ohio Board of Nursing (Board) proposes under the authority of Section 4723.28, ORC, to deny or permanently deny your application for reinstatement of your license to practice nursing in Ohio as a registered nurse; permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: On or about August 16, 2010, the Texas Board of Nursing, (Texas Board), issued an Agreed Order (Texas 2010 Order), in which you received the sanction of Remedial Education With A Fine, and which prohibited you from working outside the State of Texas pursuant to a nurse licensure compact privilege without prior written permission. A copy of the Texas 2010 Order is attached hereto and incorporated herein. Section 4723 .28(B)(1) [as in effect prior to March 20, 2013], ORC authorizes the Board to discipline a licensee for denial, revocation, suspension, or restriction of authority to practice a health care occupation, including nursing, for any reason other than a failure to renew, in Ohio or another state or jurisdiction. Accordingly, the Board is authorized to impose one or more of the sanctions as cited in Section 4723.28 ORC. You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in writing. At the hearing you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to: Lisa Ferguson-Ramos, Compliance Unit Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, OH 43215-7410, or to the email address, hearin @nursin .ohio ov.

Brent Donovan Mathews, R.N. Page 2

If the Board fails to receive a request for a hearing within thirty {30) days cif the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Opportunity for Hearing, deny or permanently deny your application for reinstatement of your license to practice nursing in Ohio as a registered nurse; permanently revoke, revoke, suspend or place restrictions on, your license to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely,

Rhonda S. Barkbeimer, RN., C.N.P. Supervising Board Member Certified Mail Receipt No. 7012 2210 0000 6272 3063 cc: Henry G. Appel, Senior Assistant Attorney General

BEFORE THE TEXAS BOARD OF NURSING *******************************=i4************* in the Matter of Registered Nurse License Number 704348 . issued to BRENT DONOVAN MATFIEWS - AGREED ORDER

On this day the Texas Board of Nursing, hereinafter referred to as the Board, considered the matter of BRENT DONOVAN MATHEWS, Registered Nurse License Number 704348, hereinafter referred to as Respondent. Information received by the Board produced evidence that Respondent may have violated Section 301.452(b)(2)&(10), Texas Occupations Code, Respondent waived representation by counsel, informal proceedings, notice and hearing, and agreed to the entry of this Order offered on July 9, 2010, by Katherine A. Thomas, MN, RN, Executive Director.

FINDINGS OF FACT

1.

Prior to the institution of Agency proceedings, notice of the matters specified below in these Findings of Fact was served on Respondent and Respondent was given an opportunity to show compliance with all requirements of the law for retention of the license, Respondent waived representation by counsel, informal proceedings, notice and hearing, and agreed to the entry of this Order. Respondent is currently licensed to practice professional nursing hi the State of Texas. Respondent received an Associate Degree in Nursing from Owens Community College, Toledo, Ohio, on December I, 1998. Respondent was licensed to practice Profesional nursing in the State of Texas on April 9, 2004. Respondent's complete professional nursing employment history is -unknown.

2.

3. 4.

5.

70434N:14

C20

6.

On or about July 1, 2008, Respondent submitted an Online Renewal Document for Registered Nurses to the Texas Board or Nursing, in which he provided false, deceptive, and/or misleading information, in that he answered "No" to the question: "Have you, Within the past 24 months or since your last renewal, for any criminal offense, including those pending appeal: A. B. C, D. E, P. G. H. I. .1. been convicted of a misdemeanor? been convicted of a felony? pled nolo contendere, no contest, or guilty? received deferred adjudication? been placed on community supervision or court-ordered probation, whether or not adjudicated guilty? been sentenced to serve jail or prison time? court-ordered confinement? been granted pre-trial diversion? been arrested or have any pending criminal charges? been cited or charged with any violation of the law? been subject of a court-martial; Article 15 violation; or received any form of military judgment/punishment/action?"

Respondent failed to disclose that on or about June 5, 2008, be was arrested by the Fort Bend County Sheriffs Office, Richmond, Texas, and charged with INDECENCY WITH A CHILD SEXUAL CONTACT (a 2nd Degree Felony), under Cause No. 50178. The case was dismissed on April 20, 2010. 7. In response to Finding of Fact Number Six (6), Respondent states: In June of 2008, I was arrested for Indecency with a Child by my adopted son, I was arrested and lost my job in October of 2008 when charges were brought up. The case.was dismissed because it was not true first of all and there was insufficient evidence. Formal Charges were filed on June 17, 2010. Formal Charges were mailed to Respondent on June 17, 2010. CONCLUSIONS OF LAW 1. Pursuant to Texas Occupations Code, Sections 301.451-301.555 , the Board has jurisdiction over this matter. Notice was served in accordance with law. The evidence received is sufficient to prove violations of Section 301.452(b)(2)&(10), Texas Occupations Code, and 22 TEX,,ADMIN, CODE 217.12(6)(1). -2-

8. 9.

2, 3.

70434R:14i

Cgs)

4.

The evidence received issutficientcause pursuant to Section 301.452(h), Texas Occupations Code, to take disciplinary action against Registered Nurse License Number 704348, heretofore issued to BRENT DONOVAN MATHEWS, including . revocation of Respondent's license to practice professional nursing in the State of Texas.

ORDER IT IS THEREFORE AGREED and ORDERED, subject to ratification by the Texas Board of Nursing, that RESPONDENT SHALL receive the sanction of REMEDIAL EDUCATION WITH A FINE, and RESPONDENT SHALL comply in all respects with the Niirsing Practice Act, Texas Occupations Code 301.001 et seq., the Rules and Regulations, Relating to Nurse Education, Licensure and Practice, 22 TEX. ADM IN, CODE 21 1,1 et seq. and this Order, IT IS FURTHER AGREED and ORDERED that this Order SHALL be applicable to Respondent's nurse licensure compact privileges, if any, to practice nursing in the State of Texas, IT IS FURTHER AGREED and ORDERED that while Respondent's license is encumbered by this Order, Respondent may not work outside the State of Texas pursuant to a nurse licerisure compact privilege without the written permission or the State of Texas and the Board of Nursing in the party state where Respondent wishes to work, IT IS FURTHER AGREED that: (I) RESPONDENT SHALL, within one (1) year of entry of this Order, successfully complete a course in Texas nursing jurisprudence and ethics. RESPONDENT SHALL obtain Board approval of the course prior to enrollment only if the course is not being offered by a pre-approved provider. Home study courses and video programs will not be approved. In order for the course to be approved, the target audience shall include nurses. It shall be a minimum of six (6) hours in length. The course's content shall .include the Nursing Practice Act! standards of practice, -3-

7000:14i

documentation of care, principles of nursing ethics, confidentiality, professional boundaries, and the Board's Disciplinary Sanction Policies regarding: Sexual Misconduct; Fraud, Theft and Deception; Nurses with Substance Abuse, Misuse, Substance Dependency, or other Substance Use Disorder; and Lying and Falsification. Courses focusing on malpractice issues will not be accepted. RESPONDENT SHALL CAUSE the sponsoring institution to submit a Verification of Course Completion form, provided by the Board, to the Office of the Board to verify RESPONDENTS successful completion of the course. This course shall be taken in addition to any other courses stipulated in this Order, if any, and in addition to any continuing education requirements the Board has for relieensure. Board-approved courses may be found at the following Board website address: http://www.bonataie.ix.res/disciplinaryaction/stipscourses,htrni (2) RESPONDENT SHALL pay a monetary fine in the amount of two hundred fifty. dollars ($250.00), RESPONDENT SHALL pay this fine within forty-five (45) days of entry of this Order. Payment is to be made directly to the Texas Board of Nursing in the form of cashier's check or U.S. money order. Partial payments will not be accepted. IT IS FURTHER AGREED, that upon full compliance with the terms of this Order, all encumbrances will be removed from RESPONDENT'S license to practice nursing in the State of Texas and RESPONDENT shall be eligible for nurse licensure compact privileges, if any.

BALANCE OF THIS PAGE INTENTIONALLY LEFT BLANK, CONTINUED ON NEXT PAGE.

70048:141

-4-

CZO

RESPONDENT'S CERTIFICATION
understand that I have the right to legal counsel prior to signing this Agreed Order. I waive representation by counsel. I have reviewed this Order. I neither admit nor deny the violations alleged herein. By my signature on this Order, I agree to the Findings of Fact, Conclusions of Law, Order, and any conditions o ['said Order, to avoid further disciplinary action in this matter, I waive judicial review of this Order. I understand that when this Order becomes final and the terms of this Order become effective, a copy will be mailed to me. I understand that 111 fail to comply with all terms and conditions of this Order, I will be subject to investigation and discipi inary sanction, including revocation of my license to practice professional nursing in the State of Texas, as a consequence of my noncompliance,

Signed this

'2

day o

tieirtimgf a i(
BRENT DONOVAN MA JEWS, Respondent

Sworn to and subscribed before me this

Notary Public in and or the State of

704345:14

-5-

C20

WHEREFORE, PREMISES CONSIDERED, tbe Executive Director, on behalf of the Texas Board of Nursing, does hereby rat fy .and adopt the Agreed Order that was signed on the 7th day of August 20 /0 , by BRENT DONOVAN MATHEWS,

Registered Nurse License Number 704348, and said Order is final.

Effective this

16th

day of

Attgust

20 10

Katherine A. Thomas, MN, RN Executive Director on behalf . of said Board

70434M:141

Case #2013-000261

(31-iicy Board of Nursing

17 South High Street, Suite 400 A March 22, 2013

www,nursing.ohio7gov Columbus, Ohio 43215-7410 m (614) 466-3947

NOTICE OF1OPPORT1JNITY FOR HEARING

Kay McConnell, R.N., C.R.N A. 301 Demonbreun Street #1006 Nashville, Tennessee 37201 Dear Ms. McConnell: In accordance with Chapter 119. of the Ohio Revised Code (ORC), you are hereby notified that the Ohio Board of Nursing (Board) proposes under the authority of. Section 472328, ORC, to deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a registered nurse and your certificate of authority as a certified registered nurse anesthetist in Ohio; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: 1. On or about August 7, 2012, Case No. 2013-90, the Board of Registered Nursing, Department of Consumer Affairs State of California issued an Accusation against your license to practice nursing as a registered nurse in California and your nurse anesthetist certificate (California Board 2012 Accusation). Effective on or about January 14, 2013, the California Board issued a Default Decision and Order, revoking your license to practice nursing as a registered nurse and your nurse anesthetist certificate (California Board 2013 Default Decision and Order). A copy of the California Board 2012 Accusation and the California Board 2013 Default Decision and Order are attached hereto and incorporated herein.

Section 4723.28(B)(1.) [as in effect prior to March 20, 2013], ORC, authorizes the Board to discipline a certificate and/or license for denial, revocation, suspension, or restriction of authority to practice a health care occupation, including nursing, for any reason other than a failure to renew, in Ohio or another state or jurisdiction. Accordingly, the Board is authorized to impose one or more of the sanctions as cited in Section 472328 ORC. You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in writing. At the hearing you may also present evidence and examine witnesses appearing for and against you.

Kay McConnell, RN., C.R.N.A. Page 2

Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to: Lisa Ferguson-Ramos, Compliance Unit Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, 011 432157410, or to the email address, hearin @nursin .ohio ov. If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Opportunity for Hearing, to deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a registered nurse as and your certificate of authority as a certified registered nurse anesthetist in Ohio; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely,

Rhonda S. Barkheimer, R.N., C.N.P. Supervising Board Member Certified Mail Receipt No. 7012 2210 0000 6272 3070 cc: Henry G. Appel, Senior Assistant Attorney General

1 2 3 4 5 6 7 8 In the Matter of the Accusation Against ' BEFORE THE BOARD OF REGISTERED NURSING DEPARTMENT OF CONSUMER AFFAIRS STATE OF CALIFORNIA Case No, 2013-90

10' 11' 301 Demonbrean Street, 41006

12 13 14 '15 Respondent. 16 17 Nashville, TN 37201 Registered Nurse License No..501447 Nurse Anesthetist Certificate No. 2094 KAY OSWALD MCCONNELL

DEFAULT DECISION AND ORDER [Gov.. code, 11520]

1.8
19 20 21 22 23 .24 25 1.

'

FINDINGS OF FACT

On or about August 7, 2012, Cotnplainant Louise R. Bailey, M.Ed.,RN, in her

official Capacityas the Executive Officer of the Board of Registered Nursing, Department of Consumer Affairs, filed Accusation No. 2013-90 against Kay Oswald McConnell (Respondent) before the Board of Registered Nursing. (Accusation attached as Exhibit A.) 2. '

On or about May 26,, 1994, the Board of Registered Nursing (Board) issued

Registered Nurse License No, 501447 to Respondent, The Registered Nurse License was in fill] force and effect at all times relevant to the charges brought in,Accusation No, 2013-90 atewiII

26. expire on July 31, 2013, unless renewed. 27. 28 ' 3. On or about June 7, 1994, the Board of Registered Nursing issued Nurse Anesthetist Certificate No, 2094 to Respondent. The Nurse Anesthetist Certificate was in full force and . 1
DEFAULT DECISION AND ORDER,

effect at all times relevant to the chaigei brought in Accusation No, 2013-90 and will expire on 2 3 Slily 31, 2013, unless renewed, 4, On or about August 7, 2012, Respondent was served by Certified Mail and United

States First Class naafi with copies of the Accusation No, 2013.90, Statement to Respondent, 5
6

Notice of Pefense, Request for Discovery, and Discoyery Statutes (Gayer:at:tient Code sections 11507.5, 11507.6 and 11507.7) at Respondent's address of record -which, pursuant to California Code of Regulations, title 16, section 1409.1, is required to be reported and maintained with the Board, Respondent's address of record was and is: 301 bernonbretin Street, 41006, Nashville, TN 37201. 5, Service of the Accusation was effective as a matter of law under the provisions of

7 8 9 10
11

Government Code section 11505, subdivision (c) and/or Business & Professions Code section 124. 6. On or about September 5, 2012, the United States Postal Service returned to the Board the eertified mail to Respondent stamped "unclaimed", The first class mailing to Respondent described in Paragraph 4 has not been returned by the United States Postal Service, 7. Goveniment Code section 11506 states, in pertinent part:

12 1.3 14 15 16. 17 18 19 20 21 22 23 . 24 25 26 27 28

(c) The respondent shall be entitled to a bearing on the merits if the respondent files a notice of defense, and the notice shall be deemed a specific denial of all parts ..Of the accusation not expressly admitted. Failure to file a notice of defense shall constitute. a waiver 'of respondent's right to a hearing, but the agency in its discretion may nevertheless grant a hearing, 8. ReSpondent failed to file a Notice of Defense vkritbin 15 days after service upon her of

the Accusation, and therefore waived her.righrto a hearing on the merits of Accusation No, 201390, 9. California. Government Code section 11520 states, in pertinent part:

(a) 'If the respondent either fails to file a notice of defense or to appear at the hearing, the agency may take action based upon the respondent's express admissions or, upon other evidence and affidavits may be used as evidence without any notice to respondent. 10. Pursuant to its authority under Government Code section 11520, the Board finds Respondent is in default: The Board will take action without further hearing and, based on the .
DEFAULT DECISION AND ORDER.

egicaAramZeromp3Asorn

relevant evidence contained in the Default Decision Investigatory Evidence Packet in this matter, as well as taking official notice of all the investigatory reports, exhibits and statements contained therein on file at the Board's offices regarding the allegations contained in Accusation No. '201390, finds that the charges. and allegations in Atensation No. 2013-90, are separately and severally, found to be true and coweet by clear and convincing evidence, 6 7 1I. Taking official notice of its own internal records, pursuant to Business and Professions Code section 125.3, it is hereby determined thatbe reasonable costs for Investigation and Enforcement is $ 1,232.50 as of September 13, 2012, 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25
26

DETERMINATION OF ISSIIES 1, Based on the foregoing findings of fact, Respondent Kay Oswald McConnell has

subjected her Registered Nurse License No. 501447 and her Nurse Anesthetist Certificate No. 2094 to discipline. 2. 3, The agency has jurisdiction to adjudicate this case by default, The Board of Registered Nursing is authorized to revoke Respondent's Registered

Nurse License and her Nurse Anesthetist Certificate based upon the violations de,scribed.below as alleged in the Accusation, which are supported by the:evidence contained in the Default Decision Investigatory Evidence Packet in this case. Respondent violated BUsiness & Professions Code sections 2761(f) and.2762(c) by her 2007 conviction for violating Kentucky Revised Statutes section 189.A.010 (driving under the infihence of alcohol), Respondent also violated BusineSs & Professions Code section 2762(b) by her use of alcohol to an extent or in a marmortiangerous. or injurious to herself or others, 11/1 / III It/ /1/ /// 1 II

27
28

DEFAULT DECISION AND ORD

1. 2 3 4 5 6 7

ORDER IT is SO ORDERED that Registered Nurse License Nd. 501447 and Nurse Anesthetist Certificate No. 2094, heretofore issued to Respondent Ray Oswald McConnell, are revoked. , Pursuant to Government Cade-section 11520, subdivision (c), Respondent may serve a written motion requesting that the Decision be vacated and stating the grounds relied on within seven (7) days after service of the Decision on Respondent. The agency in its discretion may vacate the Decision and grant a hearing on a showing of good cause, as defined in the statute. This Decision shall become effective on It is so ORDERED

a
9 10 Il 12, 13 14 15 16 17 18 19 20 21 22 23 24' 25 26 27

(beitit 0 10 /

Aor_i

FOR ,HE B ARD OF REGISTERED NiJRS G DEPARTMENT OF CONS-OMER AFFAIRS

AttachMent: . Exhibit A: Accusation. I hereby certify the

foregoing to be a true copy of the documents on file in our office.

'BOARD OF REGISTERED NURSING 4.1

Louise R. 13alley,
ExeCutive Ortit.er

ED., RN

ii

28 4
DEFAULT DECISION AND ORDER

1=.

2 3 4 5 6 7

KAMA.LA D. HARRIS 'Attorney General of California ARTHUR D. TAGGART Supervising Deputy Attorney General STERLING A. SMITH Deputy Attorney General State Bar No. 84287 1300 I Street, Suite 125 P.O. 'Box_ 944255 Sacramento, CA 94a44-2550 Telephone.; (916) 445-0378 Facsimile: (916) 327-8643 Attorneys for Complainant BEFORE TILE BOARD OF REGISTERED NURSING DEPARTMENT OF CONSUMER AFFAIRS STATE OF CALIFORNIA In the Matter of the Accusation. Against: KAY OSWALD MCCONNELL 301 Demorihrenn Street, #1.006 Nashville, TN 37201 Registered Nurse License N. 501447 Nurse Anesthetist Certificate No. 2094 Respondent Case No.

10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25. 26 27 28 1. Louise R. Bailey, M.Ed., RN ("Complaiiant") alleges: PARTIES Complainant brings this Accusation solely in her official capacity as the Executive

q'o

ACCUSATLON

Officer of the Board of Registered Nursing ("Board"), Department of Consumer Affairs. 2. On or about May 26, 1994, the Board issued Registered Nurse License Number

501447 to Kay Oswald McConnell ("Respondent."). The license was in full force and effect at all times relevant to the charges. brought herein and will expire on 7uly.31, 2013, unless renewed. .3. On or about June 7, 1994, the Board issued Nurse Anesthetist Certificate Number

2094 to Respondent. The license was in full force and effect at all times relevant to the'charges brought herein and will expire on July 31, 2013, unless renewed. ///
Accusation

JURISDICTION 4. Business and Professions -Code ("Cede") section 2750 provides, in pertinent part, that

the Board may discipline any licensee, including a licensee holding a temporary or an inactive license, for any reason provided in Article 3 (commencing with section 2750) of the Nursing Practice Act' 7
3

5. .. Code section 2764 provides, in pertinent part, that the expiration of a license shall not

deprive the Board of jurisdiction to proceed with a disciplinary proceeding against the licensee or to render a decision imposing discipline on the license. Under Code section 2811(h), the Board may renew an expired license at any time within eight years after the expiration. STATUTORY PROVISIONS 6. Code section 2761 states, in pertinent part:

9 10 11 12 13

The.board may take disciplinary action against a certified or licensed nurse or deny an application for a. certificate or license for any of the following: (a) Unprofessional conduct...

. 14 15 16 17 18 (f) Conviction of a felony or of any offense substantially related to the qualifications, functions,.and duties of a registered nurse, in which event the record of the conviction shall be conclusive evidence thereof. 7. Code section 2762 states, in pertinent part:

In addition to other acts constituting unprofessional conduct within the meaning of this chapter [the Nursing Practice Act], it is unprofessional condUct for a person licensed under this chapter to do the following: (b) Use any controlled substance as defined in Division 10 (commencing with Section 11000) of the Health and Safety Code, or any dangerous drug Or dangerous device as defined in Section 4022, or alcoholic beverages, to an extent or in a manner dangerous or injurious to biinself or herself, any other person, or the public or to the extent that such use impairs his or her ability to conduct with safety to the public the practice authorized by his or her license, (c) Be convicted of a criminal offense involving the prescription;consumption, or self administration of any of the substances described in Subdivisions (a) and (b) of this section, or the possession of, or falsification of a record pertaining to, the substances described in subdivision (a) of this section, in which event the record of . the conviction is conclusive evidence thereof.

20 21 22 23 24 25 26 27 23
/1/

/11

Accusation

COST RECOVERY 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
20 .

8.

Code section 125.3 provides, in pertinent part, that the Board may request the

administrative law judge to direct a licentiate found to have committed a violation or violations of the licensing act to pay a sum not to exceed the reasonable costs of the investigation and enforcement of the case. FIRST CAUSE FOR DISCIPLINE (Conviction of a Crime) 9, Respondent is Subject to discipline Under Code section 2761(f), in that on or about

January 25, 2007, in the case of Commonwealth of Kentucky v, Kay McConnell, (Commonwealth of Kentucky, 28th Judicial District, Pulaski District Court, Case No, 05-T-5283), Respondent was . convicted by the Court on her plea of guilty of violating KRS section 189A.010 (operating a. motor vehicle with a blood alcohol level of .08% or higher), a crime that is substantially related to the qualifications, functions .or duties of a licensed registered nurse. The circumstances of the crime were that on or about December 8, 2005, Respondent drove a vehicle while having a blood alcohol level of 0,2.0%, and was involved in a collision. After striking the other vehicle, Respondent fled the scene of the accident but was immediately caught. SECOND CAUSE FOR DISCIPLINE (Dangerous Use of Alcohol) 10. Respondent is subject to discipline under Code sections 2761(a), on the grounds of unprofessional conduct, as defined in Code section 2762(b), in that on or about December 8, 2005, Respondent used an alcoholic beverage to an extent or in a manner dangerous or injurious to herself and the public when she operated a vehicle with a blood alcohol level of 0.20%, as more particularly set forth above in paragraph 9, THIRD CAUSE FOR DISCIPLINE (Conviction Involving the Consumption.of Controlled Substances and Alcohol) 11. Respondent is subject to discipline under Code section 2761(a), on the grounds of unprofessional conduct as defined in Code section 2762(c), in that on or about January 25, 2007: /// 3
Accusation

21 22 23 24 25 26 27 28

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 .17 18 19
24

Respondent was convicted of a crime involving the consumption of alcohol, as more particularly set forth above in paragraph 9, PRAYER WHEREFORE, Complainant requests that a hearing be held on the matters herein alleged, and that following the hearing, the Board of Registered Nursing issue a 'decision:. 1. Revoking or suspending Registered Nurse License Number 501447, issued to Kay .

Oswald McConnell; 2.

Revoking or suspending Nurse Anesthetist Certificate Number 2094, issued to Kay

,Oswald McConnell; 3. Ordering Kay Oswald McConnell to pay the Board of Registered Nursing the

reasonable costs of the investigation and enfoMement of this case, pursuant to Business and Professions Code section 125.3; and, 4. DATED: SE R. BAILEY, M. Executive Officer Board of Registered Nursing Department of Consumer Affairs State of California
Complainant

Taking such other and further action as deemed necessary and proper.

21 22 23 24 25 26 27 28 4 Accusation

Case #12-005018

Ohio Board of Nursing.

17 South High Street,' Suite 400 March 22, 2013

www.nursing.ohio.gov

Columbus, Ohio 43215-7410 40 (614) 466-3947

NOTICE OF IMMEDIATE SUSPENSION AND OPPORTUNITY FOR HEARING

David Paul Middleton, R.N. 5045 Cedar Creek Road Urbana, Ohio 43078 Dear Mr. Middleton: In accordance with Sections 2929.42 and/or 3719.12 of the Ohio Revised Code (ORC), the Ohio Board of Nursing (Board) has been notified that, on or about March 5, 2013, in Clark County Court of Common Pleas Case Number 13-CR-136, you pled guilty to one (1) count of Theft of Drugs, a felony of the fourth degree, in violation of Section 2913 .02(A)(1), ORC, and were found eligible for. Intervention in Lieu of Conviction. Section 3719.121(C), ORC, states in pertinent part as follows: On receiving notification pursuant to Section 2929.42 or 3719.12 of the Revised Code, the board under which a person has been issued a license, certificate or evidence of registration immediately shall suspend the license, certificate, or registration of that person on a plea of guilty to, a finding by a jury or court of the person's guilt of, or conviction of a felony drug abuse offense; a finding by a court of the person's eligibility for intervention in lieu of conviction; a plea of guilty to, or a finding by a jury or court of the person's guilt of, or the person's conviction of an offense in another jurisdiction that is essentially the same as a felony drug abuse offense; or a finding by a court of the person's eligibility for treatment or intervention in lieu of conviction in another jurisdiction. Theft of Drugs, a felony of the fourth degree, in violation of Section 2913.02(A)(1), ORC, constitutes a "felony drug abuse offense" as defined in Section 2925.01, ORC. WHEREFORE, PURSUANT TO SECTION 3719.121(C), ORC, YOU ARE HEREBY NOTIFIED THAT YOUR LICENSE TO PRACTICE NURSING AS A REGISTERED NURSE, RN-353638, IS HEREBY SUSPENDED. Continued practice after receipt of this notice of suspension shall be considered engaging in the practice of nursing without a current, valid license, which is a violation of Section 4723.03(A), ORC. You are further notified that in accordance with Chapter 119, ORC, the Board proposes under authority of Section 4723.28, ORC, to deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise

David Paul Middleton, R.N. Page 2 discipline you; or impose a fine of not more than five hundred dollars ($500.00) per v 0 ation four the following reasons: 1. On or about March 5, 2013, in Clark County Court of Common Pleas Case Number 13-CR-136, you pled guilty to one (1) count of Theft of Drugs, a felony of the fourth degree, in violation of Section 2913 .02(A)(1), ORC, and were found eligible for Intervention in Lieu of Conviction. The acts underlying this case occurred on or about May 1, 2012 to September 10, 2012, and involve you obtaining or exerting control over a dangerous drug without the consent of the owner or a person authorized to give consent. Section 4723.28(B)(4) [as in effect prior to March 20, 2013], ORC, authorizes the Board to discipline a licensee for conviction of, a plea of guilty to, a judicial finding of guilt of, a judicial finding of guilt resulting from a plea of no contest to, or a judicial finding of eligibility for intervention in lieu of conviction for, any felony. Section 4723.28(B)(5) [as in effect prior to March 20, 2013], ORC, authorizes the Board to discipline a licensee for conviction of, a plea of guilty to, a judicial finding of guilt of, a judicial finding of guilt resulting from a plea of no contest to, or a judicial finding of eligibility for intervention in lieu of conviction for, violating any municipal, state, county, or federal drug law. 2. In written statements, dated October 3, 2012, you admitted that for approximately one (1) year you stole narcotics, including Dilaudid, Morphine, and Ativan, from Springfield Regional Medical Center where you worked as a nurse. In addition, you wrote: "Around a year ago I began taking small amounts of waste narcotics from my employer (SRMC). ... Also in the beginning of the summer, I stole a Comfort Pack from my mother-in-law which contained oral Morphine as well as other prescribed medications. The oral Morphine in the pack I began consuming with alcohol in excess about 4 weeks ago. I would place about 5 mg liquid (20mg/mi) under my tongue about every 15-20 minutes until desired effect."

Section 4723.28 (B)(8), ORC, authorizes the Board to discipline a licensee for selfadministering or otherwise taking into the body any dangerous drug, as defined in Section 4729.01, ORC, in any way not in accordance with a legal, valid prescription issued for that individual, or self-administering or otherwise taking into the body any drug that is a schedule I controlled substance. Section 4723.28(B)(13) [as in effect prior to March 20, 2013], ORC, authorizes the Board to discipline a licensee for obtaining or attempting to obtain money or anything of value by intentional misrepresentation or material deception in the course of practice. Accordingly, the Board is authorized to impose one or more of the sanctions as cited in Section 4723.28, ORC.

David Paul Middleton, R.N. Page 3

In accordance with Chapter 119, ORC, you are heifeby informed that you are entitled to a hearing in this matter. If you wish to request such hearing, the request must be made in writing and must be received in the Board office within thirty (30) days of the time of mailing of this notice. As required, by Section 3719.121(C), ORC, the suspension ordered herein shall remain in effect until this hearing is held. You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in writing. At the hearing you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to: Lisa Ferguson-Ramos, Compliance Unit Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus OH 43215-7410, or to the email address, hearing@nursing.ohiotgov. If the Board fails to receive a request for a hearing within thirty {30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Immediate Suspension and Opportunity for Hearing, deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely,

Rhonda S. Barkheimer, R.N., C.N.P. Supervising Board Member Certified Mail Receipt No. 7012 2210 0000 6272 3940 Attorney Certified Mail Receipt No. 7012 2210 0000 6272 3957 cc: Henry G. Appel, Senior Assistant Attorney General Paul J. Kavanagh, Esq.

Case# 12-005576

Ohio Board of Nursing

17 South Flhih Street, Suite 400 March 22, 2013

www.nursing7ohio.goy
(614) 466-3947

Columbus, Ohio 43215-7410

NOTICE OF AUTOMATIC SUSPENSION AN OPPORTUNITY F IR HEARING

Beverly Jo Mullen, L.P.N. 633 Reinhard Avenue Columbus, Ohio 43206 Dear Ms. Mullen: You are hereby notified that, on or about January 21, 2011, the Ohio Board of Nursing (Board), issued an Order (January 2011 Order) a copy of which is attached hereto and incorporated herein, in which the Board ordered that your license be suspended indefinitely and that such suspension be stayed subject to probationary terms, conditions, and limitations for a minimum period of two (2) years. A. Item 2. of the January 2011 Order states, "MS. MULLEN shall appear in person for interviews before the full Board or its designated representative as requested by the Board." Despite this provision, on or about November 20, 2012, you failed to appear at the Board's office for your scheduled personal interview with your Board Monitoring Agent. You were sent a letter dated October 26, 2012, to your address of record notifying you of this scheduled personal interview. B. Item 3. of the January 2011 Order states, "MS. MULLEN shall submit a request to the Bureau of Criminal Identification and Investigation (BCII) to conduct a criminal records check of MS. MULLEN, including a check of Federal Bureau of Investigation (FBI) records, and shall cause BCII to submit MS. MULLEN's criminal records check reports to the Board. MS. MULLEN's completed criminal records check, including the FBI check, must be received by the Board within six (6) months of effective date of this Order" Despite tlitis provision, as of March 5, 2013, you have failed to cause BCII to submit criminal records check reports to the Board. C. Item 4. of the January 2011 Order states, "Within six (6) months of the effective date of this Order, MS. MULLEN shall pay the fine of five hundred dollars (S500.00), by certified check, cashier check, or money order, made payable to the "Treasurer, State of Ohio," to the Board. Payment shall be mailed to the attention of the Compliance Unit, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, OH 43215-7410."

Beverly Jo Mullen, L.P.N. Page 2

Despite this provision, as of as of March 5, 2013, you have failed to submit to the Board a certified check, cashier check, or money order, made payable to the "Treasurer, State of Ohio," in the amount of five hundred dollars ($500.00). D. Item 5. of the January 2011 Order states, "Witldn six (6) months of the effective date of this Order, MS. MULLEN shall, in addition to the requirements of licensure renewal, successfully complete and submit satisfactory documentation of successful completion of the following continuing nursing education taken subsequent to the effective date of this Order: five (5) hours of Professionalism and five (5) hours of Ethics." Despite this provision, as of as of March 5, 2013, you have failed to submit to the Board documentation of successful completion of five (5) hours of Professionalism and five (5) hours of Ethics. Section 472328(B)(17), ORC, authorizes the Board to discipline a licensee for violation of any restrictions placed on a nursing license by the Board. In accordance with the paragraph under "FAILURE TO COMPLY" of the January 2011 Order, you are hereby notified that it appears to the Board that you have violated Items 2., 3., 4., and 5. of the January 2011 Order. YOU ARE FURTHER NOTIFIED THAT YOUR LICENSE TO PRACTICE NURSING AS A LICENSED PRACTICAL NURSE, PN-111420, IS HEREBY AUTOMATICALLY SUSPENDED. Continued practice after receipt of this notice of suspension shall be considered engaging in the practice of nursing as a licensed practical nurse without a current, valid license, which is a violation of Section 4723.03(B), ORC. You are further notified that in accordance with Chapter 119, ORC, the Board proposes under authority of Section 4723.28, ORC, to deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: 1. On or about January 21, 2011, the Ohio Board of Nursing (Board), issued an Order (January 2011 Order) a copy of which is attached hereto and incorporated herein, in which the Board ordered that your license be suspended indefinitely and that such suspension be stayed subject to probationary terms, conditions, and limitations for a minimum period of two (2) years. 2. Item 2. of - the January 2011 Order states, "MS.: MULLEN shall appear in person for interviews before the full Board or its designated representative as requested by the Board."

Beverly Jo Mullen, L.P.N. Page 3 Despite this provision, on or about November 20, 2012, you failed to appear at the Board's office for your scheduled personal interview with your Board Monitoring Agent. You were sent a letter dated October 26, 2012, to your address of record notifying you of this scheduled personal interview. 3. Item 3. of the January 2011 Order states, "MS. MULLEN shall submit a request to the Bureau of Criminal Identification and Investigation (BCII) to conduct a criminal records check of MS. MULLEN, including a check of Federal Bureau of Investigation (FBI) records, and shall cause BCII to submit MS. MULLEN's criminal records check reports to the Board. MS. MULLEN's completed criminal records check, including the FBI check, must be received by the Board within six (6) months of effective date of this Order." Despite this provision, as of March 5, 2013, you have failed to cause BCII to submit criminal records check reports to the Board. 4. Item 4. of the January 2011 Order states, "Within six (6) months of the effective date of this Order, MS. MULLEN shall pay the fine of five hundred dollars ($500.00), by certified check, cashier check, or money order, made payable to the "Treasurer, State of Ohio," to the Board. Payment shall be mailed to the attention of the Compliance Unit, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, OH 43215-7410." Despite this provision, as of as of March 5, 2013, you have failed to submit to the Board a certified check, cashier check, or money order, made payable to the "Treasurer, State of Ohio," in the amount of five hundred dollars ($500.00). 5. Item 5. of the January 2011 Order states, "Within six (6) months of the effective date of this Order, MS. MULLEN shall, in addition to the requirements of licensure renewal, successfully complete and submit satisfactory documentation of successful completion of the following continuing nursing education taken subsequent to the effective date of this Order: five (5) hours of Professionalism and five (5) hours of Ethics." Despite this provision, as of as of March 5, 2013, you have failed to submit to the Board documentation of successful completion of five (5) hours of Professionalism and five (5) hours of Ethics. Section 4723.28(B)(1.7), ORC, authorizes the Board to discipline a licensee for violation of any restrictions placed on a nursing license by the Board. Accordingly, the Board is authorized to impose one or more of the sanctions as cited in Section 4723.28, ORC.

Beverly Jo Mullen,I.P.N. Page 4 In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing in this matter. If you wish to request such hearing, the request must be made in writing and must be received in the Board office within thirty (30) days of the time of mailing of this notice. You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in writing. At the hearing you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to: Lisa Ferguson-Ramos, Compliance Unit Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, Ohio 43215 7410, or to the e-mail address, hearing@nursing.ohio.gov. If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Automatic Suspension and Opportunity for Hearing, deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely,
44:!1 -77 -427 -et,

Rhonda S. Barkheimer, R.N., C.N.P. Supervising Board Member Certified Mail Receipt No. 7012 2210 0000 6272 3780 cc: Henry Q. Appel, Senior Assistant Attorney General

Ohio oar of Nursing

17 South High Street, Suite 400

WWW.E1 LI

o. gov

Columbus, Ohio 43215-7410 a (614) 466-3947

BEFORE THE OHIO BOARD OF NURSir

IN THE MATTER OF: ORDER: 2047 CASE # 10-2671

BEVERLY JO MULLEN, L

0 DER
By letter, dated August 2, 2010, notice was given to BEVERLY JO MULLEN, L.P.N., that the Ohio Board of Nursing intended to consider disciplinary action regarding MS. MULLEN's license to practice nursing as a licensed practical nurse in the State of Ohio, and that MS. MULLEN was entitled to a hearing if such hearing was requested within thirty (30) days of the mailing of said notice. In accordance with Section 119.07, Ohio Revised Code, said notice was sent via certified mail, return receipt requested, to the address of record of MS. MULLEN. No hearing request has been received from MS. MULLEN and more than thirty (30) days have now elapsed since the mailing of the notice. Upon consideration of the charges stated against BEVERLY JO MULLEN in the July 30, 2010 Notice of Opportunity for Hearing and evidence supporting the charges, the Board finds that MS. MULLEN has committed acts in violation of the Nurse Practice Act, Ohio Revised Code Chapter 4723, as stated in the Notice of Opportunity for Hearing and the Ohio Board of Nursing ORDERS that MS. MULLEN's license to practice nursing as a licensed practical nurse is hereby suspended and that the suspension is stayed subject to the probationary terms, conditions, and limitations for a minimum period of two (2) years and the Permanent Practice Restrictions set forth below. MS. MULLEN's license to practice nursing as a licensed px'actical nurse shall be subject to the following probationary terms, conditions, and limitations: MS, MULLEN shall obey all federal, state, and local laws, and ail laws and rules governing the practice of nursing in Ohio. 2. MS. MULLEN shall appear in person for interviews before the full Board or its designated representative as requested by the Board. 4 Page 1 of 6

3. MS. MULLEN shall submit a request to the Bureau of Criminal Identification and Investigation (BCII) to conduct a criminal records check of MS. MULLEN, including a check of Federal Bureau of Investigation (FBI) records, and shall cause BCH to submit MS. MULLEN's criminal records check reports to the Board. MS. IWULLEN's completed criminal records check, including the FBI check, must be received by the Board within six (6) months of effective date of this Order. 4. Within six (6) months of the effective date of this Order, MS. MULLEN shall pay the fine of five hundred dollars ($500.00), by certified check, cashier check, or money order, made payable to the "Treasurer, State of Ohio," to the Board. Payment shall be mailed to .the attention of the Compliance Unit, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, OH 43215-7410. 5. Within six (6) months of the effective date of this Order, MS. MULLEN shall, in addition to the requirements of licensure renewal, successfully complete and submit satisfactory documentation of successful completion of the following continuing nursing education taken subsequent to the effective date of this Order: five (5) hours of Professionalism and five (5) hours of Ethics. Employment Conditions 6. MS. MULLEN shall notify the Board, in writing, of the name and address of any current employer within fifteen (15) days of the effective date of this Order, or any new employer prior to accepting employment. 7. MS. MULLEN, within fifteen (15) days of the effective date of this Order, if working in a position in which a nursing license is required, shall provide her employer(s) with a copy of this Order and the Notice of Opportunity for Hearing. MS. MULLEN shall have her employer(s), if working in a position where a nursing license is required, submit written reports regarding job performance on a quarterly basis. MS. MULLEN shall have her employer(s) send documentation to the Board, along with the first employer report, of receipt of a copy of this Order and Notice of Opportunity for Hearing, including the date they were received. Further, MS. MULLEN is under a continuing duty to provide a copy of this Order and Notice of Opportunity for Hearing to any new employer prior to accepting employment. Reporting Requirements of MS. MULLEN 8. MS. MULLEN shall sign release of information forms allowing health professionals and other organizations to submit the requested documentation directly to the Board. 9. MS. MULLEN shall submit any and all information that the Board may request regarding her abi'ity to practice according to acceptable and prevailing standards of safe nursing practice.

Page 2 of 6

10. MS. MULLEN shall riot submit or cause to be submitted any false, rnislea.ding or deceptive statements, information, or documentation to the Board or to employers or potential employers. 11. MS, MULLEN shall submit the reports arid documentation required by this Order on forms specified by the Board. All reporting and coratnunications required by this Order shall be made to the Compliance Unit of the Board. 4 12.MS. MULLEN shall submit the repo'rts and documentation required by this Order or any. other documents required by the Board to the attention of the Compliance Unit, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, OH 43215-7410, 13. MS. MULLEN shall verify that the reports and documentation required by this Order are received in the Board office. 14. MS. MULLEN shall inform the Board within five (5) business days, in writing, of any change in employment status or of any change in residential or home address or telephone number, Permanent Practice Restrictions MS. MULLEN shall not practice nursing as a licensed practical nurse (1) for agencies providing home care in the patient's residence; (2) for hospice care programs providing hospice care in the patient's residence; (3) for staffing agencies or pools; (4) as an independent provider where the nurse provides nursing care and is reimbursed for services by the State of Ohio through State agencies or agents of the State; or (5) for an individual or group of individuals who directly engage MS. MULLEN to provide nursing services for fees, compensation, or other consideration or as a volunteer. MS. MULLEN shall not function in a position or employment where the job duties or requirements involve management of nursing and nursing responsibilities, or supervising and evaluating nursing practice. Such positions include but are not limited to the following. Director of Nursing, Assistant Director of Nursing, Nurse Manager, Vice President of Nursing. MS. MULLEN shall not be involved in financial activities or 'supervise financial activities, FAILURE TO COMPLY The stay of MS. MULLEN's suspension shall be lifted and MS. MULLEN's license to practice nursing as a licensed practical nurse will be automatically suspended if it appears to the Board that MS. MULLEN has violated or . breached. any terms or conditions of this Order. Following the automatic suspension, the Board shall notify MS. MULLEN via certified mail of the specific nature of the charges and automatic suspension of her license. Upon receipt of this notice, MS. MULLEN may request a hearing regarding the charges.

Page 3 of 6

DURATION The Board may only. alter the probationary period imposed by this Order if: (I) the Board determines that MS. MULLEN has complied with all aspects of this Order; and (2) the Board determines that MS. MULLEN is able to practice according Co acceptable and prevailing standards of safe nursing care without Board monitoring, based upon an interview with MS. MULLEN and review of the reports as required herein. Any period during which MS. MULLEN does not works in a position for which a nursing license is required shall not count toward fulfilling the probationary period imposed by this Order. This ORDER shall become effective immediately and is hereby entered upon the Journal of the Board for the 21st day of January, 201 t.

Page 4 of 6

TIME AN f METHOD TO PERFECT AN APPEAL

Any pary desiring to appeal shall file a Notice of Appeal with the Ohio Board of Nursing, 17 S. High St., Ste 400, Columbus OH 43215-7410, setting forth the order appealed from and the grounds of the party's appeal. A copy of such Notice of Appeal shall also be filed by the appellant with the Franklin County Court of Common Pleas, Columbus, Ohio. Such notiles of appeal shall be filed within fifteen (15) days after the mailing of the notice of the Ohio Board of Nursing's Order as provided in Section 119.12 of the Ohio Revised Code.

CERTIFICATION

The State of Ohio County of Franklin

1, the undersigned Betsy J. Houchen, Executive Director for the Ohio Board of Nursing, hereby certify that the foregoing is a true and exact reproduction of the original Order of the Ohio Board of Nursing entered on its journal, on the 21st day of .January, 201.1

Betsy J. Houchen, R.N., M.S., T.D. Executive Director

January 21, 2011 Date

Page 5 of 6

(SEAL)

CERTIFICATE OF SERVICE
I hereby certify that a true and accurate copy of the foregoing Order, concerning BEVERLY JO MULLEN, was sent via certified mail, return receipt requested, this 31 day of

January , 2011 to BEVERLY JO MULT,,EN, 633 Reinhard Avenue, Columbus, Ohio, 43206.

I also certify that a copy of the same was sent via regular U.S. mail this

31 day of January , 2011 to Lamont Pugh, SAC, Sanctions & Exclusions, Department of Health

and Human Services, Office of Inspector General, Office of Investigations, PO Box 81020, Chicago IL 60601-81020.

7 &I

147)-

Betsy J. Houchen, R.N., MS., J.D. Executive Director

bal cc: IVIells,sa L. Wilburn, Assistant Attorney General

Certified Mail Receipt No. 7010 1870 0002 0349 7137

Page 6 of 6

Case #10-2671

July 30, 2010

,o, ... .N, . .

.5... .. www.nursing,ohip,gov

17 South High Street, Suite 400 .0. Columbus, Ohio 43215-7410 q (614) 466-3947

NOTICE OF OPPORTUNITY FOR HEARING

Beverly Jo 'Mullen 633 Reinhard Ave. Columbus, OH 43206 Dear Ms. Mullen: In accordance with Chapter 119, Ohio Revised Code (ORC), you are hereby notified that the Ohio Board of Nursing (Board) proposes under authority of Section 4723.28, ORC, to deny or permanently deny your June 2010 request to renew, restore, or reactivate your license to practice nursing as a licensed practical nurse; permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: 1. On or about February 12, 2010, in Franklin County Court of Common Pleas Case No. 20060R-3652, you pled guilty to and were subsequently convicted of one (1) count of Theft, a first-degree misdemeanor, in violation of Section 2913.02, ORC. The acts underlying your criminal case noted above consist of you, on or about March 1, 2006, while working as a nurse at Village of Westerville in Westerville, Ohio, stealing a debit/credit card from a co-worker's wallet. Section 4723.28(B)(3), ORC, authorizes the Board to discipline a licensee for conviction of, a plea of guilty to, a judicial finding of guilt of, a judicial finding of guilt resulting from a plea of no contest to, or a judicial finding of eligibility for intervention in lieu of conviction for, of a misdemeanor committed in the course of practice. Section 4723.28(B)(4), ORC, authorizes the Board to discipline a licensee for conviction of, a plea of guilty to, a judicial finding of guilt of, a judicial finding of guilt resulting from a plea of no contest to, or a judicial finding of eligibility for intervention in lieu of conviction for, any felony or of any crime involving gross immorality or moral turpitude. Section 4723.28(B)(13), ORC, authorizes the Board to discipline a licensee for obtaining or attempting to obtain money or anything of value by intentional misrepresentation or material deception in the course of practice. Accordingly, the Board is authorized to impose one or more of the sanctions as cited in Section 4723.28, ORC. in accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing on this matter. If you wish to request such hearing, the request must be made in writing and must be received in the Board office within thirty (30) days of the time of mailing this notice, 4 4

Beverly So Mullen Page 2

You are hereby further informed that if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present you position, argument, or contentions in writing. At the hearing you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, pl6ase mail or deliver the request, in addition to any other correspondence regarding this matter to; Lisa Ferguson-Ramos, Compliance Unit Manager, 17 South High Street, Suite 400, Columbus, OH 43215-7410, or to the email address, hearin@nursingaluov. If the Board fails to receive a request for a hearing within thirty (30) days of . the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in the Notice of Opportunity for Hearing, to deny or permanently deny your June 2010 request to renew, restore, or reactivate your license to practice nursing as a _licensed practical nurse; permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons, Sincerely,

Anne Barnett, RN, BSN, CWS Supervising Board Member Certified Mail Receipt No. 7009 1680 0001 8226 8936 cc; Melissa Wilburn, Assistant Attorney General

Case # 12-002388

Ohio Board of Nursing

9

www.nursing.ohio.gov
(614) 466-3947

17 South High Street, Suite 400 b. Columbus, Ohio 43215-7410

March 22, 2013

NOTICE OF OPPORTUNITY FOR HEARING

Megan M. Neuman, R.N. 51 Cherrywood Circle Geneva, Ohio 44041 Dear Ms. Neuman: In accordance with Chapter 119, Ohio Revised Code (ORC), you are hereby notified that the Ohio Board of Nursing (Board) proposes under authority of Section 4723.28 ORC, to deny, revoke, permanently revoke, suspend or place restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: 1. On or about June 7, 2012, you admitted to a Board Compliance Agent that, while working as a nurse, you diverted narcotics from University Hospitals in Cleveland, Ohio, Section 4723.28(B)(13), ORC, authorizes the Board to discipline a licensee for obtaining or attempting to obtain money or anything of value by intentional misrepresentation or material deception in the course of practice. 2. As set forth in Attachment A, while working as a nurse at University Hospitals in Cleveland, Ohio, you failed to account for medications you withdrew, withdrew medications in violation of physician orders, and documented the administration of medications in violation of physician orders. Section 4723.28(B)(19), ORC, authorizes the Board to discipline a licensee for failure to practice in accordance with acceptable and prevailing standards of safe nursing care. Section 4723.28(B)(16), ORC, authorizes the Board to discipline a licensee for violation of Chapter 4723, ORC, or any rules adopted under it. Specifically, Rule 4723-4-03(B), Ohio Administrative Code (OAC), states that a registered nurse shall maintain current knowledge of the duties, responsibilities, and accountabilities for safe nursing practice. Rule 4723-4-03(F), OAC, states that when clarifying an order, the registered nurse shall, in a timely manner: (1) Consult with an appropriate licensed practitioner; (2) Notify the prescribing practitioner when the licensed nurse makes the decision not to follow the direction or administer the medication or treatment as prescribed; (3) Document that the practitioner was notified of the decision not to follow the direction or administer the medication or treatment, including the reason for not doing so; and (4) Take any other action needed to assure the safety of the client. Rule 4723-4-06(E), OAC, states

Megan M. Neuman, R.N. Page 2 that a licensed nurse shall, in a complete, accurate, and timely manner, report and document nursing assessments or observations, the care provided by the nurse for the client,, and the client's1 response to that care. Rule 4723-4-06(H), OAC, states that a licensed nurse shall implement measures to promote'a safe environment for each client. ?Accordingly, the Board is authorized to impose one or more of the sanctions cited in Section 4723.28, ORC. In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing in this matter. If you wish to request such hearing, the request must be made in writing and must be received in the Board office within thirty (30) days of the time of mailing of this notice. You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in writing. At the hearing, you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to Lisa Ferguson-Ramos, Compliance Unit Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, Ohio 432157410 or to the email address, hearing@nursing.ohio.gov. If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Opportunity for Hearing, deny, revoke, permanently revoke, suspend, or place restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely,

Rhonda S. Barkheimer, R.N., C.N.P. Supervising Board Member Certified Mail Receipt No. 7012 2210 0000 6272 3568 Attorney's Certified Mail Receipt No. 7012 2210 0000 6272 3575

cc:

Henry G. Appel, Senior Assistant Attorney General Steven A. Sindell, Attorney at Law

Megan M. Neuman, R.N. Page 3 ATTACHMENT A

11

PATIENT # Patient #1

Physician Order

Medication Withdrawal Percocet (Oxycodone/Apap) 3/2/12 2 tablets @ 4:51 AM 1 tablet @ 4:52 AM

MAR

Comments

Percocet (Oxycodone/Apap) 2 tablets every 4 hours as needed

2 tablets You withdrew 2 tablets at 4:51 @ AM and documented 4:45AM administration at 4:45 AM. You removed 1 tablet @ 4:52 AM, before ordered, and did not document administration. No waste. 1 tablet unaccounted for.

Patient #2

Dilaudid Dilaudid (Hydromorphone) (Hydromorphone) 2 mg every 4 hours as 1 tablet (2 mg) needed 3/7/12 8:52 AM 11:34 AM 1:05 PM Percocet (Oxycodone/Apap) 5 mg. every 4 hours as needed Percocet (Oxycodone/Apap) 1 tablet (5 mg) 3/15/12 7:48 PM 10:19 PM 3/16/12 1:41 AM 4:14 AM 6:31 AM

None None None

No waste. Doses removed too soon. 3 tablets (6 mg) unaccounted for.

Patient #3

None None

No waste. Doses removed too soon. 5 tablets (25 mg) unaccounted for.

None None None

Patient #3

Ativan (Lorazepam) 1 mg every 2 hours as needed

Ativan (Lorazepam) 2 tablets (0.5 mg) 3/15/12 7:48 PM 10:19 PM 3/16/12 1:41 AM 4:14 AM

No waste. None None 10 tablets (5 mg) unaccounted for.

None None

Megan M. Neuman, R.N. Page 4 6:31 AM Patient #4 Oxycodone 10 mg. every 4 hours as needed Oxycodone 2 tablets (5 mg) 3/18/12 2:05 AM 6:06 AM None )

3:01 AM 6:00 AM

7:21 PM 9:10 PM 10:59 PM 3/19/12 3:07 AM

None 9:15 PM 11:47 PM

Too soon, dose given @ 12:30AM Documented as given before removed; too soon, dose given @ 3:01 AM Too soon, dose given @ 6:24 PM Too soon, dose given @ 6:24 PM Too soon, dose given @ 9:15 PM

3:00 AM

Documented as given before withdrawn; too soon, dose given @11:47 PM Too soon, dose given @ 3:00 AM. Too soon, dose given @ 3:00 AM No waste. 8 tablets (40 mg) unaccounted for.

3:40 AM 6:22 AM

None None

Patient #5

Oxycodone/Apap 2 tablets every 4 hours as needed

Oxycodone/Apap 2 tablets 3/21/12 9:05 AM 1:37 PM 4:25 PM 6:10 PM 6:35 PM

None. None None None None

Too soon, dose given @10:30 AM Too soon, dose given @ 2:30 PM

No waste. 10 tablets unaccounted for. Patient #6 Percocet (Oxycodone/Apap) 2 tablets every 4 hours as needed Percocet (Oxycodone/Apap) 2 tablets 3/23/12 5:26 PM 6:22 PM Percocet (Oxycodone/Apap) 2 tablets 3/26/12

None 6:31 PM

Too soon, dose given @ 3:30 PM Too soon, dose given @ 3:30 PM No waste, 2 tabs unaccounted for.

Patient #7

Percocet (Oxycodone/Apap) 2 tablets every 4 hours as needed.

Megan M. Neuman, R.N. Page 5 8:17 AM * 11:11 AM 3/27/12 9:59 AM (2 tablets) 5:28 PM (lttablet) Patient #8 Oxycodone Oxycodone 5 mg every 6 hours as 1 tablet needed 4/29/12 10:18 AM 3:18 PM 5:38 PM 9:15 AM 11:14 AM Too soon, dose given @8:15 AM Too soon, dose given @ 9:15 AM

None None

Dose given @ 7:43 and 8:09 AM Too soon, dose given @ 4:45 PM No waste, 3 tabs unaccounted for,

None None None

Too soon, dose given @ 8:30 AM Too soon, dose given @ 2:07 PM Too soon, dose given @ 2:07 PM No waste. 3 tablets unaccounted for.

Patient #9

No Order

Oxycodone 2 tablets 5/8/12 4:36 AM 5:55 AM

No waste. 4 tablets unaccounted for. None None

Cases # 12-003467; 12-007375; & 13-000124

Ohio. oard of Nursing

March 22, 2013

www..nursing

17 South High Street, Suite 400 -0 Columbus, Ohio 43215-7410 6 (614) 466-3947 V

NOTICE OF AUTO ATIC SUSPENSION AND OPPORTUNITY FOR HEARING

Christy Elizabeth Noel, L.P.N. 213 W. Water Street Urbana, Ohio 43078 Dear Ms. Noel: You are hereby notified that, on or about January 20, 2012, you entered into a Consent Agreement (January 2012 Consent Agreement) with the Ohio Board of Nursing (Board), a copy of which is attached hereto and incorporated herein, in which you agreed with the Board that your license to practice nursing as a licensed practical nurse in the State of Ohio would be suspended indefinitely and that such suspension would be stayed subject to probationary terms, conditions, and limitations for a minimum period of three (3) years. Attached to and incorporated within the January 2012 Consent Agreement is a July 29, 2011 Notice of Automatic Suspension and Opportunity for Hearing and a January 21, 2011 Consent Agreement. A. Item 7. of the January 2012 Consent Agreement states, "MS. NOEL shall abstain completely from the use of alcohol or products containing alcohol." Item 8. of the January 2012 Consent Agreement states, "For a minimum, continuous period of three (3) months immediately prior to requesting to work as a nurse and continuing throughout the probationary period, MS, NOEL shall submit, at her expense and on the day selected, blood or urine specimens for drug and/or alcohol analysis at a collection site specified by the Board at such times as the Board may request. Refusal to submit such specimen, or failure to submit such specimen on the day she is selected, or in such a manner as the Board may request, shall constitute a violation of a restriction placed on a license for purposes of Section 4723.28(B), ORC. This screening shall require a daily call-in process. The specimens submitted by WIS. NOEL shall be negative, except for substances prescribed, administered, or dispensed to her by another so authorized by law who has received a complete copy of this Consent Agreement prior to prescribing for MS. NOEL" Despite these provisions, on the following dates, you provided a specimen for analysis to Firstlab, the Board's random drug/alcohol screen program administrator, that tested positive for Ethyl Glucuronide (Alcohol): July 5, 2012; December 4, 2012; and December 17, 2012.

Christy Elizabeth Noel, L.P.N. Page 2 In a statement you provided to the Board, on or about January 8, 2013, regarding ydur positive test for December 4, 2012, you stated: "I drank 2 Mike's hard lemonades on 12-03-2012. I have no reasonable explanation as to why." Furthermore, in a statement you provided to the Board regarding your positive test for December 17, 2012, you stated: " . for some reason I am allowing my past demons to get the best of me, time and time again. That saturday night, what would be 12-15-12, 1, for some reason, decided that if I'm getting suspended., again, then it really didn't matter what I did. Of course the following day I was filled with regret." B. Item 11. of the January 2012 Consent Agreement states, "Prior to initiating drug screening, MS. NOEL shall provide a copy of this Consent Agreement to all treating practitioners and shall provide to the Board a list of all treating practitioners, including addresses arid telephone numbers. Further, MS. NOEL shall be under a continuing duty to provide a copy of this Consent Agreement, prior to initiating treatment, to additional treating practitioners, and to update the list of treating practitioners with the Board within forty-eight (48) hours of being treated by another practitioner." Despite this provision, on or about December 22, 2012, you failed to provide a copy of your Consent Agreement to your treating practitioner at Mercy Memorial Hospital (Mercy Hospital) prior to initiating treatment. During a telephone conversation with a Board Monitoring Agent on December 28, 2012, when you were asked if you provided a copy of your Consent Agreement to Mercy Hospital, you stated, "No,1 didn't even think about it." C. Item 19. of the January 2012 Consent Agreement states, "MS. NOEL shall not submit or cause to be submitted any false, misleading, or deceptive statements, information, or documentation to the Board or to employers or potential employers." Despite this provision, on or about December 14, 2012, you provided a Board Monitoring Agent with false information by verbally affirming that you were abstaining from alcohol/products containing alcohol. In a statement you provided the Board on December 16, 2012, you indicated, "She asked if I had refrained from alcohol and I lied and said yes." Section 4723.28(B)(17), CRC, authorizes the Board to discipline a licensee for violation of any restrictions placed on a nursing license by the Board.. In accordance with the paragraph under "FAILURE TO COMPLY" of the January 2012 Consent Agreement, you are hereby notified that it appears to the Board that you have violated Items 7., 8., 11. and 19. of the January 2012 Consent Agreement. YOU ARE FURTHER NOTIFIED THAT YOUR LICENSE TO PRACTICE NURSING. AS A LICENSED PRACTICAL NURSE, PN-143542, IS HEREBY AUTOMATICALLY

Christy Elizabeth Noel, L.P.N. Page 3 SUSPENDED. Continued practice after receipt of this notice of suspension shall be considered engaging in the practice of nursing as a licensed practical arse without a current, valid license, which is a violation of Section 4723.03(B), ORC. You are further notified that in accordance with Chapter 119, ORC, the Board proposes under authority of Section .4723.28, ORC, to deny, permanently revoke, revqike, suspend or place restrictions on your license to practice nursing as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: 1. On or about January 20, 2012, you entered into a Consent Agreement (January 2012 Consent Agreement) with the Ohio Board of Nursing (Board), a copy of which is attached hereto and incorporated herein, in which you agreed with the Board that your license to practice nursing as a licensed practical nurse in the State of Ohio would be suspended indefinitely and that such suspension would be stayed subject to probationary terms, conditions, and limitations for a minimum period of three (3) years. Attached to and incorporated within the January 2012 Consent Agreement is a July 29, 2011 Notice of Automatic Suspension and Opportunity for Hearing and a January 21, 2011 Consent Agreement. 2. Item 7. of the January 2012 Consent Agreement states, "MS. NOEL shall abstain completely from the use of alcohol or products containing alcohol." Item 8. of the January 2012 Consent Agreement states, "For a minimum, continuous period of three (3) months immediately prior to requesting to work as a nurse and continuing throughout the probationary period, MS. NOEL shall submit, at her expense and on the day selected, blood or urine specimens for drug and/or alcohol analysis at a collection site specified by the Board at such times as the Board may request. Refusal to submit such specimen, or failure to submit such specimen on the day she is selected, or in such a manner as the Board may request, shall constitute a violation of a restriction placed on a license for purposes of Section 4723.28(B), ORC. This screening shall require a daily call-in process. The specimens submitted by MS. NOEL shall be negative, except for substances prescribed, administered, or dispensed to her by another so authorized by law who has received a complete copy of this Consent Agreement prior to prescribing for MS. NOEL." Despite these provisions, on the following dates, you provided a specimen for analysis to Firstlab, the Board's random drug/alcohol screen program administrator, that tested positive for Ethyl Glucuronide (Alcohol): July 5, 2012; December 4, 2012; and December 17, 2012. In a statement you provided to the Board, on or about January 8, 2013, regarding your positive test for December 4, 2012, you stated: "I drank 2 Mike's hard lemonades on 12-03-2012. I have no reasonable explanation as to why."

Christy Elizabeth Noel, L.P.N. Page 4 Furthermore, in a statement you provided to the Board regarding your positive test for December 17, 2012, you stated: " . . . for some reason 1 am allowing my past demons to get the best of me, time and time again. That saturday night, what would be 12-15-12, 1, for some reason, decided that if I'm getting suspended, again, then it really didn't matter what I did. Of course the following day I was filled with regret." 3. Item 11. of the January 2012 Consent Agreement states, "Prior to initiating drug screening, MS. NOEL shall provide a copy of this Consent Agreement to all treating practitioners and shall provide to the Board a list of all treating practitioners, including addresses and telephone numbers. Further, MS. NOEL shall be under a continuing duty to provide a copy of this Consent Agreement, prior to initiating treatment, to additional treating practitioners, and to update the list of treating practitioners with the Board within forty-eight (48) hours of being treated by another practitioner." Despite this provision, on or about December 22, 2012, you failed to provide a copy of your Consent Agreement to your treating practitioner at Mercy Memorial Hospital (Mercy Hospital) prior to initiating treatment. During a telephone conversation with a Board Monitoring Agent on December 28, 2012, when you were asked if you provided a copy of your Consent Agreement to Mercy Hospital, you stated, "No, I didn't even think about it." 4. Item 19. of the, January 2012 Consent Agreement states, "MS. NOEL shall not submit or cause to be submitted any false, misleading, or deceptive statements, information, or documentation to the Board or to employers or potential employers." Despite this provision, on or about December 14, 2012, you provided a Board Monitoring Agent with false information by verbally affirming that you were abstaining from alcohol/products containing alcohol. In a statement you provided the Board on. December 16, 2012, you indicated, "She asked if I had refrained from alcohol and I lied and said yes." Section 4723.28(B)(17), ORC, authorizes the Board to discipline a licensee for violation of any restrictions placed on a nursing license by the Board. Accordingly, the Board is authorized to impose one or more of the sanctions as cited in Section 4723 .28, O.Q.C. In accordance with Chapter 119, CRC, you are hereby informed that you are entitled to a hearing in this matter. If you wish to request such hearing, the request must be made in writing and must be received in the Board office within thirty (30) days of the time of mailing of this notice. You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in

Christy Elizabeth Noel, L.P.N. Page 5 writing. At the hearing you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to: Lisa Ferguson-Ramos, Compliance Unit Manager, Ohio Board of Nursing, 17 South High Street, Suit0400, Columbus, Ohio 432157410, or to the e-mail address, hearing nursing.ohio.gov. If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideratiOn of the factual and legal allegations set forth in this Notice of Automatic Suspension and Opportunity for Hearing, deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely, X. At C.N.P. Rhonda S. Barkheimer, Supervising Board Member Certified Mail Receipt No. 7012 2210 0000 5272 3766 cc: Henry G. Appel, Senior Assistant Attorney General

Case # 1 1-00 1376 & 11-002153

Ohio Board of Nursing

www.rtursingohio.gov

17 South High Street, Suite 400 0 Columbus, Ohio 43215-7410 . (614) 466-3947

CONSENT AGREEMENT ETWEEN CHRISTY ELIZABETH NOEL, L.P.N. AND OHIO BOARD OF NURSING

This Consent Agreement is entered into by and between CHRKSTY ELIZABETH NOEL, (MS. NOEL) and the Ohio Board of Nursing (Board), the state agency charged with enforcing Chapter 4723, of the Ohio Revised Code (ORC), and ail administrative rules promulgated thereunder. For purposes of this Agreement, "Consent Agreement" shall be defined as this Agreement, and the following document which, are attached hereto and incorporated herein: July 29., 2011 Notice of Automatic Suspension and Opportunity for Hearing (July 2011 Notice); and January 21, 2011 Consent Agreement (January 2011 Consent Agreement), This Consent Agreement contains the entire agreement between the parties, there being no other agreement of any kind, verbal or otherwise, which varies the terms of this Consent Agreement. BASIS F R ACTION This-Consent Agreement is entered into on the basis of the following stipulations, admissions and understandings: A. The Board is empowered by Section 4723.28, ORC, to deny, permanently revoke, revoke, suspend, or place restrictions on any license issued by the Board; reprimand or otherwise discipline a licensee; or impose a fine of five hundred dollars ($500.00) or less per violation. Section 4723.28(B)(8), ORC, authorizes the Board to discipline a licensee for selfadministering or otherwise taking into the body any dangerous drug, as defined in Section 4729.01, ORC, in any way not in accordance with a legal, valid prescription issued for that individual. Section 4723.28(B)(17), ORC, authorizes the Board to discipline a licensee for violation of any restrictions placed on a nursing license by the Board. MS. NOEL has been licensed to practice nursing as a licensed practical nurse in the State of Ohio, Ply-.143542, since January 2011. MS. NOEL's license to practice as a licensed practical nurse was suspended in July 2011.

B.

CHRISTY ELIZABETH NOEL, L.P.N. Page 2 C. MS. NOEL knowingly and voluntarily admits to the factual and legal allegations set forth in the July 2011 Notice. MS. NOEL states that her positive marijuana screen resulted after she was with friends who were smoking marijuana. MS. NOE4 states that after her chemical dependency evaluation in January 2011, she participated in alcohol and cannabis treatment with Consolidated Care, West Liberty, Ohio, including attending counseling, participating in twelve step meetings, and submitting drug screens to Consolidated Care. Consolidated Care has submitted correspondence to the Board indicating that MS. NOEL submitted four eight-panel screens, all with negative results. F. S. NOEL has provided the Board with letters of support from.... Stating... add quote here MS. NOEL expresses remorse for her actions and is willing to cooperate with the Board to ensure her safe return to the practice of nursing.

I.

G.

AGREED CONDITIONS Wherefore, in consideration of the foregoing and mutual promises hereinafter set forth, and in lieu of any formal proceedings at this time, MS. NOEL knowingly and voluntarily agrees with the Board to the following terms, conditions, and limitations: MS. NOEL's license to practice nursing as a licensed practical nurse shall be suspended indefinitely. Such suspension shall be stayed, subject to the following PROBATIONARY terms, conditions, and limitations for a minimum period of three (3) years: 1. MS. NOEL shall obey all federal, state, and local laws, and all laws and rules governing the practice of nursing in Ohio. MS. NOEL shall appear in person for interviews before the full Board or its designated representative as requested by the Board or its designee. MS. NOEL shall not work in a position that requires a nursing license until she submits a written request to work as a nurse and obtains written approval from the Board or its designee. S. NOEL must be in full compliance with this Consent Agreement prior to requesting to work as a nurse. 4, MS. NOEL agrees that she will submit a request to the Bureau of Criminal Identification and Investigation (BCH) to conduct a. criminal records check of MS. NOEL, including a check of Federal Bureau of Investigation (FBI) records, and shall cause BCII to submit MS. NOEL'S criminal records check NOEL's completed criminal records check, reports to the Board.

2.

CHRISTY ELIZABETH NOEL, L.P.N. Page 3 including the FBI check, must be received by the Board prior to MS. NOEL being released from these probationary terms. Educational Requirement 5. Prior to requesting to work as a nurse, S. NOEL shall, in addition, to the requirements of licensure renewal, successfully complete and submit satisfactory documentation of successful completion of the following continuing nursing education, or another comparable course approved in advance by the Board or its designee, all taken subsequent to the effective date of this Consent Agreement: eight (8) hours of Alcohol Abuse; five (5) hours of Cannabis Abuse; and four (4) hours of Anger Management.

Monitor.ing 6, MS. NOEL shall abstain completely from the personal use or possession of drugs, except those prescribed, administered, or dispensed to her by another so authorized by law who has received a complete copy of this Consent Agreement prior to prescribing for MS. NOEL. MS. NOEL shall selfadminister the prescribed drugs only in the manner prescribed. MS. NOEL shall abstain. completely from the use of alcohol or products containing alcohol, For a minimum, continuous period of three (3) months immediately prior to requesting to work as a nurse and continuing throughout the probationary period, S. NOEL shall submit, at her expense and on the day selected, blood or urine specimens for drug and/or alcohol analysis at a collection site specified by the Board at such times as the Board may request. Refusal to submit such specimen, or failure to submit such specimen on the day she is selected, or in such a manner as the Board may request, shall constitute a violation of a restriction placed on a license for purposes of Section 4723.28(B), ORC. This screening shall require a daily call-in process. The specimens submitted by MS. NOEL shall be negative, except for substances prescribed, administered, or dispensed to her by another so authorized by law who has received a complete copy of this Consent Agreement prior to prescribing for MS. NOEL. Within three (3) months immediately prior to requesting to work as a nurse, S. NOEL shall, at her expense, obtain a chemical dependency evaluation by a Board approved chemical dependency professional and shall provide the Board with complete documentation of this evaluation. Prior to the evaluation, MS. NOEL shall provide the chemical dependency professional with a copy of this Consent Agreement and assessments, evaluations, and treatment records from Consolidated Care. Further, MS. NOEL shall execute releases to permit the chemical dependency professional to obtain any

7.

8.

9.

CHRISTY ELIZABETH NOEL, LPN. Page 4 information deemed appropriate and necessary for the evaluation. The professional shall submit a written opinion to the Board that includes diagnoses, recommendations for treatment and monitoring, any additional restrictions that should be placed on MS. NOEL's license to practice, and stating whether MS. NOEL is capable of practicing nursing according to acceptable and prevailing standards of safe nursing care. 10. ( MS. NOEL shall provide, the Board with satisfactory documentation of compliance with all aspects of the treatment plan developed by the chemical dependency professional described above until released. Further, MS. NOEL agrees that the Board may utilize the professional's recommendations and conclusions from the evaluation as a basis for additional terms, conditions, and limitations on MS. NOEL's license and that the terms, conditions, and limitations may be incorporated in an addendum to this Consent Agreement,

Treating Practitioners and Reporting 11. Prior to initiating drug screening, MS. NOEL shall provide a copy of this Consent Agreement to all treating practitioners and shall provide to the Board a list of all treating practitioners, including addresses and telephone numbers. Further, MS. NOEL shall be under a continuing duty to provide a copy of this Consent Agreement, prior to initiating treatment, to additional treating practitioners, and to update the list of treating practitioners with the Board within forty-eight (48) hours of being treated by another practitioner. After initiating drug screening, MS. NOEL shall cause all treating practitioners to complete a medication prescription report that is to be mailed by the practitioner directly to the Board. The medication report is to be completed for any and all substances prescribed, administered, or dispensed to MS. NOEL throughout the duration of this Consent Agreement. Within twenty-four (24) hours of release from hospitalization or medical treatment, MS. NOEL shall notify the Board of any and all medication(s) or prescription(s) received.

12.

13,

Employment Conditions 14. Prior to accepting employment as a nurse, each time and with every employer, MS. NOEL shall notify the oard, in writing. MS. NOEL is under a continuing duty to provide a copy of this Consent Agreement to any new employer prior to accepting nursing employment. MS. NOEL shall have her employer(s), if working in a position where a nursing license is required, submit written reports regarding job performance on a quarterly basis beginning within thirty (3(k) days of accepting nursing employment. MS. NOEL shall have her employer(s) send documentation to 4

15,

CHRISTY ELIZABETH NOEL, L.P,N. Page 5the Board, along with the first employer report, of receipt of a copy of this Consent Agreement, inclucling the date the Consent Agreement was received, Reporting Requirements of Licensee 16. MS. NOEL shall report to the Board, in writing, any violation of this Consent Agreement within thirty (30) days of the occurrence of the violation. MS. NOEL shall sign release of information forms allowing health professionals and other organizations to submit the requested documentation directly to the Board. MS. NOEL shall submit any and all information that the Board may request regarding her ability to practice according to acceptable and prevailing standards of safe nursing practice, MS. NOEL shall not submit or cause to be submitted any false, misleading, or deceptive statements, information, or documentation to the Board or to employers or potential employers. MS. NOEL shall submit the reports and documentation required by this Consent Agreement on forms specified by the Board, All reporting and communications required by this Consent Agreement shall be made to the Compliance Unit of the Board. MS. NOEL shall submit the reports and documentation required by this Consent Agreement or any other documents required by the Board to the attention of the Compliance Unit, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, OH 43215-7410. MS. NOEL shall verify that the reports and documentation required by this Consent Agreement are received in the Board office, MS. NOEL shall inform the Board within five (5) business days, in writing, of any change in employment status or of any change in residential or home address or telephone number.

17.

18,

19.

20.

21.

22.

23.

Nursing Refresher Course Upon request by the Board or its designee, MS. NOEL shall, prior to working in a position where a nursing license is required, complete and submit satisfactory documentation of completion of a refresher course or an extensive orientation to be approved in advance by the Board or its designee.

CHRISTY ELIZA.Bbl H NOEL, L.P.N. Page 6 Temporary Practice Restrictions MS. NOEL shall not practice nursing as a licensed practical nurse (1) for agencies providing home care in the patient's residence; (2) for hospice care programs providing hospice care in the patient's residence; (3) for staffing agencies or pools; (4) as an independent provider where the nurse provides nursing care and is reimbursed for services by the State of Ohio through State agencies or agents of the State; or (5) for ap individual or group of individuals who directly engage MS. NOEL to provide nursing services for fees, compensation, or other consideration or as a volunteer. MS. NOEL shall not function in a position or employment where the job duties or requirements involve management of nursing and nursing responsibilities, or supervising and evaluating nursing practice. Such positions include but are not limited to the following: Director of Nursing, Assistant Director of Nursing, Nurse Manager, Vice President of Nursing. FAILURE TO comry_x MS. NOEL agrees that her license to practice nursing as a licensed practical nurse will be automatically suspended if it appears to the Board that MS. NOEL has violated or breached any terms or conditions of the Consent Agreement. Following the automatic suspension, the Board shall notify MS, NOEL via certified mail of the specific nature of the charges and automatic suspension of her license. MS. NOEL may request a hearing regarding the charges. The above described terms and conditions shall constitute "restrictions placed on a license" for purposes of Section 4723.28(B), ORC. If, in the discretion of the Board, MS. NOEL appears to have violated or breached any terms or conditions of this Consent Agreement, the Board reserves the right to institute formal disciplinary proceedings for any and all possible violations or breaches, including, but not limited to, alleged violations of the laws of Ohio occurring before the effective date of this Consent Agreement. DURATION / MODIFICATION OF TERMS The terms, limitations and conditions of this Consent Agreement may be modified or terminated, in writing, at any time upon the agreement of both MS. NOEL and the Board. The Board may only alter the probationary period imposed by this Consent Agreement if: (1) the Board determines that MS. NOEL has complied with all aspects of this Consent Agreement; and (2) the Board determines that S. NOEL is able to practice according to acceptable and prevailing standards of safe nursing care without Board monitoring, based upon an interview with MS. NOEL and review of the reports as required herein. Any period during which S. NOEL does not work in a position for which a nursing license is required shall not count toward fulfilling the probationary period imposed by this Consent Agreement.

BI/17/2B12 15i24 37-653'-E,817

HEARTLAND/URBANA

PAGE 61/01 .

CHRISTY EL1ZABb.i.H NOEL, Page 7 A,CE:NOWLEDGMIRMS .I.SABIT TY RE BASE

MS. NOEL acknowledges that she has had an opportunity to ask questions concerning the terms
of this Consent Agreement and that all questions asked have been answered in a satisfactory manner, KS. NOEL waives all of her rights under Chapter 119, CRC, as they relate to matters that are the subject of this Consent Agreement. MS. NOEL waives any and all claims or causes of action she may have against the Board, and its members, officers, employees and/or agents arising out of matters which are the subject of this Consent Agreement. This Consent Agreement shall be considered a public record as that term is used in Section I 49A3, CRC. The information contained herein may be reported to appropriate organisations, data banks and governmental bodies. This Consent Agreement is not an adjudication order as discussed in Chapter 119, CRC. Any action initiated by the Board based on alleged violations of this Consent Agreement shall comply with the Administrative Procedures Act, Chapter 119, CRC. EF 'fly A E MS, NOEL understands that this Consent Agreement is subject to ratification by the Board prior to signature by the Board President and shall become effective upon ttie last date of signature be1Ow,

CYRTSTY ..A.ZAB 4.4 El NOEL, L.P.N.

DATE

1 lAo
BERTHA LOVELACE, Pre'sident. Ohio Board of Nursing DA.TE

01/17/2012 TUE 17:10 [TX/RH NO 7445] RO.01

Cases# 2011-001376 & 2011-002153

Ohio Board of Nursing

17 South High Street, Suite 400 July 29, 2011

www.nirsing.obio.gov (614) 466-3947 Columbus, Ohio 43215-7410

NOTICE OF AUTOMAflC SUSPENSION AND OPPORTUNITY FOR BEARING

Christy Elizabeth Noel, L.P.N. 114 S. Edgewood Avenue Urbana, Ohio 43078 Dear Ms. Noel: You are hereby notified that, on or about January 21, 2011, you entered into a Consent Agreement (January 2011 Consent Agreement) with the Ohio Board of Nursing (Board), a copy of which is attached hereto and incorporated herein, in which you agreed with the Board that upon meeting the requirements for Iicernsure, your license to practice nursing as a licensed practical nurse in the State of Ohio would be granted and suspended indefinitely and that such suspension would be stayed subject to probationary terms, conditions, and limitations until at least January 2012. A. You were issued a license to practice nursing as a licensed practical nurse in the State of Ohio on January 25, 2011. B. Item 1. of the January 2011 Consent Agreement states, "MS. NOEL shall obey all federal, state, and local laws, and all laws and rules governing the. practice of nursing in Ohio." Section 4723.28(B)(8), Ohio Revised Code, ORC, authorizes the Board to discipline a licensee for self-administering or otherwise taking into the body any dangerous drug, as defined in Section 4729.01, -ORC, in any way not in accordance with a legal, valid prescription issued for that individual, Item 4. of the January 2011 Consent Agreement states, "MS. NOEL shall abstain completely from the personal use or possession of drugs, except those prescribed, administered, or dispensed to her by another so authorized by law who has full knowledge of MS. NOEL's history of alcohol use. MS. NOEL shall self-administer prescribed drugs only in the manner prescribed." Item 5. of the January 2011 Consent Agreement states, "MS. NOEL shall abstain completely from the use of alcohol, if recommended by a chemical dependency professional in Paragraph 8 below." Item 6. of the January 2011 Consent Agreement states, "Within sixty (60) days following the effective date of this Consent Agreement and continuing throughout the probafionary period, MS. NOEL shall submitting, at her expense and on the day selected, blood or urine specimens for drug and/or alcohol analysis at a collection site specified by the Board at such times as the Board may request. Refusal to submit such specimen, or failure to submit such specimen. on the day she is selected, or in such a manner as the Board may request, shall constitute a violation of a restriction placed on

Christy Elizabeth Noel, L.P.N.Page 2 a license for purposes of Section 4723.28(B), ORC. This screening shall require a daily call-in process. The specimens submitted by MS. NOEL shall be negative, except for substances prescribed, administered, or dispensed to her by another so authorized by law who has full knowledge of MS. NOEL's history of alcohol use." Despite these provisions, on March 29, 2011 and April 6, 2011, you provided a mine specimen for analysis to First-lab, the Board's random drug/alcohol screen program administrator, that tested positive for Cannabinoid (Marijuana). Section 4723.28(B)(8), Ohio. Revised Code, ORC, authorizes the Board to discipline a licensee for self-administering or otherwise taking into the body any dangerous drug, as defined in Section 4729,01, ORC, in any way not in accordance with a legal, valid prescription issued for that individual. Section. 4723.28(3)(17), Ohio Revised Code, ORC, authorizes the Board to discipline a licensee for violation of any restrictions placed on a nursing license by the Board, C. Furthermore, on or about January 17, 2011, you obtained a chemical dependency evaluation from Consolidated Care in. West Liberty, Ohio and your chemical dependency counselor recommended that you abstain from alcohol during the time you were in treatment, On May 6, 2011, you provided a urine specimen for analysis to Firstlab that tested positive for Ethyl Glucuronide (Alcohol). Your chemical dependency counselor submitted a letter to the Board dated May 25, 2011 stating that you had not been discharged from treatment and the recommendation for you to abstain from alcohol had not changed. On or about June 8, 2011, you submitted a statement to your Board Monitoring Agent admitting to drinking alcohol. D. Item 3. of the January 2011 Consent Agreement states, "Within nhiety (90) days from the effective date of this Consent Agreement, MS. NOEL shall, in addition to the requirements of liceasure renewal, successfully complete and submit satisfactory documentation of successful completion of the following continuing education taken subsequent to the effective date of this Consent Agreement: eight (8) hours in Alcohol Abuse/Alcoholism, and four (4) hours in Anger Management" Despite this provision, as of June 28, 2011, you have failed to submit to the Board satisfactory documentation of successful completion of the following continuing education: eight (8) hours in Alcohol Abuse/Alcoholism, and four (4) hours in Anger Management. Section. 4723.28(B)(17), Ohio Revised Code, ORC, authorizes the Board to discipline a licensee for violation of any restrictions placed on a nursing license by the Board. 4 In accordance with the paragraph under "FAILURE TO COWL?' of the January 2011 Consent Agreement, you are hereby notified that it appears to the Board that you have violated Items 1., 3,, 4., 5., and 6. of the January 2011 Consent Agreement. 4

Christy Elizabeth Noel, L.P.N. Page 3

YOU ARE FURTHER NOTIFIED THAT YOUR LICENSE TO PRACTICE NURSING AS A LICENSED PRACTICAL NURSE, PN-143542, IS HEREBY AUTOMATICALLY SUSPENDED. Continued practice after receipt of this notice of suspension shall be considered engaging in the practice of nursing as a licensed practical nurse without a current, valid license, which is a violation of Section 4723.03(B), ORC. You are further notified that in accordance with Chapter 119f ORC, the Board proposes under authority of Section 4723.28, ORC, to deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: 1. On or about January 21, 2011, you entered into a Consent Agreement (January 2011 Consent Agreement) with the Ohio Board of Nursing (Board), a copy of which is attached hereto and incorporated herein, in which you agreed with the Board that upon meeting the requirements for licensure, your Heel= to practice nursing as a licensed practical nurse in the State of Ohio would be granted and suspended indefinitely and that such suspension would be stayed subject to probationary terms, conditions, and limitations until at least January 2012. 2. You were issued a license to practice nursing as a licensed practical nurse in the State of Ohio on January 25, 2011. 3. Item I. of the January 2011 Consent Agreement states, "MS. NOEL shall obey all federal, state, and local laws, and all laws and rules governing the practice of nursing in Ohio." Section 4723.28(B)(8), Ohio Revised Code, ORC, authorizes the Board to discipline a licensee for self-administering or otherwise taking into the, body any dangerous drug, as defined in Section 4729.01, ORC, in any way not in accordance with a legal, valid prescription issued for that individual. Item 4. of the January 2011 Consent Agreement states, "MS. NOEL shall abstain completely from the personal use or possession of drugs, except those prescribed, administered, or dispensed to her by another so authorized by law who has full knowledge of MS. NOEL's history of alcohol use. MS. NOEL shall self-administer prescribed drugs only in the manner prescribed." Item 5. of the January 2011 Consent Agreement states, "MS. NOEL shall abstain completely from the use of alcohol, if recommended by a chemical dependency professional in Paragraph 8 below." Item 6, of the January 2011 Consent Agreement states, "Within sixty (60) days following the effective date of this Consent Agreement and continuing throughout . the probationary period, MS. NOEL shall submitting, at her expense and on the day selected, blood or urine specimens for drug and/or alcohol analysis at a collection site specified by the Board at such times as the Board may request. Refusal to submit such specimen, or failure to submit such specimen on the day she is selected, or in such a manner

Christy Elizabeth Noel, L.P.N. Page 4 as the Board may request, shall constitute a violation of a restriction placed on a license for purposes of Section 4723.28(B), ORC. This screening shall require a daily call-in process. The specimens submitted by MS. NOEL shall be negative, except for substances prescribed, administered, or dispensed to her by another so authorized by law who has full knowledge of MS. NOEL'S history of alcohol use." (Despite these provisions, on March 29, 2011 and April 6, 2011, you provided a Mine specimen for analysis to Firstlab, the Board's random drag/alcohol screen program administrator, that tested positive for Cannabinoid (Marijuana). Section 4723.28(B)(8), Ohio Revised Code, ORC, authorizes the Board to discipline a licensee for self-administering or otherwise taking into the body any dangerous drug, as defined in Section 4729.01, ORC, in any way not in accordance with a legal, valid prescription issued for that individual. Section 4723.28(B)(17), Ohio Revised Code, ORC, authorizes the Board to discipline a licensee for violation of any restrictions placed on a nursing license by the Board. 4. Furthermore, on or about January 17, 2011, you obtained a chemical dependency evaluation from Consolidated Care in West Liberty, Ohio and your chemical dependency counselor recommended that you abstain from alcohol during the time you were in treatment. On May 6, 2011, you provided a urine specimen for analysis to Firsdab that tested positive for Ethyl Glucuronide (Alcohol). Your chemical dependency counselor submitted a letter to the Board dated May 25, 2011 stating that you had not been discharged from treatment and the recommendation for you to abstain from alcohol had not changed. On or about June 8, 2011, you submitted a statement to your Board Monitoring Agent admitting to drinking alcohol. 5. Item 3. of the January 2011 Consent Agreement states, "Within ninety (90) days from the effective date of this Consent Agreement, MS. NOEL shall, in addition to the requirements of licensure renewal, successfully complete and submit satisfactory documentation of successful completion of the following continuing education taken subsequent to the effective date of this Consent Agreement: eight (8) hours in Alcohol Abuse/Alcoholism, and four (4) hours in Anger Management." Despite this provision, as of June 28, 2011, you have failed to submit to the Board satisfactory documentation of successful completion of the following continuing education: eight (8) hours in Alcohol Abuse/Alcoholism, and four (4) hours in Anger Management. Section. 4723,28(B)(17), Ohio Revised Code, ORC, authorizes the Board to discipline a licensee for violation Qf any restrictions placed on a nursing license by the Board. Accordingly, the Board is authorized to impose one or more of the sanctions as cited in Section 4723.28, ORC.

Christy Elizabeth Noel, Page 5

In accordance with Chapter 119, ORC, you are. hereby informed that you are entitled to a hearing in this matter. If you wish to request such hearing, the request must be made in writing and must be received in the Board office within thirty (30) days of the time of mailing of this notice. You are. hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, argutents, or contentions in writing. At the hearing you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to: Lisa Ferguson-Rarnos, Compliance Unit Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Cohnnbus, Ohio 432157410, or to the e-mail address, hearing0,nursing,ohia.zov. If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Automatic Suspension and Opportunity for Hearing, deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a licensed practical nurse; reprimand or otherwise discipline you.; or impose a fine of not more than. five hundred dollars ($500.00) per violation. Sincerely, a_ Judith A. Church, R.N., C.N.P. Supervising Member Certified Mail Receipt No. 7011 1150 0000 9357 0509 cc: Michelle T. Sutter, Assistant Attorney General

Case #10-4962

Ohio Board of Nursin

Vs1 WW,Illarsing.ohio.gay
(614)

17 South High Street, Suite 400 0 Columbus, Ohio 43215-7410

466-3947

CONSENT AGREEMENT BETWEEN CHRISTY F. NOEL, LPN. APPLICANT AND OHIO BOARD OF NURSING
This Consent Agreement is entered into by and between CH_. ISTY E. NOEL, L.P.N. APPLICANT (MS. NOEL) and the Ohio Board of Nursing (Board), the state. agency charged with enforcing Chapter 4723. of the Ohio Revised Code (ORC), and all administrative rules promulgated thereunder. MS. NOEL voluntarily enters into this Consent Agreement being fully informed of her rights under Chapter 119, ORC, including the right to representation by legal counsel and the right to a formal adjudicative hearing on the issues considered herein. This Consent Agreement contains the entire agreement between the parties, there being no other agreement of any kind, verbal or otherwise, which varies the terms of this Consent Agreement. BASIS FOR ACTION This Consent Agreement is entered into on the basis of the following stipulations, admissions and understandings: A. The Board is empowered by Section 4723.28, ORC, to deny, permanently revoke, revoke, suspend, or place restrictions on any license, issued by the Board; reprimand or otherwise discipline a licensee; or impose a fine of five hundred dollars ($500.00) or less per violation. Section 4723.28(B)(4), ORC, authorizes the Board to deny a license or otherwise discipline a licensee for a conviction of, a plea of guilty to, a judicial finding of guilt of, a judicial finding of guilt resulting from a plea of no contest to, or a judicial finding of eligibility for intervention in lieu. of conviction for, any felony or of any crime involving gross immorality or moral turpitude. Section 4723.28(B)(9), ORC, authorizes the Board to deny a license or otherwise discipline a licensee for habitual indulgence in the use of controlled substances, other habit-forming drubs, or alcohol or other chemical substances to an extent that impairs ability to practice.

Christy E. Noel, L.P.N. Applicant Page 2

B.

On or about September 30, 2010, MS. NOEL submitted to the Board an Application for Licensure by Examination to Practice in Ohio as a Licensed Practical Nurse. MS. NOEL knowingly. and voluntarily admits that she has twice been convicted of Driving Under the Influence .of Alcohol (DUI) in Champaign County (Ohio) Municipal Court, once in 20011 and Morn recently in 2008. MS. NOEL also admits that, also in. Champaign County Municipal Court, she was convicted of Disorderly Conduct (2001) and Criminal Damaging (2003). All of the offenses noted above were misdemeanors. In a personal statement, MS. NOEL reported that she has worked in the. healthcare field for over 12 years. MS. NOEL also reported that after she and her husband separated, she made some poor choices and began drinking for a period. HS. NOEL further reported that she no longer drinks, has grown up and is now more responsible, MS. NOEL was permitted to take the NCLEX-PN, and on or about November 18, 2010, MS. NOEL passed the NCLEX-PN, AGREED CONDITIONS

C.

D.

E.

Wherefore, in consideration of the foregoing and mutual promises hereinafter set forth, and in lieu of any formal proceedings at this time, MS. NOEL knowingly and voluntarily agrees with the Board to the following terms, conditions, and limitations: Upon meeting the requirements for licensure, MS. NOEL shall be granted a license to practice nursing as a licensed practical nurse in the State of Ohio. MS. NOEL's license to practice nursing as a licensed practical nurse shall be suspended indefinitely. Such suspension shall be stayed, subject to the following PROBATIONARY terms, conditions, and limitations until at least January 2012: 1. MS. NOEL shall obey all federal, state, and local laws, and all laws and rules governing the practice of nursing in Ohio. MS. NOEL shall appear in person for interviews before the full Board or its designated representative as requested by the Board or its designee.

2.

Continuing Education Hours 3. Within ninety (90) days from the effective date of this Consent Agreement, MS. NOEL shall, in addition to the requirements of licensure renewal, successfully complete and submit satisfactory

Christy B. Noel, P.N. Applicant Page 3

documentation of successful completion of the following continuing education taken. subsequent to the effective date of this Consent Agreement: eight (8) hours in Alcohol Abuse/Alcoholism, and four (4) hours in Anger Management, Monitoring &r. Evaluation 4. MS.,. NOEL shall abstain. completely from the personal use or possession of drugs, except those prescribed, administered, or dispensed to her by another so authorized by law who has full. knowledge of M.S. NOEL'S history of alcohol use. MS. NOEL shall self-administer prescribed drugs only in the manner prescribed. MS, NOEL shall abstain completely from the use of alcohol, if recommended by a chemical dependency professional in Paragraph 8. below. 6. Within sixty (60) days of the effective date of this Consent Agreement and continuing throughout the probationary period, MS. NOEL shall submitting, at her expense and on the day selected, blood or urine specimens for drug and/or alcohol analysis at a collection site specified by the Board at such times as the Board may request. Refusal to submit such specimen., or failure to submit such specimen on the day she is selected, or in such a manner as the Board may request, shall constitute a violation of a restriction placed on a license for purposes of Section 4723,28(B), ORC, This screening shall require a daily call-in process. The specimens submitted by MS. NOEL shall be negative, except for substances prescribed, administered, or dispensed to her by another so authorized by law who has full knowledge of MS. NOEL's history of alcohol use. IdS. NOEL shall continue attending a minimum of one (1) meeting per week of a support or peer group meeting approved in advance by the Board, or a Twelve Step program, and MS. NOEL shall provide satisfactory documentation of such attendance to the Board every six (6) months beginning March 1, 2011. Within sixty (60) days following the effective date of this Consent Agreement, MS. NOEL shall, at her own expense, obtain a chemical dependency evaluation by a Board approved chemical dependency professional and shall provide the Board with complete documentation of this evOuanort. Prior to the evaluation, MS. NOEL shall provide the chemical dependency professional with a copy of this Consent Agreement Further, MS. NOEL shall execute releases to permit the chemical dependency professional to obtain any information deemed 4

7.

8.

Christy B. Noel, LPN. Applicant Page 4 The evaluating appropriate and necessary for the evaluation. professional shall submit a written opinion to the Board that includes diagnoses, recommendations for treatment and monitoring, any additional restrictions that should be placed onM S. NOEL'S license to practice, and a statement as to whether MS. NOEL is capable of practicing nursing according to acceptable and prevailing standards of safe nursing care. 9. If treatment recommendations are made, S. NOEL shall provide the Board with satisfactory documentation of compliance with all aspects of the treatment plan developed by the chemical dependency professional described above until released. Further, MS. NOEL agrees that the Board may utilize the chemical dependency professional's recommendations and conclusions from the evaluation as a basis for additional terms, conditions, and limitations on MS. NOEL's license and that the terms, conditions, and limitations shall be incorporated in an addendum to this Consent Agreement.

Treating Practitioners and Reporting 10. Within sixty (60) days of the effective date of this Consent Agreement, MS. NOEL shall provide a copy of this Consent Agreement to all treating practitioners and shall provide to the Board a list of all treating practitioners, including addresses and telephone numbers. Further, MS. NOEL shall be under a continuing duty to provide a copy of this Consent Agreement, prior to initiating treatment, to additional treating practitioners, and to update the list of treating practitioners with the Board within forty-eight (48) hours of being treated by another practitioner. Within sixty (60) days of the effective date of this Consent Agreement, MS. NOEL shall provide a copy of this Consent Agreement to all treating practitioners and shall provide to the Board a list of all treating practitioners, including addresses and telephone numbers, Further, MS. NOEL shall be under a continuing duty to provide a copy of this Consent Agreement, prior to initiating treatment, to additional treating practitioners, and to update the list of treating practitioners with the Board within forty-eight (48) hours of being treated by another practitioner. MS. NOEL shall cause all treating practitioners to complete a medication prescription report that is to be mailed by the practitioner directly to the Board. The medication report is to be completed for any and all substances prescribed, administered, or dispensed to S. NOEL throughout the duration of this Consent Agreement.
4

11.

12.

Christy E. Noel, L.P.N. Applicant Page 5

13.

Within twenty-four (24) hours of release from hospitalization or medical treatments MS. NOEL shall notify the Board of any and all medication(s) car prescription(s) received.

Employment Conditions ..14. Prior to accepting employment as a nurse, each time with every employer, MS. NOEL shall notify the. Board. MS. NOEL is under a continuing duty to provide a copy of this Consent Agreement to any new employer prior to accepting employment in a position in which a nursing license is required. MS, NOEL shall have. her employer(s), if working in a position where a nursing license is required, submit written reports regarding job performance on a quarterly basis beginning March 1, 2011 or within thirty (30) days of accepting nursing employment. MS. NOEL shall have her employer(s) send documentation to the Board, along with the first employer report, of receipt of a copy of this Consent Agreement, including the date the Consent Agreement was received.

15.

Reporting Requirements of Licensee 16. MS. NOEL shall report to the Board, in writing, any violation of this Consent Agreement within thirty (30) days of the occurrence of the violation, MS. NOEL shall sign release of information forms allowing health professionals and other organizations to submit the requested documentation directly to the Board. MS. NOEL shall submit any and all information that the Board may request regarding her ability to practice according to acceptable and prevailing standards of safe nursing practice. MS. NOEL shall not submit or cause to be submitted any false, misleading, or deceptive statements, information, or documentation to the Board or to employers or potential employers. MS. NOEL shall submit the reports and documentation required by this Consent Agreement on forms specified by the,Board. All reporting and communications required by this Consent Agreement shall be made to the Compliance Untit of the Board. MS. NOEL shall submit the. reports and documentation required by this Consent Agreement or any other documents required by the Board to
4

17.

.18.

19.

2.0.

21.

Christy H. Noel, L.P.N. Applicant Page 6

the attention of the Compliance Unit, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, OH 43215-7410. 22. MS. NOEL shall verify that the reports and documentation required by this Consent Agreement are received in the Board office. MS. NOEL shall inform the Board within five (5) business days, in writing, of any change in employment status or of any change in residential or home address or telephone number,

23,

Temporary Practice Restrictions MS. NOEL shall not practice nursing as a Licensed practical nurse (1) for agencies providing home care in the patient's residence; (2) for hospice care programs providing hospice care in the patient's residence; (3) for staffing agencies or pools; (4) as an independent provider where the nurse provides nursing care and is reimbursed for services by the State of Ohio through State agencies or agents of the State; or (5) for an individual or group of individuals who directly engage MS. NOEL to Provide nursing services for fees, compensation, or other consideration or as a volunteer: MS. NOEL shall not function in a position or employment where the job duties or requirements involve management of nursing and nursing responsibilities, or supervising and evaluating nursing practice. Such positions include, but are not limited to, the following: Director of Nursing, Assistant Director of Nursing, Nurse Manager, Vice President of Nursing. FAILURE TO COMPLY MS. NOEL agrees that her license to practice nursing as a licensed practical nurse will be automatically suspended if it appears to the Board that MS. NOEL has violated or breached any terms or conditions of the Consent Agreement. Following the automatic suspension, the Board shall notify MS. NOEL via certified mail of the specific nature of the charges and automatic suspension of her license. Upon receipt of this notice, MS. NOEL may request a hearing regarding the charges. The above described terms and conditions shall constitute "restrictions placed on a license" for purposes of Section 4723.28(B), ORC. If, in the discretion of the Board, MS. NOEL appears to have violated or breached any terms or conditions of this Consent Agreement, the Board reserves the right to institute formal disciplinary proceedings for any and all possible violations or breaches, including, but not limited to, alleged violations of the laws of Ohio occurring before the effective date of this Consent Agreement.

Christy B. Noel, L.P.N. Applicant Page 7

DURATION/ MODE141CATION OF TERMS The terms, liMitations, and conditions, of this Consent Agreement, may be modified or terminated, in writing, at any time upon the agreement of both MS. NOEL and the Board, The Board may only alter the probat opry period imposed by this Consent Agreement if: (1) the BOard determines that S. NOEL has complied with ail aspects of this Consent Agreement; and (2) the Board determines that MS. NOEL is able to practice according to acceptable and prevailing standards of safe nursing care without Board monitoring, based upon an interview with MS. NOEL and review of the reports as required herein. Any period. during which MS. NOEL does not work in a position for which a nursing license is required shall not count toward fulfilling the probationary period imposed by this Consent Agreement. ACKNOWLE TY RELEASE

MS. NOEL acknowledges that she has had an opportunity td ask questions concerning the terms of this Consent Agreement and that all questions asked have been answered in, a satisfactory manner. MS. NOEL waives all of her rights under Chapter 119, ORC, as they relate to matters that are the subject of this Consent Agreement, MS. NOEL waives any and all claims or causes of action she may have against the Board, and its members, officers, employees and/or agents arising out of matters, which are the subject of this Consent Agreement. This Consent Agreement shall be considered a public record as that term is used in Section 149.43, ORC. The information contained herein may be. reported to appropriate organizations, data banks and governmental bodies. This Consent Agreement is not an adjudication order as discussed in Chapter 119, ORC. Any action initiated by the Board based on alleged violations of this Consent Agreement shall comply with the Administrative Procedures Act, Chapter 119, ORC,

{The remainder of this page has been intentionally left blank.}

Cbristy. B Noel, L.PN. App3icant ?age 8 EFFECTIVE DA.TE MS. NOEL understands that this Consent Agreement s.s subject to ratification by the Board prior to signature by the Board President and shall become effective upon the last date of signature below. I I

CEIRLST7 E. OEL, L.P.N. APPLICANT

DATE

.0

FLA LOVELACE, Pres'ident 01 -110 Board of Nursing -

DAT

Case #13-000373

Ohio Board of Nursing

March 22, 2013

wwliv.nursingohio.gov
(614) 466-3947

17 South High Street, Suite 400 4. Columbus, Ohio 43215-7410

NOTICE OF OPPORTUNITY FOR HEARING

Florence Osei-Bonsu, L.P.N., R.N. 6956 E. Broad Street Columbus, Ohio 43213 Dear Ms. Osei-Bonsu: In accordance with Chapter 119 Ohio Revised Code (ORC), the Ohio Board of Nursing (Board) proposes under authority of Section 4723.28, ORC, deny, permanently revoke, revoke; suspend or place restrictions on your licenses to practice nursing as a licensed practical nurse and registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: 1. In or about July 2012, you submitted an Application for Licensure by Examination to Practice Nursing in Ohio as a Registered Nurse (RN Application). On the Citizenship portion of your RN Application, you answered that you are a citizen of the United States. You are not, and have never been, a United States citizen. On or about January 17, 2012, the Board was notified by the U.S. Department of Homeland Security, U.S. Immigration and Customs Enforcement (US DHS), that you are in the United States unlawfully and a final order of removal from the United States was issued April 10, 2010. US DHS also informed the Board that your appeal of the final order of removal was dismissed May 22, 2012. In submitting the RN Application, you signed a sworn Affidavit that the statements you made on the application were true. Section 4723.28(A) [as in effect prior to March 20, 2013], ORC, authorizes the Board to revoke the license or refuse to grant a license to a person who has been found by the Board to have committed fraud, misrepresentation, or deception in applying for or securing any license issued by the Board. 2. You failed the NCLEX-RN, and subsequently, in order to be authorized to repeat the examination, in or about October 2012, you submitted a Re-Registration of Application for Licensure by Examination to Practice Nursing in Ohio as a Registered Nurse (RN Re-Registration Application). On the Citizenship portion of your RN Re-Registration Application, you answered that you are a citizen of the United States. Despite this, as referenced in Item 1., above, you are not, and have never bdn, a citizen of the United States. In submitting the RN Re-Registration Application, you signed a sworn Affidavit that the statements you made on the application were true. Section 4723.28(A) [as in effect prior to March 20, 2013], ORC, authorizes the Board to revoke the license or refuse to grant a license to a person who has been found by the Board to have

Florence Osei-Bonsu, L.P.N., R.N. Page 2 committed fraud, misrepresentation, or deception in applying for or securing any license issued by the Board. 3. In or about January 2010, you submitted a Re-Registration of Application for Licensure by Examination to Practice Nursing in Ohio as a Licensed Practical Nurse (PN Re-Registration Application). On the Citizenship portion of your PN Re-Registration Application, you answered that you) are a citizen of the United States. Despite this, as referenced in Item 1., above, you are not, and have never been, a citizen of the United States. In submitting the PN Re-Registration Application, you signed a sworn Affidavit that the statements you made on the application were true. Section 4723.28(A) [as in effect prior to March 20, 2013], ORC, authorizes the Board to revoke the license or refuse to grant a license to a person who has been found by the Board to have committed fraud, misrepresentation, or deception in applying for or securing any license issued by the Board 4. In or about June 2012, you submitted an application to renew your license to practice as a licensed practical nurse (PN Renewal Application). On the PN Renewal Application, you answered Yes to the following statement: I am a U.S. Citizen or lawfully admitted into the U.S., or I am a foreign national not living in the United States. I verify that all information provided is true and accurate. I am aware that misrepresentation may result in disciplinary action in accordance with Section 4723.28(A) and/or (B), ORC. Despite this, as referenced in Item 1., above, you are not, and have never been, a U.S. Citizen, and were not lawfully present in the United States. Section 4723.28(A) [as in effect prior to March 20, 2013], ORC, authorizes the Board to revoke the license or refuse to grant a license to a person who has been found by the Board to have committed fraud, misrepresentation, or deception in applying for or securing any license issued by the Board. Accordingly, the Board is authorized to impose one or more of the sanctions as cited in Section 4723.28 ORC. In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing in this matter. If you wish to request such hearing, the request must be made in writing and must be received in the Board office within thirty (30) days of the time of mailing of this notice. You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other reprpentative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in writing. At the hearing you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to: Lisa Ferguson-Ramos, Compliance Unit Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus OH 432157410, or to the email address, hearing@nursing..ohio.gov.

Florence Osei-Bonsu, L.P.N., R.N. Page 3 If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Opportunity for Hearing, deny, permanently revoke, revoke, suspend or place restrictions on your licenses to practice nursing as a licensed practical nurse and registered nurse; reprimand or otherwise discipline you; or impose a fine of not more thqn five hundred dollars ($500.00) per violation. Sincerely, KA/ Rhonda S. Barkheimer, R.N., C.N.P. Supervising Board Member Certified Mail Receipt No. 7012 2210 0000 6272 3315 cc: Henry G. Appel, Senior Assistant Attorney General

Case 42012-006834

Ohio oard of Nursing

17 South High Street, Suite 400 March 22, 2013

www.nursing.ohio.gov

Columbus, Ohio 43215-7410. 6 (614) 46673947

NOTICE OF OPPORTUNITY FIR HEARING

Cheri Kay Ostrander, L.P.N., R.N. 9599 Oxley Road Athens, Ohio 45701 Dear Ms. Ostrander: In accordance with Chapter 119. of the Ohio Revised Code (ORC), you are hereby notified that the Ohio Board of Nursing (Board) proposes under the authority of Section 4723.28, ORC, to deny, permanently deny, permanently revoke, revoke, suspend or place restrictions on your licenses to practice nursing as a licensed practical nurse and as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: On or about October 18, 2012, you and the State of West Virginia Board of Examiners for Registered Professional Nurses entered into a Proposed Consent Agreement and Order (West Virginia Board 2012 Order) in which your license to practice as a registered professional nurse in West Virginia was subjected to a stayed suspension and probationary terms. A copy of the West Virginia Board 2012 Order is attached hereto and incorporated herein. Section 4723.28(B)(1) [as in effect prior to March 20, 2013], ORC, authorizes the Board to discipline a license for denial, revocation, suspension, or restriction of authority to practice a health care occupation, including nursing, for any reason other than a failure to renew, in Ohio or another state or j urisdiction. Accordingly, the Board is authorized to impose one or more of the sanctions as cited in Section 4723.28 ORC. You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, Or you may present your position, arguments, or contentions in writing. At the hearing you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to: Lisa Ferguson-Ramos, Compliance Unit Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, OH 43215 7410, or to the email address, head @nursino.ohio ov.

Cheri Kay Ostrander, L.P.N., R.N. Page 2

If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Opportunity for Hearing, deny, permanently deny, permanently revoke, revoke, suspend or place restrictions on your licenses to practice nursing as a licensed practical nurse and as a registered nurse; reprimand or othemise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation_ Sincerely, X'. A/ Rhonda S. Barkheimer, Supervising Baud Member C.N.P .

Certified Mail Receipt No. 7012 2210 0000 6272 3230 cc: Henry G. Appel, Senior Assistant Attorney General

Laura S. Rhodes, M.S.N., R.N. Executive Director email: rrilloard@wv.gov web adciss: www.wvrnboard.com STATE OF WEST VinGINIA

TELEPHONE: (304) 558-3596 FAX (304) 558-2666

BOARD OF EXAMINERS FOR REGISTERED PROFESSIONAL NURSES . 101 Dee Drive, Suite 102
1 Charleston, WV 25311-1620
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November 29, 2012

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Ohio Board of Nursing Compliance Unit 17 South High Street, Suite 400 Columbus, OH 43215 Attention: Carol Polanski

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I, ALICE R FAUCETT, JO, GENERAL COUNSEL & DIRECTOR OF DISCIPLINE of the West Virginia Board of Examiners for Registered Professional Nurses do hereby certify that the attached documents, all in the matter of Cheri Ostrander, registered professional nurse, license number 77249, are true and correct copies of said public documents as they appear among the files and records of this office. Witness my hand and seal of the Board of Nursing this 29' day of November, 2012. BOARD y: Alice R. Faucett, JD General .Counsel and Director of Discipline RS1NG

WEST VIRGINIA STATE BOARD OV EXAMINERS FOR REGISTERED PROFESSIONAL NURSES IN THE MATTER OF CHERI OSTRANDER PROPOSED CONSENT AGREEMENT

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Comes now CHERI OSTRANDER (OSTRANDER), and the West Virginia ar of Examiners for Registered Professional Nurses ("Board"), for the purpose of determining what disciplinary action should be taken against OSTRANDER by the Board pursuant to West Virginia Code 30-7-1 et seq. (1993). As reflected in this document, OSTRANDER has admitted to the stipulations set forth herein; and moves the Board consider these stipulations and the terms of the accompanying proposed agreement, and enter an ORDER accepting the proposed terms set forth below. In offering this proposal for settlement of the complaint against license number 77249, OSTRANDER acknowledges that the Board may reject this proposal, and may hold a hearing to impose revocation or other conditions of a disciplinary nature as it deems appropriate, STIPULATIONS OSTRANDER holds registered professional nursing license number 77249, 1. issued by the Board on or about January 7,2010. At all times pertinent OSTRANDER was employed at Camden Clark Memorial 2. Hospital (CCMH), Parkersburg, West Virginia, The Board received a complaint letter alleging OSTRANDER falsified medical '3. records and neglected to provide any patient care for three (3) hours and forty-five minutes after the patients arrival and admittance to the Emergency Department (ED). During the complaint investigation the Board reviewed the Nurse Emergency 4. Department Report. OSTRANDER charted she performed a head to toe assessment as well as asked patient screening questions one minute after his arrival to the ED, OSTRANDER documented in the chart the patients 1V as patent, side rails were up, lights were dimmed, and warm blanket given. OSTRANDER charted a full set of vital signs she never obtained. There is no 'documentation OSTRANDER provided any parent care. During The Camden Clark Memorial Hospital inve.stigatbn OSTRANDER 5. acknowledged she backed dated the patient assessment and did not validate or invalidate the actual assessment of grips, strengths; and pupils, that was completed by another nurse, 6. The Board sent OSTRANDER an official Notice of Complaint incorporating the

RECg . rVED
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allegations from Camden Clark Memorial Hospital. in response to the allegations made by Camden Clark Memorial Hospital, 7. OSTRANDER provided the following in pertinent part: "The alleged incident involved the l?ck of report and proper patient turnover from the RN acting as Triage Nurse in Camden-Clark Emergency Department that night. The Triage Nurse triaged the patient and held him in the second triage area until approximately 0100. The Triage Nurse never gave a nursing report to me and never handed the patient over to me as can be seen in the charting. 1 could see the patient from the nursing station where I was calling on many patient admissions The Triage Nurse was in the room for the majority of the time from Triage until 0300-330. The Triage nurse placed the patient in the patient room. closest to Triage so she could go back and forth to the room. 1 checked on the patient after the Triage Nurse left as she did not give me any report when she left her shift. The Triage Nurse did not tell me when she was leaving and did not hand the patient care to me." OSTRANDER resigned her position at Camden Clark Memorial Hospital without 8. notice, OSTRANDER acknowledges that her conduct violated West Virginia Code 9. 30-7-11 (f), which state that the licensee may be disciplined if he or she (-Ws guilty of conduct derogatory to the morals or standing of the profession of registered nursing;".
CONCLUSIONS OF LAW

The West Virginia Board of Examiners for Registered Professional NurSes concludes that the stipulations support the sanction of disciplinary action pursuant to West Virginia Code 30-7-1 et seq. pertaining to the practice of registered professional nursing. Specifically, the stipulations support sanctions under the following sections of the West Virginia Code: and West Virginia Code 30-7-11 (f), which states that a licensee may be disciplined upon proof that he or she Os guilty of conduct .derogatory to the morals or standing of the profession of registered nursing;

CON SENT

OSTRANDER, by affixing her signature hereon, agrees to the following: She acknowledges that she is aware of her option to retain legal counsel and to 1. be represented by legal counsel at a formal hearing before the Board. She intelligently and voluntarily waives her right to a formal hearing before the 2. Board in this matter, if the Board accepts the terms and conditions set forth herein and

joins with her in executing this agreement. She acknowledges that she is fully aware that without her consent, no legal 3. action can be taken against her by this Board, except pursuant to West Virginia Code 30-7-1 et seq. and relevant rules. She submits this proposed agreement freely and voluntarily and not under 4. duress, restraint or compulsion. She agrees that the Board may investigate her background at any time during the 5. term of this agreement. She consents to the entry of the following order affecting her license to practice 6. registered professional nursing in the State of West Virginia. She understands that the Board may accept or reject the facts and terms set forth 7. in this proposed agreement, and may impose revocation or other conditions of a disciplinary nature as are deemed appropriate. ORDER On the basis of the foregoing, the Board hereby ORDERS that license number 77249, issued to OSTRANDER, be suspended for the period of one (1) year. Such suspension is hereby stayed contingent upon OSTRANDER complying with the terms .set forth below, and license number 77249 is placed on probation for a period of (6) months employment as a registered professional nurse. The computation of such period is to begin on the date on which notice is received in the office of the Board that OSTRANDER is employed as a registered professional nurse and shall run only during such time that she is employed as a registered professional nurse' on at least a permanent part-time basis (forty hours every two weeks) or full time basis in the State of West Virginia. The Board also ORDERS OSTRANDER pay a fine and administrative costs in the amount of Five Hundred Dollar(s) ($500,00). To receive and maintain a probationary license, regardless of eMployment state OSTRANDER shall meet the following conditions: Terms: OSTRANDER shall not violate the provisions of West Virginia Code 30-7-1 et 1. seq. OSTRANDER shall not commit any act which woad be a crime under West 2. Virginia or federal law. If CHERI OSTRANDER is charged by any law enforcement agency with committing any such criminal act, she shall notify the Board in writing of the formal charge(s) against her, and resolution of same, 3. OSTRANDER shall maintain a current and active license in the State of West

Virginia. She shall not allow her license to lapse or be placed on an inactive status. OSTRANDER shall not, under any circumstances, misrepresent her licensure 4. status, OSTRANDER shall not be employed. by a nursing registry, temporary nursing 5. agency, home health care agency, or as a private duty nurse. OSTRANDER shall not work in an autonomous nursing position. She shall work 6. only under the direct supervision of a registered professional nurse in a structured setting throughout the term of her probation. Such supervising registered professional nurse must, at the time of said supervision, hold an active, unencumbered West Virginia license. OSTRANDER shall inform the Board in writing within ten (10) days of the date 7, she assumes the practice of registered professional nursing, or any employment in the health care field, in the State of West Virginia and shall include the name, address, and telephone number of her employer. She shall provide in writing the name of her immediate registered professional nurse supervisor. OSTRANDER shall inform the Board of any interruption in nursing practice or change in employment within ten (10) days of such interruption or change. OSTRANDER shall immediately inform her nursing employer, any prospective 8. nursing employer, and the director of any nursing education program in which she enrolls or teaches, that the Board has placed her license on probation, and shall provide a complete copy of this agreement to her employer(s). The Board may provide her employer(s) with a copy of this agreement and may communicate with her employer(s). OSTRANDER shall, within ten (10) days of employment or continuation of 9. practice, cause her employer or immediate registered professional nurse supervisor, to notify the Board, in writing, of the employer or supervisor's receipt of a copy of this agreement. OSTRANDER shall further cause her employer or supervisor to submit monthly reports to the Board describing OSTRANDER's job performance, attendance, attitude, and other work behaviors during the first year of probation and if her progress is satisfactory to the Board, quarterly thereafter. OSTRANDER shall submit documentation of fifteen (15) contact hours of 10, continuing education in ethics each year during the time her license is on probation, in addition to those required by law.
)

OSTRANDER shall report in person for appointment with the Board staff upon 11. request. OSTRANDER shall annually submit to the Board a written personal statement. 12, The statement shall be due at the end of the first year and in each subsequent year during the month in which this agreement is accepted by the Board.

Violation of Terms: 13. Any deviation from these requirements vvithout prior written consent of the. Board shall constitute a violation of this Order, and result in immediate suspension of OSTRANDER's probationary license. 14. The Board shall immediately notify OSTRANDER via certified mail of the specific nature of the charges, and the suspension of her license. OSTRANDER may request reinstatement of her probationary license through a, renewal of this agreement, or execution of a new agreement, which may contain different or additional terms. The Board is not bound to comply with this request. If the Board does not accept a renewed or new agreement, OSTRANDER shall b. be notified in writing. OSTRANDER may, request a hearing to seek reinstatement of her probationary license, if OSTRANDER requests a hearing following suspension for violation of this agreement and does not prevail, the cost incurred in holding such hearing shall be borne by OSTRANDER, If OSTRANDER prevails, the cost of such hearing shall be borne by the Board, Cost shall refer only to the expense of employing a court reporter and hearing examiner for the purpose of the hearing, and shall not include any legal or other fees incurred by the Board or OSTRANDER in bringing the matter to hearing. The Board. may schedule a hearing on its own initiative for the purpose of c. allowing the Board. opportunity for considering further suspension or revocation of OSTRANDER's license. Said hearing shall be scheduled in accordance with the provisions of West Virginia Code 30-1-8 and 30-1-7 et. seq. The Board shall bear the cost if it should seek a hearing following suspension of OSTRANDER's probationary license for violation of this agreement. Cost shall refer only to the expense of employing a court reporter and hearing examiner for the purpose of the hearing, and shall not include any legal or other fees incurred by OSTRANDER in bringing the matter to hearing. Petition for Reinstatement: 15. Following the (6) months probationary period, OSTRANDER may petition to appear before the Board and submit satisfactory evidence that she is presently able to safely engage in the practice of registered professional nursing. Evidence in support of this request shall include: a. b. c. Letter of reference from OSTRANDER's employer, if employed; Letter from OSTRANDER outlining her future plans; and Payment of all fines and administrative cost.

However, the terms of this Order shall remain in effect and subject to yearly review and

appropriate revision by the Board until such time as OSTRANDER's license is fully reinstated by the Board, WHEREFORE, OSTRANDER hereby requests that the Board accept the stipulations and impose sanctions in accordance with West Virginia Code 30-71 et seq.

RI OSTRANDER

Date

Date

Agreed to: orif 'or s.Jugy Nyst4 rn itisciplinary Review Committee Member
4

14- 8- /JDate

0 -6 Te se Ritchie, its , RN, FNS' Disciplinary Review Committee Member

di F

/3 Date

La ra S. Rhodes, RN, MSN Executive Director West Virginia Board of Examiners for Registered Professionai Nurses
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10fi6:7-- Date

ENTERED: This the

day of

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Case # 13-000235

Ohio Board:of Nursing

March 22, 2013

www.nursing.ohio7gov

17 South High Street, Suite 400 .0 Columbus, Ohio 43215-7410 4i (614) 466-3947

NOTICE OF OPPOkTUNITY FOR HEA X ING

Tiffany Brooke Payne, L.P.N. 814 E. Cecil Street Springfield, Ohio 45503 Dear Ms. Payne: In accordance with Chapter 119, Ohio Revised Code (ORC), you are hereby notified that the Ohio Board of Nursing (Board) proposes under authority of Section 4723.28, ORC, to deny or permanently deny reinstatement of your license to practice nursing as a licensed practical nurse; permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: 1. On or about November 18, 2011, you entered into a Consent Agreement (November 2011 Consent Agreement) with the Ohio Board of Nursing (Board), a copy of which is attached hereto and incorporated herein, in which you agreed with the Board that your license to practice nursing as a licensed practical nurse in the .State of Ohio would be suspended indefinitely, for not less than one year, with conditions for reinstatement. a. On the following dates, you provided a specimen for analysis to Firstlab, the Board's random drug/alcohol screen program administrator, that tested positive for Cocaine: January 9, 2013; and January 28, 2013. Section 4723.28 (B)(8), ORC, authorizes the Board to discipline a licensee for self-administering or otherwise taking into the body any dangerous drug, as defined in Section 4729.01, ORC, in any way not in accordance with a legal, valid prescription issued for that individual, or selfadministering or otherwise taking into the body any drug that is a schedule I controlled substance. Accordingly, the Board is authorized to impose one or more of the sanctions cited in Section 4723.28, ORC. In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing in this matter. If you wish to request such hearing, the request must be made in writing and must be received in the Board office within thirty (30) days of the time of mailing of this notice.

Tiffany Brooke Payne Page 2 You are hereby further informed that, if you timely request a hearing, you,are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in writing. At the hearing, you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to Lisa Ferguson-Ramos, Compliance Unit Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, Ohio 432157410 or to the email address, hearing@ nursing .ohio .gov If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Opportunity for Hearing, deny or permanently deny reinstatement of your license to practice nursing as a licensed practical nurse; permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely,

Rhonda S. Barkheimer, R.N., C.N.P. Supervising Board Member Certified Mail Receipt No. 7012 2210 0000 6272 3377 cc: Henry G. Appel, Senior Assistant Attorney General

Case #11-001872

. 0 .q_0 Board o Nurs

www.nursing.ohio.gov . . 17 South High Street, Suite 400 4i Columbus, Ohio 432t5-7410 e (614) 466-3947

CONSENT AGREEMENT BETWEEN TIFFANY BROOKE PAYNE, L.P.N. (A,ILA. TIFFANY BROOKE MIDKIFF; TIFFANY MIDKIFF-PAYNE) AND OHIO BOARD OF NURSING

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This Consent Agreement is entered into by and between TIFFANY BROOKE PAYNE, L.P.N., (a.k.a. TIFFANY BROOKE MIDKIFFi TIFFANY MIDICIFF-PAYNE), -(MS. PAYNE) and the Ohio Board of Nursing (Board), the state agency charged with enforcing Chapter 4723. of the Ohio Revised Code (ORC), and all administrative rules promulgated thereunder, This Consent Agreement contains the entire agreement between the parties, there being no other agreement of any kind, verbal or otherwise, which varies the terms of this Consent Agreement. BASIS FOR ACTION This Consent Agreement is entered into on the basis of the following stipulations, admissions and understandings: A. The Board is empowered by Section 4723.28, ORC, to deny, permanently revoke, revoke, suspend, or place restrictions on any license issued by the Board; reprimand or otherwise discipline a licensee; or impose a fine of five hundred dollars ($500.00) or less per violation. Section 4723.28(B)(4), ORC, authorizes the Board to discipline a licensee for conviction of, a plea of guilty to, a judicial finding of guilt of, a judicial finding of guilt resulting from a plea of no contest to, or a judicial finding of eligibility for intervention in lieu of conviction for, any felony or of any crime involving gross immorality or moral turpitude. Section 4723.28(B)(5), ORC, authorizes the Board to discipline a licensee for conviction of, a plea of guilty to, a judicial finding of guilt of, a judicial finding of guilt resulting from a plea of no contest to, or a judicial finding of eligibility for intervention in lieu of conviction for, violating any municipal, state, county, or federal drug law. Section 472328(B)(9), ORC, authorizes the Board to discipline a licensee for habitual indulgence in the use of controlled substances, other habit-forming drugs, or alcohol or other chemical substances to an extant that impairs ability to practice. MS. PAYNE's license to practice nursing as a licensed practical nurse, PN-097682 in the State of Ohio, was initially issued in 1995. MS.

B,

Tiffany Brooke Payne, L.P.N. (a.k.a., Tiffany Brooke Midkiff; Tiffany Midkiff-Payne) Page 2 PAYNE's license has been lapsed since September 1, 2040. In May 2011, MS. PAYNE submitted an application to reinstate her lapsed practical nursing license, C. MS. PAYNE knowingly and voluntarily admits to the following; 1. On or about July 6, 2010, in Clark County Municipal Court Case No. CR 1001538, MS. PAYNE pled guilty to and was found guilty of one (1) count of Abusing Harmful Intoxicants, a first-degree Misdemeanor in violation of Section 2925.31(A)(1), ORC. The events underlying this conviction occurred on or about April 15, 2010, and consisted of her being found passed out in her bedroom with a can of "Blast Away" next to her. 2. Also on or about July 6, 2010, in Clark County Municipal Court Case No. CR1001789; MS. PAYNE pled guilty to and was subsequently found guilty of one (1) count of Child Endangering; a first-degree misdemeanor, in violation of Section 2919.22(A)(1), ORC. Information contained in the Springfield-Clark County Law Enforcement Arrest Report #2010-00019801 indicates that the events leading to MS. PAYNE's conviction in this case was the result of her abusing harmful intoxicants (inhaling compressed air) and losing consciousness, while alone in her residence with her then 5-year-old child. 3. As a result of her guilty pleas noted above, four additional Abusing Harmful Intoxicant charges that had been filed . in Clark County Municipal Court between May and June of 2010 were dismissed. D. MS. PAYNE further knowingly and voluntarily admits the following: 1.. A May 2011 chemical dependency evaluation performed by Tina M. Cotto, MA, CDCA, at McKinley Hall in Springfield, Ohio diagnosed MS. PAYNE with Anxiolytic (AtivanlXanax) Abuse Sustained Full Remission, Inhalant Dependence Sustained Full Remission, Alcohol Abuse Sustained Full Remission, and Cocaine Abuse Sustained Full Remission, Further, Ms. Cotto documented that although MS. PAYNE reported suffering froth. Anxiety, Bipolar Disorder, Depression, and a Sleep Disorder, MS. PAYNE has never undergone a mental health evaluation. 2. In June 2011, MS. PAYNE initiated inpatient treatment at The Women's Recovery Center in Springfield, Ohio and completed said treatment on September 16, 2011.

Tiffany Brooke Payne, L .P.N (a.k.a. Tiffany Brooke Midkiffi Tiffany Midkiff-Payne) Page 3 3. On the evening of her completion and discharge from inpatient treatment, MS. PAYNE drove her husband to a dart tournament at a local tavern. ,MS. PAYNE consumed alcohol while at the tavern and was later charged with OVI after she drove off the road and struck a tree and a building. Shortly after this incident, MS. PAYNE enrolled in McKinley Hall's intensive outpatient treatment (IOP) at McKinley Hail. MS. PAYNE has reported to Board staff that the 10P. contained a relapse-prevention component. 4. On or about March 4, 2011, in Clark County Municipal Court Case No. 10TRC10688, MS. PAYNE pled guilty to and was found guilty of the above-referenced OVI charge. 5. On or about August 2, 2011, MS. PAYNE successfully completed IOP at McKinley Hall-Women's Program. 6. MS. PAYNE last worked as a nurse in March 2010 at Heartland of Springfield, and her nursing employment there was terminated due to absenteeism 7. MS. PAYNE is prescribed Ultram due to a diagnosis of interstitial cystitis and Lithium for Bipolar Disorder. 8. MS. PAYNE is currently enrolled in the Registered Nursing Program at Clark State Community College and has an anticipated graduation date in June 2012. MS. PAYNE has .expressed her willingness to cooperate with the Board so that she may be able to safely return to the practice of nursing. AGREED CONDITIONS Wherefore, hi consideration of the foregoing and mutual promises hereinafter set forth, and in lieu of any formal proceedings at this time, MS. PAYNE knowingly and voluntarily agrees with the Board to the following terms, conditions, and limitations: SUSPENSION OF LICENSE 1. Upon completion of the renewalheinstatement process, MS. PAYNE's license to practice nursing as a licensed practical nurse shall be renewed and indefinitely suspended for not less than ONE (I) YEAR from ratification of this Consent Agreement. MS. PAYNE may submit a written request for reinstatement anytime after the conditions for reinstatement are met.

Tiffany Brooke Payne, L.P.N. (a.k.a., Tiffany Brooke Midkiff; Tiffany Midkiff-Payne) Pap 4 CONDITIONS FOR REINSTATEMENT 2. 3. 4. MS. PAYNE shall obey all federal, state, and local laws, and all laws and rules governing the practice of nursing in Ohio. MS. PAYNE shall appear in person for interviews before the full Board or its designated representative as requested by the Board, or its designee. Prior to reinstatement, MS. PAYNE shall enter into 4 Consent Agreement with the Board for probationary terms, conditions, and limitations determined by the Board for A minimum period of THREE (3) years following reinstatement. Within six (6) months immediately prior to requesting reinstatement, MS. PAYNE agrees that she will submit a request to the Bureau of Criminal Identification and Investigation (BCII) to conduct a criminal records check of MS. PAYNE, including a check of Federal Bureau of Investigation (FBI) records, and shall cause BCII to submit MS. PAYNE's criminal records check reports to the Board. MS. PAYNE agrees that a request for reinstatement will not be considered by the Board until the completed criminal records check, including the FBI check, has been received by the Board.

5.

Monitoring of Rehabilitation and Treatment 6. MS. PAYNE shall abstain completely from the personal use or possession of drugs, except those prescribed, administered, or dispensed to her by another so authorized by law who has received a complete copy of this Consent Agreement prior to prescribing for MS. PAYNE. MS. PAYNE shall self-administer the prescribed drugs only in the manner prescribed. MS. PAYNE shall abstain completely from the use of alcohol or alcohol-containing products. Within six (6) months prior to requesting reinstatement, MS. PAYNE shall, at her expense, obtain a chemical dependency evaluation by a Board approved chemical dependency professional and shall provide the Board with complete documentation of this evaluation. Prior to the evaluation, MS. PAYNE shall provide the chemical dependency professional with a copy of this Consent Agreement and her May 2011 McKinley Hall evaluation, and treatment records from McKinley Hall and The Women's Recovery Center. Further, MS. PAYNE shall execute releases to permit the chemical dependency professional to obtain any information deemed appropriate and necessary for the evaluation. The professional shall submit a written opinion to the Board that includes diagnoses, recommendations for treatment and monitoring, any additional restrictions that should be placed en MS. PAYNE's license to practice, and 4

7. 8.

Tiffany Brooke Payne, L.P.N. (a.k.a. Tiffany Brooke Midkiff; Tiffany Midlciff-Payne) Page 5 stating whether MS. PAYNE is capable of practicing nursing according to acceptable and prevailing standards of safe nursing care. 9. 'Following the evaluation performed pursuant to the above paragraph eight (8) of this Consent Agreement, MS. PAYNE shall provide the Board with satisfactory documentation of compliance With all aspects of the treatment plan developed by the chemical dependency professional described above until released, Further, MS. PAYNE agrees that the Board may utilize the professional's recommendations and conclusions from the evaluation as a basis for additional terms, conditions, and limitations on MS. PAYNVs license and that the terms, conditions, and limitations may be incorporated in an addendum to this Consent Agreement or into a reinstatement consent agreement. For a minimum, continuous period of not less than twelve (12) months immediately prior to requesting reinstatement by the Board, MS. PAYNE shall submit, at her expense and on the day selected, blood, breath, hair, or urine specimens for drug and/or alcohol analysis at a collection site specified by the Board at such times as the Board may request. Upon and after MS. PAYNE's initiation of drug screening, refusal to submit such specimen, or failure to submit such specimen on the day she is selected, or in such a manner as the Board may request, shall constitute a violation of a restriction placed on a license for purposes of Section 4723.28(B), ORC. This screening shall require a daily call-in process. The specimens submitted by MS. PAYNE shall be negative, except for substances prescribed, administered, or dispensed to her by another so authorized by law who has received a complete copy of this Consent Agreement prior to prescribing for MS. PAYNE. a. Prior to MS. PAYNE initiating drug screening, MS. PAYNE shall provide a copy of this Consent Agreement to all treating practitioners and shall provide to the Board a list of all treating practitioners, including addresses and telephone numbers and cause all treating practitioners to complete a medication prescription report that is to be mailed by the practitioner directly to the Board. The medication report is to be completed for any and all substances prescribed, administered, or dispensed to MS. PAYNE. b. After initiating drug screening, MS. PAYNE shall be under a continuing duty to provide a copy of this Consent Agreement, prior to initiating treatment, to additional treating practitioners, and to update the list of treating practitioners with the Board within forty-eight (48) hours of being treated by another practitioner. Further, MS. PAYNE shall notify the Board of any and all medication(s) or prescription(s) received within twenty-four (24) Hours of release from hospitalization or medical treatment,

10,

Tiffany Brooke Payne, L.P.N. (a.k.a. Tiffany Brooke Midkiff; Tiffany Midkiff-Payne) Page 6 11. For a minimum, continuous period of twelve (12) months immediately prior to requesting reinstatement, MS. PAYNE shall attend a minimum of one (1) meeting per week of a support or peer group meeting approved in advance by the Board, or a Twelve Step program, and MS. PAYNE shall provide satisfactory documentation of such attendance to the Board prior to requesting reinstatement.

Psychiatric Evaluation and Treatment 12. Within three (3) months immediately prior to reinstatement, MS. PAYNE shall, at her expense, obtain a psychiatric evaluation from a Board approved psychiatrist and shall provide the Board with complete documentation of such evaluation. Prior to the . evaluation, MS. PAYNE shall provide the psychiatrist with a copy of this. Consent Agreement and her assessments, evaluations, and treatment records from. The Women's Recovery Center arid McKinley Hall, and sh.all execute releases to permit the psychiatrist to obtain any information deemed appropriate and necessary for the evaluation. The psychiatrist shall submit a written opinion to the Board that includes diagnoses, recommendations for treatment and monitoring, any additional restrictions that should be placed on MS. PAYNE's license, and a statement as to whether MS. PAYNE is capable of practicing nursing according to acceptable and prevailing standards of safe nursing care. MS. PAYNE shall provide the Board with satisfactory documentation of compliance with all aspects of the treatment plan developed by the psychiatrist until released. Further, MS. PAYNE agrees that the Board may use the psychiatrist's recommendations and conclusions from the evaluation as a basis for additional terms, conditions, limitations on MS. PAYNE's license and that the terms, conditions, and limitations may be incorporated in an addendum to this Consent Agreement or in the reinstatement consent agreement.

13.

Reporting Requirements of Licensee 14. 15. MS. PAYNE shall report to the Board, in writing, any violation of this Consent Agreement within thirty (30) days of the occurrence of the violation. MS. PAYNE shall sign release of information forms allowing health professionals and other organizations to submit requested documentation or information directly to the Board. MS. PAYNE shall submit any and all information that the Board may request regarding her ability to practice according to acceptable and prevailing standards of safe nursing practice. MS. PAYNE shall not submit or cause to be submitted any false, misleading, or deceptive statements, information, or documentation to the Board or to employers or potential employers. 4

16.

17.

Tiffany Brooke Payne, L.P.N. (a.k.a. Tiffany Brooke Midkiff; Tiffany Midkiff-Payne) Page 7

18.

MS. PAYNE shall submit the reports and documentation required by this Consent Agreement on forms specified by the Board. All reporting and communications required by this Consent Agreement shall be made to the .Compliance Unit of the Board. MS. PAYNE shall submit the reports anddocumeritation required by this Consent Agreement to the attention of the Compliance Unit, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, OH 43215-7410. MS. PAYNE shall verify that the reports and documentation required by this Consent Agreement are received in the Board office, MS. PAYNE shall inform the Board within five (5) business days, in writing, of any change in residential or home address or telephone number,

19.

20. 21

Nursing Refresher Course Upon request of the Board or its designee, MS. PAYNE shall, prior to working in a position Where a nursing license is required, complete and submit satisfactory documentation of completion of a nursing refresher course or an extensive orientation approved in advance by the Board or its designee, Temporary Narcotic Restriction MS. PAYNE shall not administer, have access to, or possess (except as prescribed for MS. PAYNE's use by another so authorized by law who has received a complete copy of this Consent Agreement prior to prescribing for MS. PAYNE) any narcotics, other controlled substances, or mood altering drugs for a minimum of six (6) months in which MS. PAYNE is working in a position that requires a nursing license. At any time after the six (6) month period previously described, MS. PAYNE may submit a written request to the Board to have this restriction re-evaluated. In addition, MS. PAYNE shall not possess or carry any work keys for locked medication carts, cabinets, drawers, or containers. MS. PAYNE shall not count narcotics. Permanent Practice Restrictions MS. PAYNE further knowingly and voluntarily agrees with the Board to the following PERMANENT LJCENSURE RESTRICTIONS: Unless otherwise approved in advance and in wilting by . the Board or its designee, MS. PAYNE shall not practice nursing as a licensed practical nurse (1) for agencies providing home care in the patient's residence; (2) for hospice care programs providing hospice care in the patient's residence; (3) for staffing agencies or pools; (4) as km. independent provider where the nurse proVides nursing care and is reimbursed for services by the State Of Ohio through State agencies or agents of the State; or (5) for an individual or group of individuals who directly

Tiffany Brooke Payne, L.P.N. (a.k.a. Tiffany Brooke Midkiff; Tiffany Midkiff-Payne) Page 8 engage MS. PAYNE to provide nursing services for fees, compensation, or other consideration or who engage MS. PAYNE as a volunteer. Unless otherwise approved in advance and in writing by the Board or its designee, MS. PAYNE shall not function in a position or employment where the job duties or requirements involve management of nursing and nursing responsibilities, or supervising and evaluating tnursing practice. Such positions include, but are not limited to, the following: Director of Nursing, Assistant Director of Nursing, Nurse Manager, Vice President of Nursing. 'FAILURE TO COMPLY The above described terms and conditions shall constitute "restrictions placed on a license" for purposes of Section 4723.28(B), ORC. If, in the discretion of the Board, MS. PAYNE appears to have violated or breached any terms or conditions of this Consent Agreement, the Board reserves the right to initiate disciplinary proceedings . for any and all possible violations or breaches, including, but not limited to, alleged violations of the laws of Ohio occurring before the effective date of this Consent Agreement, DURATION/MODIFICATION OF TERMS The terms, limitations, and conditions of this Consent Agreement, other than the permanent licensure restrictions, may be modified or terminated, in writing, at any time upon the agreement of both MS. PAYNE and the Board. The Board may only alter the indefinite suspension imposed if: (1) MS. PAYNE submits a written request for reinstatement; (2) the Board determines that MS, PAYNE has complied with all conditions of reinstatement; (3) the Board determines that MS. PAYNE is able to practice according to acceptable and prevailing standards of safe nursing care based upon an interview with MS. PAYNE and review of the doCumentation specified in this Consent Agreement; and (4) MS. PAYNE has entered into a Consent Agreement with the Board for probationary terms, conditions, and limitations determined by the Board for a minimum period of THREE (3) years following reinstatement. ACKNOWLEDGMENTS/LIABJLETY RELEASE MS. PAYNE acknowledges that she has had an opportunity to ask questions concerning the terms of this Consent Agreement and that all questions asked have been answered in a satisfactory manner. MS. PAYNE waives all of her rights under Chapter 119, ORC, as they relate to matters that are the subject of this Consent Agreement, MS. PAYNE waives any and all claims or causes of action she may have against the Board, and its members, officers, employees and/or agents arising out of matters that are the subject of this Consent Agreement.

11/10/2011 15:24 19373256341

SPRINGFIELD

PAGE 02/02

Tiffany Brooke- Payne, L.P.N, (a.k.a. Tiffany Brooke Nikildft Tiffany Midlziff-Payne) Page 9 This Consent Agreement is not an adjudication order as discussed in Chapter 119, ORC. Any action initiated by the Board based on alleged violations of this Consent Agreement shall comply with the Administrative procedures Act, Chapter 119, ORC. This Consent Agreement shall be considered a public record as that term is used in Section 149.43, ORC. The information contained herein may be repotted to appropriate organizations, data banks and governmental bodies. EFFECTIVE DATE MS, PAYNE 'understands that this Consent Agreement is subject to ratification by the Board prior to signature by the Board President and shall become effective upon the last date of signature below,

PAYNE, ke Midkiff;

DATE y Midkiff-Payne)

BA VA /014f. i Rtj ERMA LOVELACE, President Ohio Board of Nureing

0131)01 DATE

11/10/2011 THU 18:54 [IX/RX NO

1104]

gl002

Case # 12-000637

Ohio Board of Nursing

www.nursing.ohio.gov

17 South High Street, Suite 400 6 Columbus, Ohio 43215-7410 4, (614) 466-3947

March 22, 2013

NOTICE OF OPPORTUNITY FOR HEARING

Carol I. Peake, R.N., C.N.P. 1229 Grassy Lane Rossford, Ohio 43460 And 5920 Cloverlane Walbridge, OH 43465 Dear Ms. Peake: In accordance with Chapter 119 Ohio Revised Code (ORC), you are hereby notified that the Ohio Board of Nursing (Board) proposes under authority of Section 472328, ORC, to deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a registered nurse and/or your certificate of authority to practice as a nurse practitioner and/or your certificate of authority to prescribe pursuant to Section 4723.47(B), ORC; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: 1. On or about November 14, 2011, you wrote Patient #1 [See attached Patient Key to remain confidential and not subject to public disclosure] a prescription for Ativan (Lorazepam), 0.5 mg., 20 tablets, 2 to 3 times daily with 3 refills. Patient #1 is your daughter. Section 4723.28(B)(16), ORC, authorizes the Board to discipline a licensee for violation of Chapter 4723, ORC, or any rules adopted under it. Rule 4723-8-02(B)(3), Ohio Administrative Code (OAC) states each advanced practice nurse shall practice in accordance with Chapter 4723 of the Revised Code and rules adopted thereunder. Rule 4723-9-09(D), OAC, states that: (2) A nurse holding a current, valid certificate to prescribe shall not prescribe controlled substances for a family member. (3) For the purposes of this rule, "family member" means a spouse, parent, child, sibling or other individual with respect to whom a nurse's personal or emotional involvement may render the nurse unable to exercise detached professional judgment in reaching diagnostic or therapeutic decisions,

Carol I. Peake, R.N., C.N.P. Page 2

2. You entered a standard care arrangement (SCA) with Or. Climo, signed December 9, 2010 with an agreed term of one (1) year, and an agreed effective date of December 1, 2010. The SCA specified that, in collaborating with Dr. Climo, your practice would be family and geriatric care provided to residents of seven (7) identified long-term care facilities. In an interview with a Board Compliance Agent on or about March 16, 2012, you indicated that after the SCA with Dr. Climo expired you did not have a SCA with, any physician or podiatrist. (a) On or about December 16, 2011 you wrote a prescription to Patient #2 for Vicodin (Hydrocodone) (5/500), 12 tablets, one-half to.1 tablet every 6 hours for 3 days. On or about January 31, 2012, you wrote a prescription to Patient #2 for Vicodin (Hydrocodone), 32 tablets, 1 to 2 times every six hours for 4 days. Patient #2 was not a resident of any long-term care facility, and, in an interview with a Board Compliance Agent, you stated that Patient #2 was daughter's boyfriend who resided in your home for a period of time up until in or about March 2012. Section 4723.28(B)(16), ORC, authorizes the Board to discipline a licensee for violation of Chapter 4723, ORC, or any rules adopted under it. Rule 4723-8-02(B)(3), OAC, states each advanced practice nurse shall practice in accordance with Chapter 4723 of the Revised Code and rules adopted thereunder. Rule 4723-8-04(A), OAC, states that prior to engaging in practice, a standard care arrangement shall be entered into with each physician or podiatrist with whom the certified nurse practitioner collaborates. (2) A new standard care arrangement shall be executed when the nurse is employed at a different setting and engages in practice with a different collaborating physician or podiatrist. Rule 4723-8-05(C), OAC, states that each certified nurse practitioner who is a party to a standard care arrangement shall comply with all quality assurance provisions of the standard care arrangement in accordance with this chapter. Failure to provide, enter into, or practice in accordance with a standard care arrangement may result in disciplinary action in accordance with Section 4723.28 of the Revised Code. Rule 4723-9-09(A), OAC, states that a nurse who holds a current valid certificate to prescribe may prescribe a drug or therapeutic device provided the prescription is in accordance with: (1) the nurse's standard care arrangement. Rule 4723-9-09(D), OAC, states that acceptable and prevailing standards of safe nursing care require that nurse maintain a detached professional in the treatment of family members. (1) A nurse holding a current, valid certificate to prescribe shall not prescribe any drug or therapeutic device to family members unless: (a) the nurse is able to exercise detached professional judgment in reaching diagnostic or therapeutic decisions; (b) the prescription is in accordance with the nurse's scope of practice and standard care arrangements; and (c) the prescription is documented in the patient's record. (2) A nurse holding a current, valid certificate to prescribe shall not prescribe controlled substances for a family member. (3) For the purposis of this rule, "family member" means a spouse, parent, child, sibling or other individual with respect to whom a nurse's personal or emotional involvement may render the nurse unable to exercise detached professional judgment in reaching diagnostic or therapeutic decisions. (b) On or about October 18, 2011, you wrote a prescription to Patient #3 for Ativan (Lorazepam) 0.5 mg., 60 tablets. On or about January 27, 2012, you prescribed Ativan

Carol I. Peake, R.N., C.N.P. Page 3 (Lorazepam) 0.5 mg, 60 tablets to Patient #3. You told a Board Compliance Agent that Patient #3 was an old friend, and that you treated her in your home. Section 4723.28(B)(16), ORC, authorizes the Board to discipline a licensee for violation of Chapter 4723, ORC, or any rules adopted under it. Rule 4723-8-02(B)(3), OAC, states each advanced practice) nurse shall practice in accordance with Chapter 4723 of the Revised Code and rules adopted thereunder. Rule 4723-8-04(A), OAC, states that prior to engaging in practice, a standard care arrangement shall be entered into with each physician or podiatrist with whom the certified nurse practitioner collaborates. (2) A new standard care arrangement shall be executed when the nurse is employed at a different setting and engages in practice with a different collaborating physician or podiatrist. Rule 4723-8-05(C), OAC, states that each certified nurse practitioner who is a party to a standard care arrangement shall comply with all quality assurance provisions of the standard care arrangement in accordance with this chapter. Failure to provide, enter into, or practice in accordance with a standard care arrangement may result in disciplinary action in accordance with Section 4723.28 of the Revised Code. Rule 4723-9-09(A), OAC, states that a nurse who holds a current valid certificate to prescribe may prescribe a drug or therapeutic device provided the prescription is in accordance with: (1) the nurse's standard care arrangement. Accordingly, the Board is authorized to impose one or more of the sanctions cited in Section 4723.28, ORC. In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing in this matter. If you wish to request such hearing, the request must be made in writing and must be received in the Board office within thirty (30) days of the time of mailing of this notice. You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in writing. At the hearing, you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to Lisa Ferguson-Ramos, Compliance Unit Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, Ohio 432157410 or to the email address, beqripg If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in tie Notice of Opportunity for Hearing, deny; permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a registered nurse and/or your certificate of authority to practice as a nurse practitioner and/or your authority to prescribe

Carol I. Peake, R.N., C.N.P. Page 4 pursuant to Section 4723.47(B), ORC; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons. Sincerely, H A/ Rhonda S. Barkheimer, R.N., C.N.P. Supervising Board Member Certified Mail Receipt No. 7012 2210 0000 6272 3445 Second Address Certified Mail Receipt No. 7012 2210 0000 6272 3452 Attorney's Certified Mail Receipt No. 7012 2210 0000 6272 3469 cc: Henry G. Appel, Senior Assistant Attorney General Drew A. Hanna, Attorney at Law

Case #13-000842

Ohjb B.oard .of Nursing

17 South High Street, Suite 400

www.nursing.ohiagov
6

Columbus, Ohio 43215-7410

(614) 466-3947

March 22, 2013

NOTICE OF OPPORTUNITY FOR HEARING

Heidi Nicole Petrilla, R.N. 260 Terre Hill Drive Cortland, Ohio 44410 Dear Ms. PetriIla: In accordance with Chapter 119, Ohio Revised Code (hereinafter "ORC"), you are hereby notified that the Ohio Board of Nursing (hereinafter "Board") proposes under authority of Section 4723.28 ORC, to deny, revoke, permanently revoke, suspend or place restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: On July 27, 2012, the Board issued an Adjudication Order (July 2012 Adjudication Order), a copy of which is attached hereto and incorporated herein, in which the Board ordered that your license to practice nursing as a registered nurse be suspended, and that said suspension would be stayed subject to probationary terms, conditions, and limitations for a period not less than three (3) years. Attached to and incorporated within the July 2012 Adjudication Order is a May 21, 2012 Hearing Examiner's Report and Recommendation. 2. Item 3. of the July 2012 Adjudication Order states, "Within six (6) months of the effective date of this Order, MS. PETRILLA shall complete and submit satisfactory documentation of her successful completion of the following continuing education approved in advance by the Board: Documentation; Critical Thinking; Ethics; Professionalism; Establishing and Maintaining Professional Boundaries." Despite this provision, as of March 4, 2013, you have failed submit satisfactory documentation of your successful completion of the required continuing education. 3. Item 4, of the July 2012 Adjudication Order states, "Within six (6) months of the effective date of this Order, MS. PETRILLA shall pay a fine of five hundred dollars ($500.00) by certified check, cashier check, or money order, made payable to the "Treasurer, State of Ohio," to the Board. Payment shall be

Heidi Nicole Petrilla, R.N. Page 2 mailed to the attention of the Compliance Unit, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, OH 43215-7410." Despite this provision, as of March 4, 2013, you have failed to pay the five hundred dollar ($500.00) fine. Section 4723.28(B)(17), ORC, authorizes the Board to discipline a licensee for violation of any restrictions placed on a nursing license by the Board. Accordingly, the Board is authorized to impose one or more of the sanctions cited in Section 4723.28, ORC. In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing in this matter. If you wish to request such hearing, the request must be made in writing and must be received in the Board office within thirty (30) days of the time of mailing of this notice. You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in writing. At the hearing you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to Lisa Ferguson-Ramos, Compliance Unit Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus OH 43215-7410, or to the email address, hearing@nursing.ggy. If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Opportunity for Hearing, deny, revoke, permanently revoke, suspend or place restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely,

Rhonda S. Barkheimer, R.N., C.N.P . Supervising Board Member Certified Mail Receipt No. 7012 2210 0000 6272 3599 cc: Henry G. Appel, Senior Assistant Attorney General

Ohio Board of Nursing www.nu1.sin g.ohio.g9v

17 South High Street, Suite 400 4' Columbus, Ohio 43215-7410 a (614) 466-3947 BEFORE THE OHIO BOARD OF NURSING IN THE MATTER OF: CASE if 2011-001630 HEIDI PETRILLA, R.N.

ADJUDICATION ORDER

This matter came for consideration before the Ohio Board of Nursing (hereinafter "Board") on July 27, 2012. At such time the Board verified that it reviewed the following materials prior to consideration of this matter:

Hearing Transcript; State's Exhibits; Respondent's Exhibits; and Hearing Examiner's Report and Recommendation.

Beth A. Lewis was the Hearing Examiner designated in this matter pursuant to Section 119.09, Ohio Revised Code (ORC). A true copy of the Report and Recommendation of Beth A. Lewis is attached hereto and incorporated herein, On this date, the Board accepted all of the Findings of Fact, Conclusions of Law, and modified the Recommendation in the Hearing Examiner's Report and Recommendation and ordered that HEIDI PETRILLA'S license to practice nursing as a registered nurse in the State of Ohio be suspended and that the suspension be stayed subject to the probationary terms, conditions set forth below for a minimum period of three (3) years and the permanent practice restrictions set forth below, The rationale for the modification is the following: The Board has determined that the additional requirements and restrictions set forth below are necessary for effective monitoring of MS. PETRILLA'S practice.

MS. PETRILLA's license shall be subject to the following probationary terms, conditions, and limitations for not less than three (3) years.

Page 1 of 6

I. MS. PETRILLA shall obey all federal, state, and local laws, and all laws and rules governing the practice of nursing in Ohio and the terms and conditions imposed in Franklin County Common Pleas Court Number 10 CR 3548. 2. MS. PETRILLA shall appear in person for interviews before the full Board or its designated representative as requested by the Board. Within six (6) months of the effective date of this Order, MS. PETRILLA shall complete and submit satisfactory documentation of her successful completion of the following continuing education approved in advance by the Board: Documentation; Critical Thinking; Ethics; Professionalism; Establishing and Maintaining Professional Boundaries. 4. Within six (6) months of the effective date of this Order, MS. PETRILLA shall pay a fine of five hundred dollars ($500.00) by certified check, cashier check, or money order, made payable to the "Treasurer, State of Ohio," to the Board. Payment shall be mailed to the attention of the Compliance Unit, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus,OH 43215-7410. 5. Within thirty (30) days of the effective date of this Order, MS. PETRILLA shall notify her current employer of her criminal conviction in Franklin County Common Pleas Court Number 10 CR 3548. MS. PETRILLA shall have her employer send documentation to the Board, along with the first employer report, of notification of MS. PETRILLA's conviction. Employment Conditions 6. Prior to accepting employment as a nurse, each time with every employer, MS. PETRILLA shall notify the Board. 7. MS. PETRILLA shall have her emplOyer(s), if working in a position where a nursing license is required; submit written reports regarding job performance on a quarterly basis. MS. PETRILLA shall provide her employer(s) with a copy of this Order and Notice of Opportunity for Hearing and shall have her employer(s) send documentation to the Board, along with the first employer report, of receipt of a copy of this Order and Notice of Opportunity for Hearing, including the date they were received. Further, MS. PETRILLA is under a continuing duty to provide a copy of this Order and Notice of Opportunity for Hearing to any new employer prior to accepting employment. Reporting Requirements of MS. PETRILLA 8. MS. PETRILLA shall sign releases of information forms allowing health professionals and other organizations to submit the requested documentation directly to the Board.

Page 2 of 6

9. MS. PETRILLA shall submit any and all information that the Board may request regarding her ability to practice according to acceptable and prevailing standards of safe nursing practice. 10. MS. PETRILLA shall not submit or cause to be submitted any false, misleading, or deceptive statements, information, or documentation to the Board or to employers or potential employers. 4 11. MS. PETRILLA shall submit the reports and documentation required by this Order on forms specified by the Board. All reporting and communications required by this Order shall be made to the Compliance Unit of the Board. 12. MS. PETRILLA shall submit the reports and documentation required by this Order or any other documents required by the Board to the attention of the Compliance Unit, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, OH 43215-7410. 13. MS.,PETRILLA shall verify that the reports and documentation required by this Order are received in the Board office. 14.MS. PETRILLA shall inform the Board within five (5) business days, in writing, of any change in employment status or of any change in residential or home address or telephone number. 15. Prior to working as 6 nurse, if requested by the Board or its designee, MS. PETRILLA shall complete a nurse refresher course or extensive orientation approved in advance by the Board. Permanent Practice Restrictions MS. PETRILLA shall not practice nursing as a registered nurse (1) for agencies providing home care in the patient's residence; (2) for hospice care programs providing hospice care in the patient's residence; (3) as a nurse for staffing agencies or pools; (4) as an independent provider where the nurse provides nursing care and is reimbursed for services by the State of Ohio through State agencies or agents of the State; or (5) for an individual or group of individuals who directly engage MS. PETRILLA to provide nursing services for fees, compensation, or other consideration or as a volunteer. MS. PETRILLA shall not function in a position or employment where the job duties or requirements involve management of nursing and nursing responsibilities, or supervising and evaluating nursing practice. Such positions include but are not limited to the following; Director of Nursing, Assistant Director of Nursing, Nurse Manager, Vice, President of Nursing.

Page 3 of 6

DURATION The Board may only alter the probationary period imposed by this Order if; (1) the Board determines that MS. PETRILLA has complied with all aspects of this Order; and (2) the Board determines that MS. PETRILLA. is able to practice according to acceptable and prevailing standards of safe nursing care without Board monitoring, based upon an interview with MS. PETRILLA and review of the reports as required herein. Any period during which MS. PETRILLA does not work in a position for which a nursing license is required shall not count toward fulfilling the probationary period imposed by this Order.

This ORDER shall become effective immediately and is hereby entered upon the Journal of the Board for the 27th day of July, 2012.

Page 4 of 6

TIME AND METHOD TO PERFECT AN APPEAL Any party desiring to appeal shall file a Notice of Appeal with the Ohio Board of Nursing, 17 S. High Street, Suite 400, Columbus OH 43215-7410, setting forth the order appealed from and the grounds of the party's appeal. A copy of such Notice of Appeal shall also be filed by the appellant with the Franklin Coati)/ Court of Common Pleas, Columbus, Ohio. Such notices of appeal shall be filed within fifteen (15) days after the mailing of the notice of the Ohio Board of Nursing's Order as provided in Section 119.12 of the Ohio Revised Code.

CERTIFICATION

The State of Ohio County of Franklin

1, the undersigned Betsy J. Houchen, Executive Director for the Ohio Board of Nursing, hereby certify that the foregoing is a true and exact reproduction of the original Order of the Ohio Board of Nursing entered on its Journal, on the 27th day of July, 2012.

I-.

Betsy J. Houchen, R.N.N.S., J.D. Exechtive Director

July 27, 201.2 Date

(SEAL)

4 Page 5 of 6

CERTIFICATE OF SERVICE I hereby certify that a true and accurate copy of the foregoing Adjudication Order, concerning HEIM PETRILLA was sent via certified mail; return receipt requested, this 10th day of August, 2012, to HEIDI PETRILLA; 260 Terre Hill Drive, Cortland, OH 44414, and to Tracey A. Laslo, Esq., 325 East Main Street, Alliance, OH 44601.

I also certify that a copy of the same was sent via regular U.S, mail this 10th day of August, 2012, to Lamont Pugh, SAC, Sanctions & Exclusions, Department of Health and Ruman Services, Office of Inspector General, Office of Investigations, PO Box 81020, Chicago IL 60601-81020.

Betsy J. Houchen, R.N., M.S., J.D. Executive Director

cc:

Henry G. Appel, Assistant Attorney General

Certified Mail Receipt No. 7012 1010 0002 4225 4160 Attorney Certified Mail Receipt No. 7012 1010 0002 4225 4177

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State of Ohio Boird of Nursing 17 South High Street, Suite 400 Columbus, Ohio 43215-7410 In the Matter of Heidi Nicole Petrilla, R.N. Respondent

RECEIVED
21112 MAY 2 PM fib' 414 BOARD OF NURSING OHIO

Beth A. Lewis, Esq, Hearing Exanliner Case No, 2011-001630 May 21, 2012 Report and Recommendation

Appearances: For the Ohio Board of Nursing: Michael DeWine, OHIO ATTORNEY GENERAL, and Courtney L. Hagele, Esq., Assistant Attorney General, Health & Human Services Section, -30 East Broad Street, 26th Floor, Columbus, OH 43215-3428. Telephone: 614-4668600; Fax: 614-466-6090. For the Licensee/Respondent: Tracey A, Laslo, Esq., Tracey A, Laslo, LLC., 325 E. Main Street, Alliance, 01-1 44601. Telephone: 330-&23-9757; Fax: 330-823-4791. Nature of the Case This is an administrative proceeding under Chapter 119 (the Administrative Procedure Act), and Chapter 4723 (the Nurse Practice Act), of the Ohio Revised Code ("ORC")., The case involves a Notice of Opportunity for Hearing issued to the Respondent, Heidi Nicole Petrilla, R.N. ("Respondent" or "Ms, Petrilla"), on July 29, 2011. (State Exhibit 1.) In the Notice, the Ohio Board of Nursing ("Board") informed Ms, Petrilla that it intended to take disciplinary action against her license based on her pleading guilty to and being found guilty of one (1) count of Theft, a fifth-degree felony. (id) In the notice sent to Ms. Petrilla, the Board set forth its reasons for the proposed action, identified the charges against her, and advised Ms. Petrilla of her right to a hearing. (Id.) Ms. Petrilkt made a timely request for a hearing. (State Exhibit 2,) TheBoard appointed me to serve as its Hearing Examiner, A hearing was conducted on February 24, 2012, at which the parties presented their evidence on the charges against Ms, Petrilla. Ms. Petrilla was present at the hearing and was represented by counsel. This report is based on the evidence and testimony presented at the hearing.

Page 1

of 1 0

Summary of the Issues The Board .charged Ms. Petrilla with a violation of Section 4723.28(B)(4), ORC, which authorizes the Board to discipline a licensee for conviction of, a plea of guilty to, a judicial finding of guilt of, a judicial finding of guilt resulting from a plea of no contest to, or a judicial finding of .eligibility for intervention in lieu of conviction for any felony or of any crime involving gross in morality or moral turpitude. There is no dispute that Ms. Petrilla pled guilty to and was convicted of a felony; certified copies of the Entry of Guilty Plea and Judgment Entry imposing community control were admitted into evidence by the State. (State Exhibits 7c, 7d.) The Board is required to consider the merits of each case and may consider both aggravating and Mitigating circumstances shown in the record, From the evidence before me and after considering the evidence in aggravation. and in mitigation, I find sufficient basis to recommend that Ms. Petrilla's license to practice as a registered nurse be subject to a stayed suspension and a probationary period of not less than three (3) years with permanent practice restrictions. My analysis follows.

Evidence Exam hied The State presented evidence through the testimony of Respondent Heidi Petrillo as on cross-examination. Ms. Petrilla testified on her own behalf and presented the testimony of her mother, Barbara Netotea, The parties also presented evidence in the form of exhibits, identified in the record at pages 3 4 of the transcript of proceedings. All testimony and exhibits admitted in the hearing of the matter, whether or not specifically referred to in this Report, were thoroughly reviewed and considered 'by the Hearing Examiner prior to the entry of the findings, conclusions, and recommendations shown below.

Summary of the Evidence Heidi Nicole Petrillo graduated from Kent State University with a Bachelor's degree in Nursing, in May 2001. (State Exhibit 6; Tr., p. 10.) She first received her license to practice as a registered nurse in Ohio on July 18, 2001. (State Exhibit 5; Tr., p. 10.) Between 2001 and 2006, Ms. Petrilla worked as a nurse, mostly in psychiatric nursing positions, for various facilities and providers in Pennsylvania and Ohio. (See Tr., pp, 12-14.)

k
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to 2006, Ms, Petrilla became an independent .provider of nursing services for the Ohio Department of Job and Family. Services ("OD,IFS") through its CareStar program (See Tr., pp. 15-16.) Ms. Petrilla testified that she came to this position because her childhood friend needed her help, (Tr., p. 28.) Ms. Petrilla stated that her. friend, "Chris," and his wife, "Kate," gave birth to a ehild, Patient 41, who suffered from a mitochondrial disorder and required constant care, (See Tr., pp. 26, 38.) When Patient #1 was one year old, Chris and Kate asktd Ms. Petrilla if she would provide nursing care for their son through the CareStar Program. (See Tr., p. 26.) Ms. Petrillo. stated that she "sign[ed] up with the program" and became Patient #1's nurse. (Tr., p, 27.) . Ms. Petrilla stated that when she became a CareStar provider, ODJFS sent her "a list of appropriate billing agencies and a really big binder" of guidelines, (See Tr., p. 27.) She said that ODTS told her that Kate was her boss and would tell her what hours to work. (fri.) Ms. Petrilla stated that she first worked part-time as Patient #1's nurse, and became his full-time nurse in 2007. (See Tr., p. 18.) She stated that her care of Patient #1 included getting him out of bed in the morning; administering tube feedings, medications, and respiratory treatments; bathing and dressing him; doing his laundry; making his bed; taking him to doctor's appointments; and accompanying him to preschool, speech therapy and physical therapy appointments. (Tr p. 17.) As time went on, Ms. Petrilla began taking Patient #1 with her to her home,.and kept him overnight and on many weekends, (See Tr., p. 28.) She stated, "he was a part of our everyday life and our family life and special occasions. He was a part of us." (Id.) Ms. Petrilla provided the following explanation about the reasons she provided care of Patient #1 in her home, and of how she billed for this time:
A. [...I, The more complicated he became medicalwise, it was difficult on them, and they they were good parents and they loved hint but they counted on me to provide him with much of his medical care and a lot of his activities and his socialization, and it became more and -more frequent. It became weekly. He would stay the night, and, again, maybe twice a month at lcast.he would stay the weekend, and he was with us more than he wasn't. Q, Did you volunteer that-time? A. Kate told me to keep track of my billing. She told me when to bill, because she said that overnight stays, you couldn't count it, but she said keep track of It she would tell me when to bill, and that's what I did. Never was it an intentional there was no overbilling ever. There were many, many hours that have never been ,billed for, but when she told me to bill, that's when I billed, It wasn't extra ever. The billing, that was I followed her Instructions as far as the billing. It was never intentional that the billing was incorrect. I kept very good track of my hours and my paperwork. (Tr.,

p, 30,)

Page 3 of 10

In November 2008, Ms. Petrillo accepted a position as a part-time Psychiatric Nurse at the Trumbull Memorial Hospital but continued to provide nursing care to Patient #1. (See Tr., pp, II, 16.) In 2009, Ms. Petrillo was diagnosed with melanoma. (See Tr., pp. 35, 46.) In November 2009, Ms. Petrilla stated that she gave notice to Chris and Kate that she no longer wished to be Patient #1's nurse, (See Tr., p. 46.) She- stated that she left the CareStar position because of her health, and because "the boundaries were blurred with (Patient I)." (Tr., p. 36.) Ms. Petrilla stated that she felt like she was parenting Patient #I and that he was taking precedence over her own children. (fel) In April 2010, investigators from the Ohio Attorney General's Health Care Fraud Section interviewed Ms. Petrillo regarding an allegation that she billed for services not provided to Patient #1, (See State Exhibit 8,) On April 8, 2010, Ms, Petrillo wrote a handwritten statement for the investigators, admitting that she had made "mistakes" and "pbor decisions in regard to [her) Medicaid billing," (State Exhibit 8.) On June 15, 2010, Ms. Petrilla was indicted for one (1) count of Theft, a fourth-degree felony, for services billed but not provided to Patient -#1 between October I, 2008, and continuing until January 14, 2010. (State Exhibit '7a.) On April. 19, 2011, Ms. Petrillo pled guilty to the lesser-included offense of Theft, a fifth-degree felony, (State Exhibit 7e.) She was ordered to make restitution in the amount of $22,661.15. (M) On or about June 24, 2011, Ms. Petrilla was sentenced to five (5) years of community control. (State Exhibit 7d.) Ms. Petrillo continues to work as a Psychiatric Nurse for Trumbull Memorial Hospital. (Tr., p. 11.) Ms. Petrilla sated that she has not informed her employer of her felony conviction, (Tr., p. 24.) On July 29, 2011, the Board issued a Notice of Opportunity for Hearing to Ms. Petrillo based on her guilty plea to and conviction of a fifth-degree felony charge of Theft.

Analysis From the record now before the Board, it appears that there is a preponderance of evidence that Ms. Petrilla pied guilty and was found guilty of one count of Theft, a fifth-degree felony, in violation of Section 2913.02(A). (State Exhibit 7c.) The State submitted certified copies of the Respondent's guilty plea and the Judgment Entry imposing Community Control. (State Exhibits 7c, 7d.)

Page 4 of 10

The Respondent provided inconsistent testimony about the acts underlying her conviction. For example, the Respondent first stated, "[Kate] told me when to bill, E. I

followed her instructions as far as the billing. E. . .1- I kept very good track of my hours and my papenvork" (Tr., p. 30. Emphasis added.) But when asked if she might have made mistakes in keeping her records, the Respondent replied, "Of course, Pm sure .this is not a perfect system. [, .] Did 1 make mistakes? Pm certain I did, but and, again, that's why I said if I did, teen I will happily I felt terrible. I would make restitution. I would fix it, but I did not steal money," (Tr., p. 34.) Ms. Petrilla also stated, "I believe in my records, I believe in my billing, and I know that nothing was there was no theft involved in this." (Tr., p. 33.) Later, when asked if she "merely made bad billing errors," Ms. Petrilla responded, "Yes." (Tr., p. 50.) Ms. Petrillo also stated, "I just billed improperly [...1." (Tr., p. 71.) Ms. Petrilla claimed that Kate told her when to bill for the "extra" hours that she kept Patient #1 on the weekends. (Tr., p. 74.) She said that Kate would tell her to "stick four hours on Saturday, stick four hours on Sunday," and that these were hours that she had actually provided care to Patient #I. (Tr:, p. 75.) Ms. Petrillo's .explanation does not make sense. If she had provided care to Patient #1 on these days, then the hours were not "extra." In her ensiled request for hearing to the Board, Ms. Petrilla first stated that she "billed correctly for the services I provided." (State Exhibit 2.) In the same email, Ms. Petrilla states that the criminal charge against her was "based on incorrect billing" and "I did not know that my billing was incorrect." (Id.) Ms. Petrilla's conflicting statements about her "bad recordkeeping" do nothing to mitigate the charges against her. (See Tr., p. 32.) Ms. Petrilla admitted her guilt in a court of law. (See State Exhibit 7c.) "A certified copy of a conviction plea of guilty to, or a judicial finding of guilty of any crime from a court of competent jurisdiction shalt be conclusive proof of the commission of all elements of that crime." (Rule 4723-16(D), Ohio Administrative Code ("OAC").) By pleading guilty, the fact that Ms, Petrillo knowingly obtained or exerted control over property, with purpose to deprive the owner of the property, has been conclusively proven. (See Rule 4723-16(D), OAC; Section 2913,02(A), ORC.) Although she attempted to disclaim the statement she made to Attorney General's Health Care Fraud Section investigators, Ms. Petrilla's statement is a. clear admission of guilt. (See State Exhibit 8.) in the statement, Ms. Petrilla wrote,

Page 5 of 10

I would like the opportunity to correct the mistakes .& poor decisions I have' made in regards to my. Medicaid billing. Because of my bad choices, I understand there are consequences. r. I am embarrassed that my integrity is gone. I became too comfortable with my situation, l want to provide a better example for my children. The hardships over the last year have greatly overwhelmed me. When 1 reflect on the decisions I've made, I am disappointed. This is not the type of behavior I'd ever thought I would be capable of. I hope 1 will be given the chance to repair this as quickly as possible. [. .3 I am sorry.

(M) Ms. Petrilla testified at the hearing that her admissions in this statement were written when she "wasn't thinking clearly" (Tr., p, 40), and that she didn't believe the investigators would lie to her when. they told her that she had committed Medicaid Fraud (Tr., p. 39). She acknowledged that she might have made mistakes in her billing, but atler she "had time to think about it [. . she] got upset and [. .j said I didn't do this." (Tr,, p, 42.) However, instead of fighting the charges in court, Ms, Petrilla pied guilty, (State Exhibit 7c.) She stated her reason for pleading guilty was her feat about going to prison, (See Tr., p. 33.) Ms. Petrilla gave the following reason for agreeing to make restitution in the amount of $22,661.15:
Q. .3 it is your position that you made mistakes [in your billings and that's why you're paying back that money; correct? A. It's my position that they said I made mistakes, and I'm making restitution, Q. So you wouldn't have agreed to pay back 522,000 if you didn't think there was some sort of error with your billing; correct? A. I agreed to pay it back because I didn't want to go to jail.

(Tr,, p, 61, emphasis added.) Ms. Petrillo admitted that she made mistakes in ha billing and that her system of keeping track of het' hours was not perfect when it suited her purposes, but then denied making mistakes and claimed confidence in her records at other times. (See Tr., pp. 30, 33, 34, 50, 71.) Ms. Petrilla did not show remorse for her actions; she denied that she did anything wrong. (See Tr., pp, 38, 42.) Ms. Petrilla stated that she is a good nurse. (Tr., p. 35.) She stated that she loves being a nurse and takes pride in her work. ,(See Id) Ms. Petrilla has been a nurse for approximately eleven (II) years with no prior Board action being taken against her. (See State Exhibit 5.) The Respondent noted that Ms. Petrilla cooperated with both the Attorney General's investigators, and with the Board. (See Tr., p. 89.) The State requested that Ms. Petrilla's license be suspended for two (2) years, and once reinstated, that it be subject to permanent ractice restrictions prohibiting her from working in home health care and nurse supervisory roles, (Tr., p. 88.) The State also requested that Ms, Petrilla be required to complete continuing nurse education courses on documentation, critical

Page 6 of 10

thinking, ethics, and boundary issues. (Tr., pp. 88-89) The Respondent argued that a 'suspension would prevent Ms. Petrilla from making the restitution she is required to make as part . of her criminal sanction. (See Tr., p. 91.) The Respondent argued that a probationary period and permanent practice restrictions would be more appropriate. (See id) The evidence now before the Board supports a stayed suspension of Ms, Petrilla's license and the imposition of a probationary period of not less than three (3) years, with permanent practice restrictions. Ms. Petrilla used her position of trust as a nurse to claim over $22,000 in reimbursement to which she was not entitled, However, removing her from practice at this time would Only serve to prevent her from making restitution to the State.. There is no evidence that Ms. Petrilla's nursing practice caused harm to any patients. Permanent practice restrictions will ensure that the public is protected from Ms. Petrilia's "bad recordkeeping" in the future.

Findings of Fact HaVing heard the testimony of the witnesses. and the oral argument of counsel, and having examined the exhibits admitted into evidence, I make the following findings of fact and conclusions of law. To the extent that any findings of fact constitute conclusions of law, they are Offered as such. To the extent that any conclusions of law constitute findings of fact, they are so offered. 1. Respondent Heidi Nicole Petrilla was licensed in Ohio as a registered nurse on or about . July 18, 2001. 2. In or around January 2006, Ms. Petrilla became an independent provider of nursing services to Patient 41 through the Ohio Department of Job and Family Services' CareStar Program. 3. On or about April 8, 2010, Ms. Petrilla -wrote a statement to investigators of the Ohio Attorney General's Healtheare Fraud Section, in which she acknowledged that she made "mistakes [and] poor decisions [. .] in regards to [her] Medicaid billing" for the services she provided. to Patient #1. In her statement, Ms. Petrillo requested the opportunity to "repair the mistakes I've made.' 4. The State has established by at least a preponderance of the evidence that on or about April 19, 2011, in Franklin County Cote of Common Pleas Case Number 10 CR 3548,

Page 7 of 10

Ms. Petrillo pled guilty to and- was subsequently found guilty of one (1) count of theft, a fifili-degree felony, in violation of Section 2913.02(A), ORC. 5, On or about June 30, 2011, Ms. Petrilla was ordered to serve five (5) years of eonimunity control, and to pay restitution to the Ohio Department Of Job and Family Services in the amount of $22,661.15. .
z.

6. Upon finding cause to believe Ms..PRUilla had violated provisions of the Norse Practice Act, the Board of Nursing set forth charges against Ms. Petrilla in a notice dated July 29, 2011. Ms. Petrilla timely requested an administrative review of the charges.

Conclusions of Law 1. Because she holds a license to practice as a registered nurse issued by the Ohio Board of Nursing, Respondent Heidi Nicole Petrilla is subject to the jurisdiction of the Board in actions taken pursuant to Chapter 4723 of the Ohio Revised Code. 2. Upon sufficient cause to believe a licensee of the Board of Nursing has violated a provision of the Nurse Practice Act, the Board is authorized to take action with respect to that licensee's nursing license. Upon her receipt of the Board's charging document, the Respondent timely requested an evidentiary hearing before the Board took any final action based upon the Board's charges. Upon its receipt of Respondent's request for an administrative hearing, the Board set the matter for hearing in the manner provided for by R.C. Chapter 119 (Ohio Administrative Procedure Act), and provided the Respondent With an opportunity to be heard before it- took any final action with respect to the Respondent's license to practice as a registered nurse, in the manner provided for by law. 3. Section 4723.28(B)(4), ORC, authorizes the Board to discipline a licensee for conviction of, a plea Of guilty to, a judicial finding of guilt of, a judicial finding of guilt resulting from a plea of no contest to,. or a judicial finding of eligibility for intervention in lieu of conviction for, any felony or of any .Crime involving gross immorality or moral turpitude. 4. The Board is authorized to take action against Ms. Petrilla's license to practice as a registered nurse, Where by at least a .preponderance of the evidence the State establishes that -on or about April l9, 2011, in Franklin County Court of Common Pleas Case Number 10 CR 3548, Ms, Petrilla pled guilt' to and was subsequently found guilty of one (1) count of theft, a fifth-degree felony, in violation of Section 2913,02(A), ORC.

Page or 10

5. A certified copy of A conviction, plea of guilty. to, or a judicial finding of guilt of any crime from a court of competent jurisdiction shall be eoncluSive proof of the commission of all elements of that crime. (Rule 4723-16-01(D), OAC,) The State submitted a certified copy of the April 19, 2011 Entry of Guilty Plea, and the Judgment Entry imposing Community Control from the Franklin County Common Pleas Court Case No. 10 CR 3548, Therefore, all elements of the crime of Theft have been conclusively proven, 6. Pursuant to Section 4723,28(B), ORC, upon proof that the Respondent has violated a provision of the Nurse Practice Act as set forth in Section 472328, ORC, the Board, by a vote of a quorum, may impose one or more of the following sanctions: it may deny, revoke, permanently. revoke, suspend, or place restrictions on any nursing license issued by the Board; it may reprimand or otherwise discipline a holder of a nursing license; or it may impose a fine of not more than five hundred dollars ($500.00) per violation. Upon sufficient proof, as has been shown in this evidentiary proceeding, that the Respondent has violated the provisions of the Nurse Practice Act as concluded by the Hearing Examiner, the Board may implement any of the foregoing disciplinary actions.

Recommendation Upon sufficient proof that the Respondent, Heidi Nicole Petrillo, has violated Section 4723,28(B)(4), ORC, it is my recommendation that Ms. Petrilla's license should be indefinitely suspended, and that the suspension should be stayed. Ms. Petrilla's license should be subject to a probationary period of not less than three (3) years, with permanent practice restrictions prohibiting her from working as an. independent provider, hi home healthcare, in unsupervised settings, or in nurse supervisory positions. Within six months of the Board's order, Ms. Petrilla should be required to pay a fine in the amount- of five hundred dollars ($500.00), and should be required to complete continuing nurse education courses in the following areas, in addition to the requirements for renewal of her license: documentation, critical thinking, ethics, professionalism, and establishing and maintaining professional boundaries, In addition, as part of her

probationary period, Ms. Petrilla should be required to notify her current and any future employers of her criminal conviction and of the terms and conditiOns of the Board's Order, and to have her employer(s) submit regular reports.about her nursing practice. Finally,. Ms, Petrilla

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should be required to-submit documentation to the Board of her compliance with all of the terms and conditions imposed by the Franklin County Common Pleas Court Case Number 10 CR 3548. This is a recommendation only; it is not a final order. Only the Board has the authority to. enter a final order in this administrative action. The Board further has the authority to adopt, modify, or reject this recommendation, and this recommendation shall have no legal effect until and unless adopted by the Board, and a Final order is ysued by the Board as provided in Chapters 4723 and 119 of the Revised Code,

ate

t-#11M-: Beth A. Lewis, Att rney at Law Hearing Examiner, Ohio Board of Nursing.

CERTIFICATE OF SERVICE I certify that the original of this report and recommendation was served upon the Ohio Board of Nursing at its offices in Columbus, Ohio, by hand delivery, on May 21, 2012.

VAk

Beth A. Lewis, Hearing Examiner

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Case # 11-003464

Ohio Board of Nursing www.nursi.n.vh:io.gv

17 South High Street, Suite 400 Columbus, Ohio 43215-7410
e

(614) 466-3947

March 22, 2013

NOTICE OF OPPORTUNITY FOR HEARING

Laura Ann Riha, L.P.N. 1279 Idlewood Avenue Lakewood, Ohio '11107 Dear Ms. Riha: In accordance with. Chapter 119, Ohio Revised Code (ORC), you are hereby notified that the Ohio Board of Nursing (Board) proposes under authority of Section 472328 ORC, to deny, revoke, permanently revoke, suspend or place restrictions on your license to practice nursing as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: 1. On or about October 24, 2011, you admitted to a Board Compliance Agent that in or around February or March 2011, while working as a nurse at Marymount Hospital in Garfield Heights, Ohio, (Marymount) you overdosed after you self-administered a combination of your prescribed Fentanyl and your husband's Valium. Section 4723.28(B)(8), ORC [as in effect prior to June 8, 2012], authorizes the Board to discipline a licensee for self-administering or otherwise taking into the body any dangerous drug, as defined in Section 4729.01, ORC, in any way not in accordance with a legal, valid prescription issued for that individual. 2. On or about October 24, 2011, you admitted to a Board Compliance Agent that on or about July 29, 2011, while working as a nurse at Marymount, you selfadministered your husband's Methadone prior to going to work. You stated, "when went to work, I thought I could function, and was just tired..." Once at work, you fell asleep causing hospital staff to send you to the emergency room. There you submitted a specimen for drug testing that tested positive for Methadone. You did not have a valid legal prescription for this medication. Section 4723 .28(B)(8), ORC [as in effect prior to June 8, 2012], authorizes the Board to discipline a licensee for self-administering or otherwise taking into the body any dangerous drug, as defined in Section 4729.01, ORC, in any way not in accordance with a legal, valid prescription issued for that individual. Section 4723.28(B)(10) [as in effect prior to March 20, 2013], ORC, authorizes the Board to discipline a licensee for impaiiinent of the ability to practice according to acceptable and prevailing standards of safe nursing care because of habitual or excessive use of drugs, alcohol, or other chemical substances that impair the ability to practice.

Laura Ann Riha,L.P.N. Page 2 Accordingly, the Board is authorized to impose one or more of the sanctions cited in Section 4723.28, ORC. In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing in this matter. If you wish to request such hearing, the request must be made in writing and must be received in the Board office within thirty (30) days of the time of mailing of this notice. You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in writing. At the hearing, you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to Lisa Ferguson-Ramos, Compliance Unit Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, Ohio 432157410 or to the email address, hearing@nursing.ohio.gov. If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Opportunity for Hearing, deny, revoke, permanently revoke, suspend, or place restrictions on your license to practice nursing as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely,
, 1 7.. e...1\/:F

Rhonda S. Barkheimer, R.N., C.N.P . Supervising Board Member Certified Mail Receipt No. 7012 2210 0000 6272 3582 cc: Henry G. Appel, Senior Assistant Attorney General

Case# 13-000830

Ohio Board of Nursing www.nursing.ohio.gov

17 South High Street, Suite 400.6 Columbus, Ohio 43215-7410 March 22, 2013
a

(614) 466-3947

NOTICE OF AUTOMATIC SUSPENSION AND OPPORTUNITY FOR HEARING

Jeanette Marie Rogers, R.N. 5124 Scarsdale Drive, Apt. D Kettering, Ohio 45440 Dear Ms. Rogers: You are hereby notified that, on or about May 18, 2012, you entered into a Consent Agreement (May 2012 Consent Agreement) with the Ohio Board of Nursing (Board), a copy of which is attached hereto and incorporated herein, in which you agreed with the Board that, upon meeting the conditions for licensure as a registered nurse, a license would be granted to you, and your license to practice nursing as a registered nurse in the State of Ohio would be suspended and such suspension would be stayed subject to probationary terms, conditions, and limitations for a minimum period of one (1) year. A. Item 5. of the May 2012 Consent Agreement states, "MS. ROGERS shall abstain completely from the use of alcohol or products containing alcohol." Item 6. of the May 2012 Consent Agreement states, "Within forty-five (45) days of the effective date of this Consent Agreement and continuing throughout the probationary period, MS. ROGERS shall submit, at her expense and on the day selected, blood, breath, hair, or urine specimens for drug and/or alcohOl analysis at a collection site specified' by. the Board at such times as the Board may request. Upon and after MS. ROGERS's initiation of drug screening, refusal to submit such specimen, or failure to submit such specimen on the day she is selected, or in such a manner as the Board may request, shall constitute a violation of a restriction placed on a license for purposes of Section 4723.28(B), CRC. This screening shall require a daily call-in process. The specimens submitted by MS. ROGE S shall be negative, except for substances prescribed, administered, or dispensed to her by another so authorized by law who has received a complete copy of this Consent Agreement prior to prescribing for MS. ROGERS." Despite these provisions, on the dates set forth in Attachment A, attached hereto and incorporated herein, you failed to call FirstLab, the Board's random drug/alcohol screen program administrator, to determine if you had been selected to provide a specimen for analysis. In addition, on the following dates, you were selected to provide a specimen for analysis and failed to do so: November 13, 2012; and February 7, 2013. Furthermore, on January 30, 2013; you provided a specimen for analysis to Firstlab that tested positive for Ethyl Sulfate (Alcohol).

Jeanette Marie Rogers, R.N. Page 2 Section 4723.28(B)(17), Ohio Re'ised Code, ORC, authorizes the Board to discipline a licensee for violation of any restrictions placed on a nursing license by the Board. In accordance with the paragraph under "FAILURE TO COMPLY" of the May 2012 Consent Agreement. you are hereby notified that it appefs to the Board that you have violated Items 5. and 6. of the May 2012 Consent Agreement. YOU ARE FURTHER NOTIFIED THAT YOUR LICENSE TO PRACTICE NURSING AS A REGISTERED NU SE, RN-383480, IS HEREBY AUTOMATICALLY SUSPENDED. Continued practice after receipt of this notice of suspension shall be considered engaging in the practice of nursing as a registered nurse without a current, valid license, which is a violation of Section 4723.03(A), CRC. You are further notified that in accordance with Chapter 119, ORC, the Board proposes under authority of Section 4723.28, CRC, to deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: 1. On or about May 18, 2012, you entered into a Consent Agreement (May 2012 Consent Agreement) with the Ohio Board of Nursing (Board), a copy of which is attached hereto and incorporated herein, in which you agreed with the Board that, upon meeting the conditions for licensure as a registered nurse, a license would be granted to you, and your license to practice nursing as a registered nurse in the State of Ohio would be suspended and such suspension would be stayed subject to probationary terms, conditions, and limitations for a minimum period of one (1) year. 2. Item 5. of the May 2012 Consent Agreement states, "MS. ROGERS shall abstain completely from the use of alcohol or products containing alcohol." Item 6. of the May 2012 Consent Agreement states, "Within forty-five (45) days of the effective date of this Consent Agreement and continuing throughout the probationary period, MS. ROGERS shall submit, at her expense and on the day selected, blood, breath, hair, or urine specimens for drug and/or alcohol analysis at a collection site specified by the Board at such times as the Board may request. Upon and after MS. ROGERS's initiation of drug screening, refusal to submit such specimen, or failure to submit such specimen on the day she is selected, or in such a manner as the Board may request, shall constitute a violation of a restriction placed on a license for purposes of Section 4723.28(B), CRC. This screening shall require a daily call-in process. The specimens submitted by MS. ROGERS shall be negative, except for substances prescribed, administered, or dispensed to her by another so authorized by law who has received a complete copy of this Consent Agreement prior to prescribing for MS. ROGERS."

Jeanette Marie Rogers, R.N. Page 3 Despite these provisions, on the dates set forth in Attachment A, attached hereto and incorporated herein, you failed to call FirstLab, the Boalrd's random drug/alcohol screen program administrator, to determine if you had been selected to provide a specimen for analysis. In addition, on the following dates, you were selected to provide a specimen for analysis and failed to do so: November 13, 2012; and February 7, 2013. Furthermore, on January 30, 2013, you provided a specimen for analysis to Firstlab that tested positive for Ethyl Sulfate (Alcohol)." Section 4723 .28(B)(17), Ohio Revised Code, ORC, authorizes the Board to discipline a licensee for violation of any restrictions placed on a nursing license by the Board. Accordingly, the Board is authorized to impose one or more of the sanctions as cited in Section 4723.28, ORC. In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing in this matter. If you wish to request such hearing, the request must be made in writing and must be received in the Board office within thirty (30) days of the time of mailing of this notice. You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in writing. At the hearing you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to: Lisa Ferguson-Ramos, Compliance Unit Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, Ohio 43215.7410, or to the e-mail address, hearingnursing.ohio.gov. If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Automatic Suspension and Opportunity for Hearing, deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise discipline you; Or impose a fine of not more than five hundred dollars (5500.00) per violation. 'Sincerely,

x A/
Rhonda S. Barkheimer, R.N., G.N.P. Supervising Board Member Certified Mail Receipt No. 7012 2210 0000 6272 3797 cc: Henry G. Appel, Senior Assistant Attorney General

Case # I1-003748

hie Board of Nursing

17 South High Street, Suite 400

www.nursing.ollio.gov (614). 466-3947 Columbus, Ohio 432[5-7410

CONSENT AGREEMENT BETWEEN JEANETTE MARIE WAGERS, RN. APPLICANT AN OHIO BOARD OF NURSING
This . Consent Agreement is entered into by and between JEANETTE MARIE ROGERS, R.N. APPLICANT (MS. ROGERS) and the Ohio Board of Nursing (Board), the state agency charged - with enforcing Chapter 4723. of the Ohio Revised Code (ORC), and ail administrative rules promulgated thereunder. This Consent Agreement contains the entire agreement between the parties, there being no other agreement of any kind, verbal or otherwise, which varies the terms of this Consent Agreement. BASIS FOR ACTION This Consent Agreement is entered into on the basis of the following stipulations, admissions and understandings: A. The Board is empowered by Section 4723.28, ORC, to deny, permanently revoke, revoke, suspend, or place restrictions on any license issued by the Board; reprimand or otherwise discipline a licensee; or impose a fine of five hundred dollars ($500.00) or less per violation. Section 4723,28(G) of the Ohio Revised Code authorizes the Ohio Board of Nursing to compel a licensee to submit to a mental or physical examination, or both, as required by the Board and at the expense of the individual, if the Board finds reason to believe that the individual under investigation may have a physical or mental impairment that may affect the individual's ability to provide safe nursing care. Section 4723.28(13)(10, ORC, authorizes the Board to discipline a licensee for impairment of the ability to practice according to acceptable and prevailing standards of safe nursing care because of a physical or mental disability. Rule 4723-3-02, Ohio Administrative Code, defines impairment as an inability to practice according to acceptable and prevailing standards of safe nursing care without appropriate treatment, monitoring or supervision.

fi B. MS. ROGERS submitted an application to practice nursing as a registered nurse in August 2011,

C. MS. ROGERS knowingly and voluntarily admits to the following:

JEANETTE MARIE ROGERS, R.N. APPLICANT Page 2

1) a. On August 17, 2011 the Board received your application for licensare by examination to practice nursing as a registered nurse. As part of your application, you submitted criminal background check information, which shows that alcohol or illegal drugs have been a significant contributing factor in several criminal cases against you. b. On or about October 18, 2004 in Butler County Municipal Court Case No. TRC 0403737, you were convicted of one (1) count of Driving Under the Influence in violation of Section 4511.19(A)(4), ORC, a misdemeanor of the first degree. c. On or about August 14, 2006 in Miamisburg Municipal Court Case No. 06TR.004498-A, you were convicted of one (1) count of Driving Under the Influence in violation of Section 45.11.19(A)(1)(a), ORC, a misdemeanor of the first degree. d. On or about September 21, 2007 in Kettering Municipal Court Case No. 07CRB01962, you were issued a citation for Intoxication, in violation of Section 2917.11(B), ORC, a minor misdemeanor. You paid a fine and the case was closed. 2) On January 12, 2012 the Boarded ordered MS. ROGERS to an examination pursuant to Section 4723.28(G), ORC. MS. ROGERS complied with the January 2012 Exam Order and was evaluated by Dr. Michael A Gureasko (Examiner) on March 8, 2012. The Examiner issued a report to the Board on March 8, 2012. 3) The Examiner diagnosed MS. ROGERS with Alcohol Dependence-in remission by self-report. The Examiner concluded that MS. ROGERS is an intelligent and a responsible employee, and that she is likely capable of practicing nursing safely. The Examiner stated that MS. ROGERS should receive alcohol screening, and attend AA meeting twice each week in order to ensure that she does not return to using alcohol. 4) MS. ROGERS is willing to cooperate with the Board to meet the requirements to practice nursing as a registered nurse in accordance with acceptable and prevailing standards of safe nursing care. AGREED CONDITIONS Wherefore, in consideration of the foregoing and mutual promises hereinafter set forth, and in lieu of any formal proceedings at this time, MS. ROGERS shall be granted authorization to take the NCLEX examination. Upon meeting all of the requirements for licensure, including passing the NCLEX, MS. ROGERS shall be granted a license to

JEANETTE MARIE ROGERS, R.N. APPLICANT Page 3

practice nursing as a registered nurse and that license shall be suspended indefinitely. Such suspension is hereby stayed, subject to the following PROBATIONARY terms, conditions, and limitations for a minimum period of one (1) year following the effective date of MS. ROGERS's license to practice as a registered nurse: I. MS. ROGERS shall obey all federal, state Aan.(1 local laws, and all laws and rules governing the practice of nursing in Ohio. MS. ROGERS shall appear in person for interviews before the full Board or its designee as requested by the Board or its designee. MS. ROGERS agrees that she will submit a request to the Bureau of Criminal Identification and investigation (BCH) to conduct a criminal records check of MS. ROGERS, including a check of Federal Bureau of Investigation (FBI) records, and shall request BCII to submit MS. ROGERS's criminal records check reports to the Board. MS. ROGERS's completed criminal records check, including the FBI check, must be received by the Board within six (6) months following the effective date of this Consent Agreement.

2.

3.

Monitoring 4. MS. ROGERS shall abstain completely from the personal use or possession of drugs, except those prescribed, administered, or dispensed to her by another so authorized by law who has received a complete copy of this Consent Agreement prior to prescribing for MS. ROGERS. MS. ROGERS shall self-administer the prescribed drugs only in the manner prescribed. MS. ROGERS shall abstain completely from the use of alcohol or products containing alcohol. Within forty-five (45) days of the effective date of this Consent Agreement and continuing throughout the probationary period, MS. ROGERS shall submit, at her expense and on the day selected, blood, breath, hair, or urine specimens for drug and/or alcohol analysis at a collection site specified by the Board at such times as the Board may request. Upon and after MS, ROGERS's initiation of drug screening, refusal to submit such specimen, or failure to submit such specimen on the day she is selected, or in such a manner as the Board may request, shall constitute a violation of a restriction placed on a license for purposes of Section 4723.28(B), ORC. This screening shall require a daily call-in process. The specimens submitted by S. ROGERS shall be negative, except for substances prescribed, administered, or dispensed to her by another so authorized by law who has received a complete copy of this Consent Agreement prior to prescribing for MS. ROGERS.

5.

6,

JEANETTE MARIE ROGERS, R.N. APPLICANT Page 4

a, Prior to MS. ROGERS initiating drug screening, MS. ROGERS shall provide a copy of this Consent Agreement to all treating practitioners and shall provide to the Board a list of all treating practitioners, including addresses and telephone numbers and cause all treating practitioners to complete a medication prescription report that is to be mailed by the practitioner directly to the Board. The medication report is to be completed for any and all substances prescribed, administered, or dispensed to MS. ROGERS. b. After initiating drug screening, MS. ROGERS shall be under a continuing duty to provide a copy of this Consent Agreement, prior to initiating treatment, to additional treating practitioners, and to update the list of treating practitioners with the Board within forty-eight (48) hours of being treated by another practitioner. Further, MS. ROGERS shall notify the Board of any and all medication(s) or prescription(s) received -within twenty-four (24) hours of release from hospitalization or medical treatment. 7. Within thirty (30) days of the effective date of this Consent Agreement and continuing throughout the probationary period, MS. ROGERS shall attend a minimum of two (2) meetings per week of a support or peer group meeting approved in advance by the Board or its designee, or a Twelve Step program, and MS. ROGERS shall provide satisfactory documentation of such attendance to the Board beginning within six (6) months of the effective date of this Consent Agreement and every six (6) months thereafter.

Employment Conditions 8. MS. ROGERS shall notify the Board, in writing, of the name and address of any nursing employer prior to accepting nursing employment. MS. ROGERS, if working in a position in. which a nursing license is required, shall provide her employer(s) with a copy of this Consent Agreement. Further, MS. ROGERS is under a continuing duty to provide a copy of this Consent Agreement to any new employer prior to accepting nursing employment. MS. ROGERS shall have her employer(s), if working in a position where a nursing license is required, submit written reports regarding job performance on a quarterly basis beginning within thirty (30) days of working in a nursing position. MS. ROGERS shall have her employer(s) send documentation to the Board, along with the first employer report, of receipt of a copy of this Consent Agreement, including the date the Consent Agreement was received.

JEAN1-!,1 TE MARIE ROGERS, R.N. APPLICANT Page 5

Reporting Requirements 10, MS. ROGERS shall report to. the Board, in writing, any violation of this Consent Agreement within thirty (30) days of the occurrence of the violation. MS. ROGERS shall sign release of inforrnatipn forms allowing health professionals and other organizations to submit the requested documentation directly to the Board. M.S. ROGERS shall submit any and all information that the Board may request regarding her ability to practice according to acceptable and prevailing standards of safe nursing practice. MS. ROGERS shall not submit or cause to be submitted any false, misleading, or deceptive statements, information, or documentation to the Board or to employers or potential employers. MS. ROGERS shall submit the reports and documentation required by this Consent Agreement on forms specified by the Board. All reporting and communications required by this Consent Agreement shall be made to the Compliance Unit of the Board. MS. ROGERS shall submit the reports and documentation required by this Consent Agreement or any other documents required by the Board to the attention of the Compliance Unit, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, OH 43215-7410. MS. ROGERS shall verify that the reports and documentation required by this Consent Agreement are received in the Board office. MS. ROGERS shall inform the Board within five (5) business days, in writing, of any change in employment status or of any change in residential or home address or telephone number,

11.

12

13.

14.

15.

16.

17

en2pmLryPj:getcsR.estrictions MS. ROGERS further knowingly and voluntarily agrees with the Board to the following TEMPORARY LICENSURE RESTRICTIONS: Unless otherwise approved in advance by the Board or its designee, MS. ROGERS shall not practice nursing as a registered nurse: (1) for agencies providing home care in the patient's residence; (2) for hospice care programs providing hospice care in the patient's residence; (3) as an independent provider where the nurset provides nursing care and is reimbursed for services by the State of Ohio through State agencies or agents of the State; or (4) for an individual or group of individuals who directly engage S.

JEANETTE MARIE ROGERS, R.N. APPLICANT Page 6

ROGERS to provide nursing services for fees, compensation, or other consideration or as a volunteer. Unless otherwise approved in advance by the Board or, its designee, MS. ROGERS shall, not function in a position or employment where the job duties or requirements involve management of nursing and nursing responsibilities, or supervising and evaluating nursing practice. Such positions include but are not limited to the following: Director of NUrsing, Assistant Director of Nursing, Nurse Manager, Vice President of Nursing. FAILURE TO COMPLY MS. ROGERS agrees if she is granted a license to practice as a registered nurse, her license will be automatically suspended if it appears to the Board that MS. ROG-FRS has violated or breached any terms or conditions of the Consent Agreement. Following the automatic suspension, the Board shall notify MS. ROGERS via certified mail of the specific nature of the charges and automatic suspension of her License. Upon receipt of this notice, MS. ROGERS may request a hearing regarding the charges. The above described terms and conditions shall constitute "restrictions placed on a license" for purposes of Section 4723.28(8), ORC. If, in the discretion of the Board, MS. ROGERS appears to have violated or breached any terms or conditions of this Consent Agreement, the Board reserves the right to institute formal disciplinary proceedings for any and all possible violations or breaches, including, but not limited to, alleged violations of the laws of Ohio occurring before the effective date of this Consent Agreement. DURATION] MODIFICATION OF TERMS The terms, limitations and conditions of this Consent Agreement may be modified or terminated, in writing, at any time upon the agreement of both MS. ROGERS and the Board. The Board may only alter the probationary period imposed by this Consent Agreement if: (1) the Board determines that MS. ROGERS has complied with all aspects of this Consent Agreement; and (2) the Board determines that MS. ROGERS is able to practice according to acceptable and prevailing standards of safe nursing care without Board monitoring, based upon an interview with MS. ROGERS and review of the reports as required herein. Any period during which MS. ROGERS does not work in a position for which a nursing license is required shall not count toward fulfilling the probationary period imposed by this Consent Agreement.

B4/26/2012 13:43 9372977132

PME

JEANETTE MARIE ROGERS, R.N. APPLICANT Page 7

('`< -

, DGME

1,

.5:LEASE

MS. ROGERS acknowledges that she has bad an opportunity to ask questions concerning the tetras of this Consent Agreement and that all questions asked have been answered in a satisfactory manner.
t

MS. ROGERS waives all of her rights under Chapter 119, ORC, as they relate to matters that are the subject of this Consent Agreement., MS. ROGRRS. waives any and all claims or causes of action she may have against the Board, and its members, officers, employees and/or agents arising out of matters that are the subject of this Consent Asx.cernent. This Consent Agreement shall be considered a public record as that term is used in Section 149..43, CRC, The information contained herein may be reported to appropriate organizations, data banks and governmental bodies, This Consent Agreement is not an adjudication order within the meaning of Chapter 119,. ORC. Any action initiated by the Board based on alleged violations of this Consent Agreement shall comply with the Administrative Procedures Act, Chapter 119, CRC. ET=1/A2,6, F E MS. ROGERS understands that this Consent Agreement is subject to ratification by the Board prior to signature by the Board President and shall become effective upon the last date of signature below.

4-1
1%ANETTE MARIE ROGERS R.N. Applicant DATE

I 7,,

5) iZ
ERMA LOVELACE, Presid6it Ohio Board of Nursing DA't

04/20/2012 FRI 14:06 [TX/RX 1O 7680]

001

ATTACHMENT A
07113/2012 - 03/0112013 Jeanette NI Rogers

Missed Call History: i , Date 10/24/2012 10/27/2012 11/10/2012 111'17/2012 11/24/2012 11/29/2012 12/12/2012 12/15/2012 12/22/2012 12/23/2012 12/27/2012 12/29/2012 01/02/2013 01/08/2013 01/13/2013 Row Count: 15 Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Details

Case #09-11/10 & 12-004312

Ohio Board of Nursing

17 South High Street, Suite 400 March 22, 2013

www..nursing.ohio.gov

Columbus, Ohio 43215-7410 a (614) 466-3947.

NOTICE OF IMMEDIATE SUSPENSION AND OPPORTUNITY FOR HEARING

Heather Michelle Rohe, L.P.N. 501 N. Sycamore Avenue Sycamore, Ohio di 882 and 6681 Township Road 97 McCutchenville, Ohio i48di Dear Ms. Rohe: In accordance with Sections 2929.42 and/or 3719.12 of the Ohio Revised Code (ORC), the Ohio Board of Nursing (Board) has been notified that, on or about January 18, 2013, in Sandusky County Court of Common Pleas Case Number 12-CR-1178, you pled guilty to four (4) counts of Theft of Drugs, felonies of the fourth degree, in violation of Section 2913.02(A)(2), ORC, and were found eligible for Pre-Trial Diversion. Section 3719.121(C), ORC, states in pertinent part as follows: On receiving notification pursuant to Section 2929.42 or 3719.12 of the Revised Code, the board under which a person has been issued a license, certificate or evidence of registration immediately shall suspend the license, certificate, or registration of that person on a plea of guilty to, a finding by a jury or court of the person's guilt of, or conviction of a felony drug abuse offense; a finding by a court of the person's eligibility for intervention in lieu of conviction; a plea of guilty to, or a finding by a jury or court of the person's guilt of, or the person's conviction of an offense in another jurisdiction that is essentially the same as a felony drug abuse offense; or a finding by a court of the person's eligibility for treatment or intervention in lieu of conviction in another jurisdiction. Theft of Drugs, felonies of the fourth degree, in violation of Section 2913.02(A)(2), ORC, constitute "felony drug abuse offenses" as defined in Section 2925.01, ORC. WHEREFORE, PURSUANT TO SECTION 3719.121(C), ORC, YOU ARE HEREBY NOTIFIED THAT YOUR LICENSE TO PRACTICE NURSING AS A LICENSED PRACTICAL NURSE, PN-122561, IS HEREBY SUSPENDED. Continued practice after

Heather Michelle Rohe, L.P.N. Page 2 receipt of this notice of suspension shall be considered engaging in the practice of nursing without a current, valid license, which is a Ablation of Section 4723.03(B), ORC. You are further notified that in accordance with Chapter 119, ORC, the Board proposes under authority of Section 4723.28 of the Ohio Revised Code, ORC, to deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: On or about January 18, 2013, in Sandusky County Court of Common Pleas Case Number 12-CR-1178, you pled guilty to four (4) counts of Theft of Drugs, felonies of the fourth degree, in violation of Section 2913.02(A)(2), ORC, and were found eligible for Pre-Trial Diversion. The acts underlying this case occurred on or about December 22, 2010, and January 6, 2011, and involve you obtaining or exerting control over Oxycodone and Percocet without the consent of the owner or person authorized to give consent to wit: a patient(s) at Arbors at Clyde. Section 4723.28(B)(4) [as in effect prior to March 20, 2013], ORC, authorizes the Board to discipline a licensee for conviction of, a plea of guilty to, a judicial finding of guilt of, a judicial finding of guilt resulting from a plea of no contest to, or a judicial finding of eligibility for intervention in lieu of conviction for, any felony. Section 4723.28(B)(5) [as in effect prior to March 20, 2013], ORC, authorizes the Board to discipline a licensee for conviction of, a plea of guilty to, a judicial finding of guilt of, a judicial finding of guilt resulting from a plea of no contest to, or a judicial finding of eligibility for intervention in lieu of conviction for, violating any municipal, state, county, or federal drug law. 2. On or about November 16, 2009, you spoke with a Board Compliance Agent. You admitted that, while employed as a nurse at Windsor Lane, in March 2009, you withdrew Methadone to administer to a resident. You admitted that you documented administering the Methadone even though you did not administer it. You also admitted that in March 2009, you self-administered Vicodin that was prescribed to your husband.

Section 4723.28(B)(8) [as in effect prior to June 8, 2012], ORC authorizes the Board to discipline a licensee for self-administering or otherwise taking into the body any dangerous drug, as defined in Section 4729.01, ORC, in any way not in accordance with a legal, valid prescription issued for that individual. Section 4723.28(B)(16), ORC, authorizes the Board to discipline a licensee for violation of Chapter 4723, ORC, or any rules adopted under it. Specifically, Rule 4723-4-06(11), Ohio Administrative Code, states that a licensed nurse shall implement measures to promote a safe environment for each client. Section 4723.28(B)(19), ORC, authorizes the Board to discipline a licensee for failure to practice in accordance with acceptable and prevailing standards of safe nursing care.

Heather Michelle Rohe, L.P.N. Page 3 Accordingly, the Board is authorized to impose one or more of the sanctions as cited in Section 4723.28, ORC. In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing in this matter. If you wish to request such hearing, the request must be made in writing and must be received in the Board office within thirty (30) days of the time of mailing of this notice. As required by Section 3719.121(C), ORC, the suspension ordered herein shall remain in effect until this hearing is held. You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in writing. At the hearing you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to: Lisa Ferguson-Ramos, Compliance Unit Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus OH 43215-7410, or to the email address, hearing,*nursing.ohio.gov. If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Opportunity for Hearing, deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely, e-A4>g Rhonda S. Barkheimer, R.N., C.N.P. Supervising Board Member Address 1 Certified Mail Receipt No. 7012 2210 0000 6272 3643 Address 2 Certified Mail Receipt No. 7012 2210 0000 6272 3650 cc: Henry G. Appel, Senior Assistant Attorney General

Case# 13-000006; 13-000565; 13-001306; & 13-001315

Ohio Board of Nursing

17 South High Street, Suite 400

wwW.neirsing:ohio.gov

Columbus, Ohio 43215-7410 t (614) 466-3947

March 22, 2013

NOTICE OF AUTOMATIC SIJSPENSION AND OPPORTUNITY FOR HEARING

Dara L. Romans, R.N. 115 Winesap Lane Middletown, Ohio 45011 Dear Ms. Romans: You are hereby notified that, on or about January 20, 2012, you entered into a Reinstatement Consent Agreement (January 2012 Consent Agreement) with the Ohio Board of Nursing (Board), a copy of which is attached hereto and incorporated herein, in which you agreed with the Board that your license to practice nursing as a registered nurse in the State of Ohio would be reinstated and suspended indefinitely and that such suspension would be stayed subject to probationary terms, conditions, and limitations for a minimum period of three (3) years. Attached to and incorporated within the January 2012 Consent Agreement is a July 29, 2011 Consent Agreement, a March 18, 2011 Notice of Automatic Suspension. and Opportunity for Hearing, a January 22, 2010 Consent Agreement and a March 20, 2009 Notice of Opportunity for Hearing. A. Item I. of the January 2012 Consent Agreement states, "MS. ROMANS shall obey all federal, state, and local laws, and all laws and rules governing the practice of nursing in Ohio." Section 4723.28 (B)(8), ORC, authorizes the Board to discipline a licensee for self-administering or otherwise taking into the body any dangerous drug, as defined in Section 4729.01, ORC, in any way not in accordance with a legal, valid prescription issued for that individual, or self-administering or otherwise taking into the body any drug that is a schedule I controlled substance. Item 3. of the January 2012 Consent Agreement states, "MS. ROMANS shall abstain completely from the personal use or possession of drugs, except those prescribed, administered, or dispensed to her by another so authorized by law who has full knowledge of MS. ROMANS's history. MS. ROMANS shall self-administer prescribed drugs only in the manner prescribed." Item 5. of the January 2012 Consent Agreement states, "MS. ROMANS shall continue to submit, at her expense and on the day selected, blood or urine specimens for drug and/or alcohol analysis at a collection site specified by the Board at such times as the Board may request. Refusal to submit such specimen, or failure to submit such specimen on the day she is selected, or in such a manner as the Board may request, shall constitute a violation of a restriction placed on a license for purposes of Section 4723.28(B), ORC. This screening shall require a daily call-in process. The specimens submitted by MS. ROMANS shall be negative, except for substances prescribed, administered, or dispensed to her

Dara L. Romans, R.N. Page 2 by another so authorized by law who has full knowledge of MS. ROMANS's history." Despite these provisions, on the following dates, you provided a specimen for analysis to Firstlab, the Board's random drug/alcohol screen program administrator, that tested positive for Tramadol: December 18, 2012 and January 21, 2013. You did not have a legal, valid prescription for Tramadol. Furthermore, on the following dates, you failed to call Firstlab to deteunine if you had been selected to provide a specimen for analysis: April 1, 2012; September 30, 2012; December 22, 2012; and February 8, 2013. Section 4723.28 (B)(8), ORC, authorizes the Board to discipline a licensee for self-administering or otherwise taking into the body any dangerous drug, as defined in Section 4729.01, ORC, in any way not in accordance with a legal, valid prescription issued for that individual, or selfadministering or otherwise taking into the body any drug that is a schedule I controlled substance. Section 4723 .28(B)(17), Ohio Revised Code, ORC, authorizes the Board to discipline a licensee for violation of any restrictions placed on a nursing license by the Board. B. Item 2. of the January 2012 Consent Agreement states, "MS. ROMANS shall appear in person for interviews before the full Board or its designated representative as requested by the Board or its designee." Despite this provision, you failed to appear in person for a scheduled interview with a Board Monitoring Agent on January 31, 2013. C. Item 11. of the January 2012 Consent Agreement states, "MS. ROMANS shall cause all treating practitioners to complete a medication prescription report that is to be mailed by the practitioner directly to the Board. The medication report is to be completed for any and all substances prescribed, administered, or dispensed to MS. ROMANS throughout the duration of this Consent Agreement." Despite this provision, you failed to cause your treating practitioner at West Chester Hospital to provide a medication prescription report directly to the Board, despite being prescribed several medications as a result of your treatment on or about January 20, 2013. Additionally, you failed to cause your treating practitioner at Atrium Medical Center to provide a medication prescription report directly to the Board, despite being prescribed several medications as a result of your treatment on or about January 21, 2013. Furthermore, you failed to cause your treating practitioner to provide a medication prescription report directly to the Board, despite being prescribed Oxycodone on the following dates: January 24, 2013; and January 28, 2013. Section 4723.28(B)(17), Ohio Revised Code, ORC, authorizes the Board to discipline a licensee for violation of any restrictions placed on a nursing license by the Board.

Dara L. Romans, R.N. Page 3

In accordance with the paragraph under "FAILURE TO COMPLY" of the January 2012 Consent Agreement, you are hereby notified that it appears to the Board that you have violated Items 1., 2., 3., 5. and 11. of the January 2012 Consent Agreement. YOU ARE FURTHER NOTIFIED THAT YOUR LICENSE TO PRACTICE NURSING AS A REGISTERED NURSE, RN-192133, IS HEREBY AUTOMATICALLY SUSPENDED. Continued practice after receipt of this notice of suspension shall be considered engaging in the practice of nursing as a registered nurse without a current, valid license, which is a violation of Section 4723.03(A), ORC. You are further notified that in accordance with Chapter 119, ORC, the Board proposes under authority of Section 4723.28, ORC, to deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a registered nurse; reprimand' or otherwise discipline you; or impose a fine of not more than five hundred dollars (3500.00) per violation for the following reasons: 1. On or about January 20, 2012, you entered into a Reinstatement Consent Agreement (January 2012 Consent Agreement) with the Ohio Board of Nursing (Board), a copy of which is attached hereto and incorporated herein, in which you agreed with the Board that your license to practice nursing as a registered nurse in the State of Ohio would be reinstated and suspended indefinitely and that such suspension would be stayed subject to probationary terms, conditions, and limitations for a minimum period of three (3) years. Attached to and incorporated within the January 2012 Consent Agreement is a July 29, 2011 Consent Agreement, a March 18, 2011 Notice of Automatic Suspension and Opportunity for Hearing, a January 22, 2010 Consent Agreement and a March 20, 2009 Notice of Opportunity for Hearing. 2. Item 1. of the January 2012 Consent Agreement states, "MS. ROMANS shall obey all federal, state, and local laws, and all laws and rules governing the practice of nursing in Ohio." Section 4723.28 (B)(8), CRC, authorizes the Board to discipline a licensee for self-administering or otherwise taking into the body any dangerous drug, as defined in Section 4729.01, CRC, in any way not in accordance with a legal, valid prescription issued for that individual, or self-administering or otherwise taking into the body any drug that is a schedule I controlled substance. Item 3. of the January 2012 Consent Agreement states, "MS. ROMANS shall abstain completely from the personal use or possession of drugs, except those prescribed, administered, or dispensed to her by another so authorized by law who has full knowledge of MS. ROMANS's history. MS. ROMANS shall self-administer prescribed drugs only in the manner prescribed." Item 5. of the January 2012 Consent Agreement states, "MS. ROMANS shall continue to submit, at her expense and on the day selected, blood or urine specimens for drug and/or alcohol analysis at a collection site specified by the Board at such times as the Board may request. Refusal to submit such specimen, or failure to submit such

Dara L. Romans, R.N. Page 4 specimen on the day she is selected, or in such a manner as the Board may request, shall constitute a violation of a restriction placed on a license) for purposes of Section 472328(B), ORC. This screening shall require a daily call-in process. The specimens submitted by MS. ROMANS shall be negative, except for substances prescribed, administered, or dispensed to her by another so authorized by law who has full knowledge of MS. ROMANS's history." Despite these provisions, on the following dates, you provided a specimen for analysis to Firstlab, the Board's random drug/alcohol screen program administrator, that tested positive for Tramadol: December 18, 2012 and January 21, 2013. You did not have a legal, valid prescription for Tramadol. Furthermore, on the following dates, you failed to call Firstlab to determine if you had been selected to provide a specimen for analysis: April 1, 2012; September 30, 2012; December 22, 2012; and February 8, 2013. Section 4723.28 (B)(8), ORC, authorizes the Board to discipline a licensee for self-administering or otherwise taking into the body any dangerous drug, as defined in Section 4729.01, ORC, in any way not in accordance with a legal, valid prescription issued for that individual, or selfadministering or otherwise taking into the body any drug that is a schedule I controlled substance. Section 4723 .28(B)(17), Ohio Revised Code, ORC, authorizes the Board to discipline a licensee for violation of any restrictions placed on a nursing license by the Board. 3. Item 2. of the January 2012 Consent Agreement states, "MS. ROMANS shall appear in person for interviews before the full Board or its designated representative as requested by the Board or its designee." Despite this provision, you failed to appear in person for a scheduled interview with a Board Monitoring Agent on January 31, 2013. 4. Item 11. of the January 2012 Consent Agreement states, "MS. ROMANS shall cause all treating practitioners to complete a medication prescription report that is to be mailed by the practitioner directly to the Board. The medication report is to be completed for any and all substances prescribed, administered, or dispensed to MS. ROMANS throughout the duration of this Consent Agreement." Despite this provision, you failed to cause your treating practitioner at West. Chester Hospital to provide a medication prescription report directly to the Board, despite being prescribed several medications as a result of your treatment on or about January 20, 2013. Additionally, you failed to cause your treating practitioner at Atrium Medical Center to provide a medication prescription report directly to the Board, despite being prescribed several medications as a result of your treatment on or about January 21, 2013. Furthermore, you failed to cause your treating practitioner to provide a medication prescription report directly to

Dara L. Romans, R.N. Page 5 the Board, despite being prescribed Oxycodone on the following dates: January 24, 2013; and Jantary 28, 2013. Section 4723.28(B)(17), Ohio Revised Code, ORC, authorizes the Board to discipline a licensee for Violation of any restrictions placed on a nursing license by the Board.. Accordingly, the Board is authorized to impose one or rriore of the sanctions as cited in Section 4723.28, ORC. In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing in this matter. If you wish to request such hearing, the request must be made in writing and must be received in the Board office within thirty (30) days of the time of mailing of this notice. You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in writing. At the hearing you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to: Lisa Ferguson-Ramos, Compliance Unit. Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, Ohio 432157410, or to the e-mail address, hearing,@nursing.obio..gov. If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Automatic Suspension and Opportunity for Hearing, deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely,

Rhonda S. Barkheimer, C.N.P. Supervising Board Member Certified Mail Receipt No. 7012 2210 0000 6t272 3827 cc: Henry G. Appel, Senior Assistant Attorney General

(-) Case # 12-000099

Ohio Board of Nursing . www.ntirsing.ohio.gov

17 South High Street. Suite 400 Columbus, Ohio 432154410 d (614) 466-3947

REINSTATEMENT CONSENT AGREEMENT BETWEEN DARA L. ROMANS, R.N. AND OHI BOARD OF NURSING
This Consent Agreement is entered into by and between DARA L. ROMANS, R.N., (MS. ROMANS) and the Ohio Board of Nursing (Board), the state agency charged with enforcing Chapter 4723. of the Ohio Revised Code (ORC), and all administrative rules promulgated thereunder. For purposes of this Agreement, "Consent Agreement" shall be defined as this. Agreement, and the following documents, all of which are attached hereto and incorporated herein: July 29, 2011 Consent Agreement (July 2011 Consent Agreement); March 18, 2011 Notice of Automatic Suspension and Opportunity for Hearing (March 2011 Notice); January 22, 2010 Consent Agreement (January 2010 Consent Agreement); and March 20, 2009 Notice of Opportunity for Hearing (March 2011 Notice).

This Consent Agreement contains the entire agreement between the parties, there being no other agreement of any kind, verbal or otherwise, which varies the terms of this Consent Agreement, BASIS FOR ACTION This Consent Agreement is entered into on the basis of the following stipulations, admissions and understandings: A. The Board is empowered by Section 4723,28, ORC, to deny, permanently revoke, revoke, suspend, or place restrictions on any license issued by the Board; reprimand or otherwise discipline a licensee; or impose a fine of five hundred dollars ($500.00) or less per violation. MS. ROMANS also admits to violating Section 4723.28, ORC, as set forth in the attached July 2011 Consent Agreement, March 2011 Notice, January 2010 Consent Agreement and March 2009 Notice. MS. ROMANS's license to practice nursing as a registered nurse, RN192133, in the State of Ohio has been suspended since March 2011. MS. ROMANS was initially issued a license to practice nursing as a registered nurse in September 1984.

B.

it

Data L. Romans, R.N. Page 2

C.

On or about July 29, 2011, MS. ROMANS entered into a Consent Agreement (July 2011 Consent Agreement) with the Board under which MS. ROMANS's nursing license was suspended indefinitely with terms for reinstatement. MS. ROMANS has rinet the conditions for reinstatement. On or about October 24, 2011, MS. ROMANS underwent a mental health assessment with Julia Noel, MSW, LCSW in Hamilton, Ohio and was diagnosed with Major Depressive Disorder and General Anxiety Disorder. M. Noel recommends that MS. ROMANS attends weekly individual therapy and has referred her to a psychiatrist for medication management. MS. ROMANS is attending individual therapy with Ms. Noel. MS. ROMANS is willing to cooperate with the Board and acknowledges that she is fully responsible for each and every obligation imposed by this Consent Agreement. MS. ROMANS understands that further noncompliance may result in permanent revocation of her Ohio nursing license. AGREED CONDITIONS

D. B.

F.

Wherefore, in consideration of the foregoing and mutual promises hereinafter set forth, and in lieu of any formal proceedings at this time, MS. ROMANS knowingly and voluntarily agrees with the Board to the following terms, conditions, and limitations: Upon meeting the requirements for renewal, MS. ROMANS's license to practice nursing as a registered nurse shall be reinstated and suspended indefinitely. Such suspension shall be stayed, subject to the following PROBATIONARY terms, conditions, and limitations for a minimum of three (3) years: MS. ROMANS shall obey all federal, state, and local laws, and all laws and rules governing the practice of nursing in Ohio. 2. MS. ROMANS shall appear in person for interviews before the full Board or its designated representative as requested by the Board or its designee.

Monitoring of Rehabilitation and Treatment 3. MS. ROMANS shall abstain completely from the personal use or possession of drugs, except those prescribed, administered, or dispensed to her by another so authorized by law who kas full knowledge of MS. ROMANS's history. MS. ROMANS shall self-administer prescribed drugs only in the manner prescribed.

Mara L. Romans, RN. Page 3

4.

MS. ROMANS shall abstain completely from the use of alcohol and any products containing alcohol. MS. ROMANS shall continue to submit, at her expense and on the day selected, blood or urine specimens for drug and/or alcohol analysis at a collection site specified by the Board at such times as the Board may request. Refusal to submit such specimen, or failure to submit such specimen on the day she is selected, or in such a manner as the Board may request, shall constitute a violation of a restriction placed on a license for purposes of Section 4723.28(B), ORC. This screening shall require a daily call-in process. The specimens submitted by MS. ROMANS shall be negative, except for substances prescribed, administered, or dispensed to her by another so authorized by law who has full knowledge of MS. ROMANS's history.

5.

Mental Health Counseling 6. Within sixty (60) days following the effective date of this Consent Agreement, MS. ROMANS shall, at her expense, begin mental health counseling with Julia Noel, MSW, LCSW, or a licensed therapist that is approved in advance by the Board or its designee. MS. ROMANS shall cause the therapist to submit quarterly written reports to the Board regarding: (i) MS. ROMANS's current diagnosis; (ii) MS. ROMANS's compliance with treatment recommendations/plans, including but not limited to appropriate use of prescribed medications; (iii) all dates MS. ROMANS was seen in the three month period prior to the date of the report; and (iv) any concerns regarding MS. ROMANS's ability to practice nursing in accordance with acceptable and prevailing standards of safe nursing care. Further, MS. ROMANS agrees that the Board may use the therapist's recommendations during the course of treatment as a basis for additional terms, conditions, and limitations on MS. ROMANS's license and that the terms, conditions, and limitations may be incorporated in any addendum to this Consent Agreement. MS. ROMANS shall see the therapist no less than two times per month during the term of this Consent Agreement until released. At the first appointment following the effective date of this Consent Agreement, MS. ROMANS shall provide the therapist with a copy of this Consent Agreement and the attached July 2011 Consent Agreement, March 2011 Notice, January 2010 Consent Agreement and March 2009 Notice. In addition, MS. ROMANS shall execute releases to permit the therapist to obtain any information deemed appropriate and necessary for the treatment and evaluation of MS. ROMANS.

7.

Kara L. Romans, R.N. Page4

Additional Evaluation Upon Request 8. Upon request by the Board or its designee and within ninety (90) days of the request, MS. ROMANS shall, at her expense, obtain a chemical dependency evaluation and/or psychiatric evaluation from a Board approved evaluator and shall prole the Board with complete documentation of this evaluation. Prior to the evaluation, MS. ROMANS shall provide the evaluator with a copy of this Consent Agreement and the attached July 2011 Consent Agreement, March 2011 Notice, January 2010 Consent Agreement and March 2009 Notice and all relevant treatment documents and shall execute releases to permit the evaluator to obtain any information deemed appropriate and necessary for the evaluation. The evaluator shall submit a written opinion to the Board that includes diagnoses, recommendations for treatment and monitoring, any additional restrictions that should be placed on MS. ROMANS's license, and whether MS. ROMANS is capable of practicing nursing according to acceptable and prevailing standards of safe nursing care. If an evaluation is requested in the above paragraph, MS. ROMANS shall provide the Board with satisfactory documentation of compliance with all aspects of the treatment plan developed by the chemical dependency professional and/or psychiatrist until released. Further, MS. ROMANS agrees that the Board may use the evaluator's recommendations and conclusions from the evaluation as a basis for additional terms, conditions, and limitations on MS. ROMANS's license and that the terms, conditions, and limitations shall be incorporated by an addendum to this Consent Agreement. Treating Practitioners and Reporting 10, Within thirty (30) days of the effective date of this Consent Agreement, MS. ROMANS shall provide a copy of this Consent Agreement and the attached July 2011 Consent Agreement, March 2011 Notice, January 2010 Consent Agreement and March 2009 Notice, to all treating practitioners and shall provide to the Board a list of all treating practitioners, including addresses and telephone numbers, Further, MS. ROMANS shall be under a continuing duty to provide a copy of this Consent Agreement and the attached July 2011 Consent Agreement, March 2011 Notice, January 2010 Consent Agreement and March 2009 Notice, prior to initiating treatment, to additional treating practitioners, and to update the list of treating practitioners with the Board within forty-eight (48) hours of being treated by another practitioner. MS. ROMANS shall cause all treating practitioners to complete a medication prescription report that is to be mailed by the practitioner directly to the Board. The medication report is to be completed for any and all substances prescribed, administered, or dispensed to MS. ROMANS throughout the duration of this Consent Agreement.

11.

Dara L. Romans, R.N. Page 5

12.

Within twenty-four (24) hours of release from hospitalization or medical treatment, MS. ROMANS shall notify the Board of any and all medication(s) or prescription(s) received,

Employment Conditions 13. Prior to accepting employment as a nurse, each time and with every employer, MS. ROMANS shall notify the Board in writing. Prior to accepting employment as a nurse, MS. ROMANS shall provide a copy of this Consent Agreement and the attached July 2011 Consent Agreement, March 2011 Notice, January 2010 Consent Agreement and March 2009 Notice to any new employer. MS. ROMANS shall have her employer(s), if working in a position where a nursing license is required, submit written reports regarding job performance on a quarterly basis beginning within thirty (30) days of accepting nursing employment. MS. ROMANS shall have her employer(s) send documentation to the Board, along with the first employer report, of receipt of a copy of this Consent Agreement and the attached July 2011 Consent Agreement, March 2011 Notice, January 2010 Consent Agreement and March 2009 Notice, including the date they were received.

14.

15.

Reporting Requirements of MS. ROMANS 16. MS. ROMANS shall report to the Board, in writing, any violation of this Consent Agreement within thirty (30) days of the occurrence of the violation, MS. ROMANS shall sign release of information forms allowing health professionals and other organizations to submit requested documentation or information directly to the Board. MS. ROMANS shall submit any and all information that the Board may request regarding her ability to practice according to acceptable and prevailing standards of safe nursing practice. MS. ROMANS shall not submit or cause to be submitted any false, misleading, or deceptive statements, information, or documentation to the Board or to employers or potential employers. MS. ROMANS shall submit the reports and documentation required by this Consent Agreement on forms specified by the Board. All reporting and communications required by this Consent Agreement shall be made to the Compliance Unit of the Board.

17,

18.

19.

20,

Dara L. Romans, R.N. Page 6

21.

MS. ROMANS shall submit the reports and documentation required by this Consent Agreement to the attention of the Compliance Unit, Ohio, Board of Nursing, 17 South High Street, Suite 400, Columbus, OH 43215-7410, MS. ROMANS shall verify that thq reports and documentation required by this Consent Agreement are received in the Board office.. MS. ROMANS shall inform the Board within five (5) business days, in writing, of any change in employment status or of any change in residential or home address or telephone number.

22.,

23.

Nursing Refresher Course or Orientation Upon request by the Board or Fits designee, MS. ROMANS shall, prior to working in a position where a nursing license is required, complete and submit satisfactory documentation of completion of a refresher course or an extensive orientation to be approved in advance by the Board or its designee. Temporary Narcotic Restrictions MS. ROMANS shall not administer, have access to, or possess (except as prescribed for MS. ROMANS's use by another so authorized by law who has full knowledge of MS. ROMANS's history) any narcotics, other controlled substances, or mood altering drugs in which MS. ROMANS is working in a position where a nursing license is required. n addition, MS. ROMANS shall not count narcotics or possess or carry any work keys for locked medication carts, cabinets, drawers, or containers. MS. ROMANS shall not call in or order prescriptions or prescription refills for any narcotics, other controlled substances, or mood altering drugs. Permanent Practice Restrictions MS. ROMANS agrees and acknowledges that the PERMANENT LICENSURE RESTRICTIONS imposed in the January 2010 Consent Agreement continue as follows: Unless otherwise approved in advanced, in writing, by the Board or its designee, MS. ROMANS shall not practice nursing as a registered nurse (1) for agencies providing home care in the patient's residence; (2) for hospice care programs providing hospice care in the patient's residence; (3) for staffing agencies or pools; (4) as an independent provider where the nurse provides nursing care and is reimbursed for services by the State of Ohio through State agencies or agents of the State; or (5) for an individual or group of individuals who directly engage MS. ROMANS to provide nursing services for fees, compensation, or other consideration or as a volunteer. MS. ROMANS agrees and acknowledges that the PERMANENT LICENSURE RESTRICTIONS imposed in the January 2010 Consent Agreement continue, with the

Dara L. Romans, R.N. Page 7

exception that MS. ROMANS is no longer employed by Otterbein Retirement Living Community, as follows: Unless otherwise approved hz advanced, in writing, by the Board or its designee, MS. ROMANS shall not function in a position or employment where the job duties or requirements involve management of nursing and nursing responsibilities, or supervising and evaluating nursing practice, Such positions include but are not limited to the following: Director of Nursing, Assistant Director of Nursing, Nurse Manager, Vice President of Nursing. FAILURE TO COMPLY MS, ROMANS agrees that her license to practice nursing as a registered nurse will be automatically suspended if it appears to the Board that M.S. ROMANS has violated or breached any terms or conditions of the Consent Agreement. Following the automatic suspension, the Board shall notify MS. ROMANS via certified mail of the specific nature of the charges and automatic suspension of her license. Upon receipt of this notice, MS. ROMANS may request a hearing regarding the charges. The above described terms and conditions shall constitute "restrictions placed on a license" for purposes of Section 4723.28(B), ORC. If, in the discretion of the Board, MS. ROMANS appears to have violated or breached any terms or conditions of this Consent Agreement, the Board reserves the right to institute formal disciplinary proceedings for any and all possible violations or breaches, including, but not limited to, alleged violations of the laws of Ohio occurring before the effective date of this Consent Agreement. DURATION/MODIFICATION OF TERMS The terms, limitations, and conditions of this Consent Agreement, other than the permanent licensure restrictions, may be modified or terminated, in writing, at any time upon the agreement of both MS. ROMANS and the Board. The Board may only alter the probationary period imposed by this Consent Agreement if: (1) the Board determines that MS. ROMANS has complied with all aspects of this Consent Agreement; and (2) the Board determines that MS. ROMANS is able to practice according -to acceptable and prevailing standards of safe nursing care without Board monitoring, based upon an interview with MS. ROMANS and review of the reports as required herein. Any period during which MS. ROMANS does not work in a position for which a nursing license is required shall not count toward fulfilling the probationary period imposed by this Consent Agreement. ACKNOWLEDGMENTS/LIABILITY RELEASE MS. ROMANS acknowledges that she has had an opportunity to ask questions concerning the terms of this Consent Agreement and that all questions asked have been answered in a satisfactory manner,

Elms L. &MUM, R.N. Pap

M. ROMANS -wain' aUa her rigbis under Chp n9, ORC, a emy r$1404- maws that tho =Nett thL ems=tArtztent. IKS.R.COMILW Iv Rives amy awl ala dams sr c$0,4es of WI=a may IN.svc oqatost tta %AA, ana its Medilke..04 offices, employ= Exitor ohs mid as out of madam that me the sthOot of 1624 Conte Age. This Coma Avoeurituat shall ha otkusidzmd Frobac =ad as Cut tiesra is used in SextiCEIR id19A3, DRC. Thu irecormtbais ecattailit%1 ktereb2 may be repftd to Ride orgtetiassrikos, askis bull and goyernmegatal boffin. sljvaithi-lat order as ciscusged a C;' ter 119, ORC. Awry This Caestgat Agleam= iE EICIt aaiion.inlitaised 'the Board based sikgod violatioas of this. Cuasezg Agmccatunt skall comply tho Procodurto Act, nap= X ot RC,

wpv)acirrn
RCIFLOS unifcrstaztos Wile& Conscoi A.gtversent es saijoutto ratifimtiozi by tha Dora [Rios to sipatrtre, by ti:o eami PgrAtieut and shall become, efICectivis upon the flametislie of gpatan below.

RAM106- /RAI
BERTHA L(WMACK, Prasineat
Mita Board of Musing

1 194
7AT4

Case# 10-5312

Ohio:Board of v. -siAg. www.mrsing.ohio.gov

17 South High Street, Suite 400 a Columbus, Ohio 43215-7410 (614) 466-3947

CONSENT AGREEMENT BETWEEN DARA L. ROMANS, R.N. AND OHIO BOARD OF NURSING
This Consent Agreement is entered into by and between DARA L. ROMANS, R.N. (MS. ROMANS) and the Ohio Board of Nursing (Board), the state agency charged with enforcing Chapter 4723. of the Ohio Revised Cade (ORC), and all administrative rules promulgated thereunder. MS. ROMANS voluntarily enters into this Consent Agreement being fully informed of her rights under Chapter 119, ORC, including the right to representation by legal counsel and the right to a formal adjudicative hearing on the issues considered herein. This Consent Agreement contains the entire agreement between the parties, there being no other agreement of any kind, verbal or otherwise, which varies the terms of this Consent Agreement. BASIS FOR ACTION This Consent Agreement is entered into on the basis of the following stipulations, admissions and understandings: A. The Board is empowered by Section 4723.28, ORC, to deny, permanently revoke, revoke, suspend, or place restrictions on any license issued by the Board; reprimand or otherwise discipline a licensee; or impose a fine of five hundred dollars ($500.00). Section 4723.28(B)(17), ORC, authorizes the Board to discipline a licensee who violates any restrictions placed on a nursing license by the Board. MS. ROMANS's license to practice nursing as a registered nurse in the State of Ohio, RN-192133, has been suspended since March 2011. MS. ROMANS was initially licensed as nurse in September 1984. C. On or about January 22, 2010, MS. ROMANS entered into a probationary consent agreement with the Board with monitoring terms, Temporary Narcotic Restrictions and Permanent Practice Restrictions (January 2010 Consent Agreement). MS. ROMANS failed to complete the terms and conditions of her January 2010 Consent Agreement. A copy of the January 2010 Consent Agreement with the attached March 20, 2009 Notice of

Dara L. Romans, R.N. Page 2 Opportunity for Hearing (March 2009 Notice) is attached hereto and incorporated herein.. D. MS. ROMANS knowingly and voluntarily admits to the factual and legal allegations set forth in the Notice of Automatic Suspension and Opportunity for Hearing issued to her by the Board on March 18, 2011 (March 2011 Notice), a copy of which is attached hereto and irvorporateti herein. Vinnie Bitkofer, Ph.D., LPCC, LICDC in Middletown, Ohio submitted a letter to the Board dated January 18, 2011, stating that she. has provided mental health counseling to MS. ROMANS since May 2010. MS. ROMANS reports that she continues to see Dr. Bitkofer for counseling. Leah Avera, M.D. in Middletown, Ohio submitted a letter to the Board dated June 29, 2011, stating that she has served as MS. ROMANS's family physician since January 2010. Dr, Avera opines that MS. ROMANS is physically able to work as a nurse and has placed no limitations on MS. ROMANS's ability to work as a nurse. MS. ROMANS has submitted several letters of support from her former supervisor and co-workers at Otterbein Lebanon Retirement Living Community in Lebanon, Ohio, where MS. ROMANS worked as a nurse with no reported practice problems or concerns until her suspension in March 2011. MS. ROMANS apologizes for her noncompliance and is willing to cooperate with the Board. MS. ROMANS acknowledges that she is fully responsible for each and every obligation imposed by this Consent Agreement and understands that further noncompliance may result in permanent revocation of her nursing license. AGREED CONDITIONS Wherefore, in consideration of the foregoing and mutual promises hereinafter set forth, and in lieu of any formal proceedings at this time, MS. ROMANS knowingly and voluntarily agrees with the Board to the following terms, conditions, and limitations: SUSPENSION OF LICENSE 1. MS. ROMANS's license to practice nursing as a registered nurse is hereby suspended for an indefinite period of time, but not less than four (4) months from the effective date of this Consent Agreement. MS. ROMANS may submit a written request for reinstatement anytime after November 1, 2011, if the conditions for reinstatement have been satisfied.

E.

F.

G.

H.

Dam, L. Romans, R.N. Page 3 Conditions for Reinstatement 2. 3. MS. ROMANS shall obey all federal, state, and local laws, and ail laws and rules governing the practice of nursing in Ohio. MS. ROMANS shall appear in person for interviews before the full Board or its dcfsignated representative as requested by the Board or its designee. Within four (4) months prior to requesting reinstatement, MS. ROMANS agrees that she will submit a request to the Bureau of Criminal Identification and investigation (13CII) to conduct a criminal records check of MS. ROMANS, including a check of Federal Bureau of Investigation (FBI) records, and shall cause BCII to submit MS. ROMANS's criminal records check reports to the Board. MS. ROMANS agrees that a request for reinstatement will not he considered by the Board until the completed criminal records check, including the FBI check, has been received by the Board. Within four (4) months prior to requesting reinstatement, MS. ROMANS shall submit documentation of satisfactory completion of the following continuing nursing education taken -subsequent to the effective date of this Consent Agreement eight (8) hours of Chemical Dependency, Prior to reinstatement, MS. ROMANS shall enter into a Consent Agreement with the Board for probationary terms, conditions, and limitations determined by the Board for a minimum period of three (3) years following reinstatement.

4.

5.

6.

Monitoring of Rehabilitation and Treatment 8, MS. ROMANS shall abstain completely from the personal use or possession of drugs, except those prescribed, administered, or dispensed to her by another so authorized by law who has full knowledge of MS. ROMANS's history. MS. ROMANS shall self administer the prescribed drugs only in the manner prescribed. MS. ROMANS shall abstain completely from the use of alcohol . Prior to requesting reinstatement, MS. ROMANS shall, at her expense, obtain a chemical dependency evaluation by a Board approved chemical dependency evaluation and shall provide the Board with complete documentation of this evaluation. Prior to the evaluation, MS. ROMANS shall provide the chemical dependency professional with a copy of this Consent Agreement, the attached March 2011 Notice, the attached January 2010 Consent Agreement and the attached March 2009 Notice, Further, MS. ROMANS shall execute releases to permit the chemical dependency professional to obtain any information deemed appropriate and necessary for the evaluation. The professional shall submit a written opinion to the Board that includes Olagnoses, recommendations for treatment and monitoring, any additional restrictions that should be placed on MS. ROMANS's license to practice, and stating

9. 10.

Dara L. Romans, R.N. Page 4 whether MS. ROMANS is capable of practicing nursing according to acceptable and prevailing standards of safe nursing care. 11. MS. ROMANS shall provide the Board with satisfactory documentation of compliance with all aspects of the treatment plan developed by the chemical dependency professional described above until released. Further, MS. ROMANS agrees that the Board may utilize the professional's recommendations aid conclusions from the evaluation as a basis for additional terms, conditions, and limitations on MS. ROIVIA.NS's license and that the terms, conditions, and limitations shall be incorporated in an addendum to this Consent Agreement. For a FilillilTEUM, continuous period of four (4) months immediately prior to requesting reinstatement by the Board, MS. ROMANS shall submit, at her expense and on the day selected, blood or urine specimens for drug and/or alcohol analysis at a collection site specified by. the Board at such times as the Board may request. Upon and after MS. ROMANS's initiation of drug screening, refusal to submit such specimen, or failure to submit such specimen on the day she is selected, or in such a manner as the Board may request, shall constitute a violation of a restriction placed on a license for purposes of Section 4723.28(B), ORC. This screening shall require a daily call-in process. The specimens submitted by MS. ROMANS shall be negative, except for substances prescribed, administered, or dispensed to her by another so authorized by law who has full knowledge of MS. ROMANS's history. a. Within thirty (30) days prior to initiating drug screening, MS. ROMANS shall provide a copy of this Consent Agreement, the attached March 2011 Notice, the attached January 2010 Consent Agreement and the attached March 2009 Notice to all treating practitioners and shall provide to the Board a list of all treating practitioners, including addresses and telephone numbers and cause all treating practitioners to complete a medication prescription report that is to be mailed by the practitioner directly to the Board. The medication report is to be completed for any and all substances prescribed, administered, or dispensed to MS. ROMANS. b. After initiating drug screening, MS. ROMANS shall be under a continuing duty to provide a copy of this Consent Agreement, the attached March 2011 Notice, the attached January 2010 Consent Agreement and the attached March 2009 Notice, prior to initiating treatment, to additional treating practitioners, and to update the list of treating practitioners with the Board within forty-eight (48) hours of being treated by another practitioner. Further, MS. ROMANS shall notify the Board of any and all medication(s) or prescription(s) received within twenty-four (24) hours of release from hospitalization or medical treatment.

12.

Dam L. Romans, R.N. Page 5 Psychiatric Treatment 13. Unless otherwise approved by the Board or its designee, MS. ROMANS shall continue to participate in individual mental health counseling at intervals deemed appropriate by her current counselor, Vonnie Bittikofer, Ph.D., LPCC, UDC or another Board approved mental health provider. MS. ROMANS shall provide Dr. Bittikofer or another Board approved mental health counselor with a copy of this Consent Agreement, the attached March 2011 Notice, the attached January 2010 Consent Agreement and the attached March 2009 Notice. MS. ROMANS shall have her mental health professional provide the Board with quarterly reports beginning within forty-five (45) clays following the effective date of this Consent Agreement documenting compliance with all aspects of her current mental health treatment plan developed by her mental health professional until released. Further, M.S. ROMANS agrees that the Board may use the professional's recommendations and conclusion from the reports as a basis for additional terms, conditions, and limitations on MS. ROMANS' license and that the terms, conditions, and limitations may be incorporated by an addendum to this Consent Agreement.

Reporting Requirements of Licensee 14. MS. ROMANS shall report to the Board, in writing, any violation of this Consent Agreement within thirty (30) days of the occurrence of the violation. MS. ROMANS shall sign releate of information forms allowing health professionals and other organizations to submit requested documentation or information directly to the Board. MS. ROMANS shall submit any and all information that the Board may request regarding her ability to practice according to acceptable and prevailing standards of safe nursing practice. MS. ROMANS shall not submit or cause to be submitted any false, misleading, or deceptive statements, information, or documentation to the Board or to employers or potential employers. MS. ROMANS shall submit the reports and documentation required by this Consent Agreement on forms specified by the Board. Alt reporting and communications required by this Consent Agreement shall be made to the Compliance Unit of the Board. MS. ROMANS shall submit the reports and documentation required by this Consent Agreement to the attention of the Compliance Unit, Ohio Board of Nursing, .17 South High Street, Suite 400, Columbus, OH 43215-7410.

15.

16.

17.

18

19.

20.

MS. ROMANS shall verify that the reports and documentation required by this Consent Agreement are received in the Board office.

Darn L. Romans, R N. Page 6 21. MS. ROMANS shall inform the Board within five (5) business days, in writing, of any change in address and/or telephone number.

Nursing Refresher Course or Orientation Upon request by the Board or its designee, MS. ROMANS shall, prior to working(in position where a nursing license is required, complete and submit satisfactory documentation of completion of a nursing refresher course or an extensive orientation approved in advance by the Board or its designee. Temporary Narcotic Restrictions MS. ROMANS shall not administer, have access to, or possess (except as prescribed for MS. ROMANS's use by another so authorized by law who has full knowledge of MS. ROMANS's history) any narcotics, other controlled substances, or mood altering drugs in which M.S. ROMANS is working in a position where a nursing license is required, In addition, MS. ROMANS shall not count narcotics or possess or carry any work keys for locked medication carts; cabinets, drawers, or containers. MS. ROMANS shall not call in or order prescriptions or prescription refills for any narcotics, other controlled substances, or mood altering drugs, Permanent ractice estrictio s MS. ROMANS agrees and acknowledges that the PERMANENT LICENSURE RESTRICTIONS imposed in the January 2010 Consent Agreement continue as follows: Unless otherwise approved in advanced, in writing, by the Board or its designee, MS. ROMANS shall not practice nursing as a registered nurse (1) for agencies providing home care in the patient's residence; (2) for hospice care programs providing hospice care in the patient's residence; (3) for staffing agencies or pools; (4) as an independent provider where the nurse provides nursing care and is reimbursed for services by the State of Ohio through State agencies or agents of the State; or (5) for an individual or group of individuals who directly engage. MS. ROMANS to provide nursing services for fees, compensation, or other consideration or as a volunteer, MS. ROMANS agrees and acknowledges that the PERMANENT LICENSURE RESTRICTIONS imposed in the January 2010 Consent Agreement continue, with the exception that MS. ROMANS is no longer employed by Otterbein Retirement Living Community, as follows: Unless otherwise approved in advanced, in writing, by the Board or its designee, MS. ROMANS shall not function in a position or employment where the job duties or requirements involve management of nursing and nursing responsibilities, or supervising and evaluating nursing practice. Such positions include but are not

Dara L. Romans, R.N. Page 7 limited to the following: Director of Nursing, Assistant Director of Nursing, Nurse Manager, Vice President of Nursing. FAILURE TO COMPLY The above described terms and conditions shall constitute "restrictions placed on a license" for purposes of Section 4723 28(10, ORC. If, in the discretion of the Board, MS. ROMANS appears to have violated or breached any terms or conditions of this Consent Agreement, the Board reserves the right to institute formal disciplinary proceedings for any and all possible violations or breaches, including, but not limited to, alleged violations of the laws of Ohio occurring before the effective date of this Consent Agreement, DURATION I MODIFICATION OF TERMS The terms, limitations, and conditions of this Consent Agreement, other than the permanent licensure restrictions, may be modified or terminated, in writing, at any time upon the agreement of both MS. ROMANS and the Board, The Board may only alter the indefinite suspension imposed if: (1) MS. ROMANS submits a written request for reinstatement; (2) the Board determines that MS. ROMANS has complied with all conditions of reinstatement; (3) the Board determines that MS. ROMANS is able to practice according to acceptable and prevailing standards of safe nursing care based upon an interview with MS. ROMANS and review of the documentation specified in this Consent Agreement; and (4) MS. ROMANS has entered into a Consent Agreement with the Board for probationary terms, conditions, and limitations determined by the Board for a minimum period of three (3) years following reinstatement. ACKNOWLEDGIVIENTS/LIABILITY RELEASE MS. ROMANS acknowledges that she has had an opportunity to ask questions concerning the terms of this Consent Agreement and that all questions asked have been answered in a satisfactory manner. MS. ROMANS waives all of her rights under Chapter 119, ORC, as they relate to matters that are the subject of this Consent Agreement. MS. ROMANS waives any and all claims or causes of action she may have against the Board, and its members, officers, employees and/or agents arising out of matters that are the subject of this Consent Agreement. This Consent Agreement is not an adjudication order as discussed in Chapter, 119, ORC. Any action initiated by the Board based on alleged violations of this Consent Agreement shall comply with the Administrative Procedures Act, Chapter 119, ORC.

Darn Romans, R.N. Page 8 This Consent Agreement shall be considered a public record as that term is used in Section 149.43, ORC. The information contained herein may be reported to appropriate organizations, data banks and governmental bodies, EFFECTIVE DATE MS. ROMANS understands that this Consent Agreement is subject to ratification by the Board prior to signature by the Board President and shall become effective upon the last date of signature bels4.

D RA L, ROMANS, R,N.

1)

'7// 3/R6 /1
DATE

BERTHA LOVELACE, President Ohio Board of Nursing

DATE

Casa 10-5312

Ohio Board of Nursing.

March 18, 2011

www.nursing.ohio.gov

17 South High Street, Suite 400 e Columbus, Ohio 43215-7410 0 (614) 466-3947

NOTICE OF AUTOMATIC SUSPENSION AND OPPORTUNITY FOR HEARING tiara L, Romans, R.N.
115 Winesap Lane Middletown, Ohio 45044 Dear Ms. Romans: You are hereby notified that, on or about January 22, 2010, you entered into a Consent Agreement (January 2010 Consent Agreement) with the Ohio Board of Nursing (Board), a copy of which is attached hereto and incorporated herein, in which you agreed with the Board that your license to practice nursing as a registered nurse in the State of Ohio would be suspended indefinitely and that such suspension would be stayed subject to probationary terms, conditions, and limitations for a minimum period of three (3) years. Attached and incorporated within the January 2010 Consent Agreement is a March 20, 2009 Notice of Opportunity for Hearing (March 2009 Notice). A. Item 1, on Page 2 of the January 2010 Consent Agreement states, "MS. ROMANS shall obey all federal, state, and local laws, and all laws and rules governing the practice of nursing in Ohio." Section 4723.2.8(B)(8), Ohio Revised Code, ORC, authorizes the Board to discipline a licensee for selfadministering or otherwise taking into the body any dangerous drug, as defined in Section 4729.01, ORC, in any way not in accordance with a legal, valid prescription issued for that individual. Item 7. on Page 3 of the January 2010 Consent Agreement states, "MS. ROMANS shall abstain completely from the personal use or possession of drugs, except those prescribed, administered, or dispensed to her by another so authorized by law who has full knowledge of MS. ROMANS's history. MS. ROMANS shall self-administer prescribed drugs only in the manner prescribed." Item 11. on Page 4 of the January 2010 Consent Agreement states, "Within forty-five (45) days of the effective date of the Consent Agreement and continuing throughout the probationary period, M.S. ROMANS shall submit, at her expense and on the day selected, blood or urine specimens for drug and/or alcohol analysis at a collection site specified by the Board at such times as the Board may request. Upon and 'after MS. ROMANS's initiation of drug screening, refusal to submit such specimen, or failure to submit such specimen on the day she is selected, or in such a manner as the Board may request, shall constitute a violation of a restriction placed on a license for purposes of Section 4723,28(B), ORC. This screening small require a daily call-in process. The specimens submitted by MS. ROMANS shall be negative, except for

Dara L. Romans, R.N. Page 2 substances prescribed, administered, or dispensed to her by another so authorized by law who has full knowledge of S. ROMANS's history." Despite these provisions, on September 17, 2010, you provided a urine specimen for analysis to Firstlab, the Board's random drug/alcohol screen program administrator, that tested positive for Tramadol. On October 13, 2010, you submitted a statement to the Board admitting you consumed an old prescription for Tramadol, prescribed to you in September 2007. Also, on November /3, 2010 and November 16, 2010, you provided urine specimens for analysis to Firsdab, that tested positive for Proproxyphene (Darvocet). You submitted a statement dated November 17, 2010 to the Board admitting you consumed an old prescription for Darvocet, prescribed to you in June 2009. Section 4723.28(B)(8), Ohio Revised Code, ORC, authorizes the Board to discipline a licensee for self-administering or otherwise taking into the body any dangerous drug, as defined in Section 4729.01, ORC, in any way not in accordance with a legal, valid prescription issued for that individual. Section 4723.28(B)(17), Ohio Revised Code, ORC, authorizes the Board to discipline a licensee for violation of any restrictions placed on a nursing license by the Board. B. Furthermore, on the following dates, you failed to call Firstiab, to determine if you had been selected to provide a urine specimen: April 28, 2010; May 31, 2010; August 5, 2010; August 20, 2010; and January 3, 2011, Section 4723.28(B)(17), Ohio Revised Code, ORC, authorizes the Board to discipline a licensee for violation of any restrictions placed on a nursing license by the Board. C. Item 9. on Pages 3'-4 of the January 2010 Consent Agreement states, "Within three (3) months of the effective date of this Consent Agreement, MS. ROMANS shall, at her own expense, obtain a chemical dependency evaluation by a Board approved chemical dependency professional and shall provide the Board with complete documentation of this evaluation. Prior to the evaluation, MS. ROMANS shall provide the chemical dependency professional with a copy of this Consent Agreement and the March 2009 Notice. Further, MS. ROMANS shall execute releases to permit the chemical dependency professional to obtain any information deemed appropriate and necessary for the evaluation. The chemical dependency professional shall submit a written opinion to the Board that includes diagnoses, recommendations for treatment and monitoring, and any additional restrictions to be placed on MS. ROMANS's license to practice, and stating whether MS. ROMANS is capable of practicing nursing according to acceptable and prevailing standards of safe nursing care."

Kara L. Romans, R.N. Page 3 Your chemical dependency evaluation was due in April 2010. Despite this provision, you have failed to submit to the Board documentation of a complete chemical dependency evaluation. D. Item 12. on Pages 4-5 of the January 2010 Consent Agreement states, "Unless otherwise approved by the Board or its designee, MS. ROMANS shall continue to participate in individual ttiental health counseling at intervals deemed appropriate by her current counselor, Gene Colina, LISW, or another Board approved mental health provider. MS. ROMANS shall provide her mental health counselor or another Board approved mental health counselor with a copy of this Consent Agreement and the attached March 2009 Notice. MS. ROMANS shall have her mental health professional provide the Board with quarterly reports beginning within thirty (30) days following the effective date of this Consent Agreement documenting compliance with all aspects of her current mental health treatment plan developed by her mental health professional until released. Further, MS. ROMANS agrees that the Board may use the professional's recommendations and conclusion from the reports as a basis for additional terms, conditions, and limitations on MS. ROMANS' license and that the terms, conditions, and limitations may be incorporated by an addendum to this Consent Agreement." Despite this provision, you have failed to submit to the Board quarterly mental health counseling reports from your mental health provider since May 10, 2010. E. Item 13. on Page 5 of the January 2010 Consent Agreement states, "Within three (3) months of the effective date of this Consent Agreement, MS. ROMANS shall, at her own expense, obtain a comprehensive physical examination by a Board approved physician for the purposes of evaluating MS. ROMANS's fitness for duty and safety to practice nursing as a registered nurse, This Board approved physician shall provide the Board with complete documentation of MS. ROMANS's comprehensive physical examination and with a comprehensive assessment regarding MS. ROMANS's fitness for duty and safety to practice nursing as a registered nurse. Prior to the examination, MS. ROMANS shall provide the Board approved physician with a copy of this Consent Agreement and the attached March 2009 Notice. Further, MS. ROMANS shall execute releases to permit the Board approved physician performing the comprehensive physical examination and assessment to obtain any information deemed appropriate and necessary for the assessment. The evaluating physician shall submit a written opinion to the Board that includes diagnoses, recommendations for treatment and monitoring, any additional restrictions that should be placed on MS. ROMANS's license to practice, and stating whether MS. ROMANS is capable of practicing nursing according to acceptable and prevailing standards of safe nursing care."

Kara L. Romans, R.N. Page 4 Your comprehensive physical examination was due in April 2010. Despite this provision, you have failed to submit to the Board documentation of a complete comprehensive physical examination. In accordance with the paragraph under "FAILURE TO. COMPLY" of the January 2010 Consent Agreement, you are hereby notified that it appears to the Board that you have violated items 1., 7., 9., 11., 12, and 13. of the January 2010 Consent Agreement, YOU ARE FURTHER NOTIFIED THAT YOUR LICENSE TO PRACTICE NURSING AS A REGISTERED NURSE, RN-192133, IS HEREBY AUTOMATICALLY SUSPENDED. Continued practice after receipt of this notice of suspension shall be considered engaging in the practice of nursing as a registered nurse without a current, valid license, which is a violation of Section 4723.03(A), ORC, You are further notified that in accordance with Chapter 119, ORC, the Board proposes under authority of Section 4723.28, ORC, to deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars (500.00) per violation for the following reasons: 1. On or about January 22, 2010, you entered into a Consent Agreement (January 2010 Consent Agreement) with the Ohio Board of Nursing (Board), a copy of which is attached hereto and incorporated herein, in which you agreed with the Board that your license to practice nursing as a registered nurse in the State of Ohio would be suspended indefinitely and that such suspension would be stayed subject to probationary terms, conditions, and limitations for a minimum period of three (3) years. Attached and incorporated within the January 2010 Consent Agreement is a March 20, 2009 Notice of Opportunity for Hearing (March 2009 Notice). 2.. Item 1. on Page 2 of the January 2010 Consent Agreement states, "MS. ROMANS shall obey all federal, state, and local laws, and all laws and rules governing the practice of nursing in Ohio." Section 4723.28(B)(8), Ohio Revised Code, ORC, authorizes the Board to discipline a licensee for selfadministering or otherwise taking into the body any dangerous drug, as defined in Section 4729.01, ORC, in any way not in accordance with a legal, valid prescription issued for that individual. Item 7. on Page 3 of the January 2010 Consent Agreement states, "MS. ROMANS shall abstain completely from the personal use or possession of drugs, except those prescribed, administered, or dispensed to her by another so authorized by law who has full knowledge of MS. ROMANS's history. MS. ROMANS shall self-administer prescribed drugs only in the manner prescribed." Item 11. on Page 4 of the January 2010 Consent Agreement states, "Within forty-five (45) days of the effective date of the Consent Agreement and continuing throughout the probationary period, MS. ROMANS shall submit, at her expense and on the day selected, blood or urine specimens for drug and/or alcohol analysis at a

 Data L. Romans, R.N. Page 5 collection site specified by the Bard at such times as the Board may request. Upon and after MS. ROMANS's initiation of drug screening, refusal to submit such specimen, or failure to submit such specimen on the day she is selected, or in such a manner as the Board may request, shall constitute a violation of a restriction placed on a license for purposes of Section 4723.28(B), ORC, This screening shall require a daily call-in process. The specimens submitted by MS. ROMANS ghat be negative, except for substances prescribed, administered, or dispensed to her by another so authorized by law who has full knowledge of MS. ROMANS's history." Despite these provisions, on September 17, 2010, you provided a urine specimen for analysis to Firstlab, the Board's random drug/alcohol screen program administrator, that tested positive for Tramadol. On October 13, 2010, you submitted a statement to the Board admitting you consumed an old prescription for Tramadol, prescribed to you in September 2007. Also, on November 8, 2010 and November 16, 2010, you provided urine specimens for analysis to Firstlab, that tested positive for Proproxyphene (Darvocet). You submitted a statement dated November 17, 2010 to the Board admitting you consumed an old prescription for Darvocet, prescribed to you in June 2009. Section 4723.28(B)(8), Ohio Revised Code, ORC, authorizes the Board to discipline a licensee for self-administering or otherwise taking into the body any dangerous drug, as defined in Section 4729.01, ORC, in any way not in accordance with a legal, valid prescription issued for that individual. Section 472328(3)(17), Ohio Revised Code, ORC, authorizes the Board to discipline a licensee for violation of any restrictions placed on a nursing license by the Board. 3. Furthermore, on the following dates, you failed to call Firstlab, to determine if you had been selected to provide a urine specimen: April 28, 2010; May 31, 2010; August 5, 2010; August 20, 2010; and January 3, 2011, Section 4723.28(B)(17), Ohio Revised Code, ORC, authorizes the Board to discipline a licensee for violation of any restrictions placed on a nursing license by the Board. 4. Item 9, on Pages 3-4 of the January 2010 Consent Agreement states, "Within three (3) months of the effective date of this Consent Agreement, MS. ROMANS shall, at her own expense, obtain a chemical dependency evaluation by a _Board approved chemical dependency professional and shall provide the Board with complete documentation of this evaluation. Prior to the evaluation, MS. ROMANS shall provide the chemical dependency professional with a copy of this Consent Agreement and the March 2009 Notice. Further, MS. ROMANS shall execute releases to permit the chemical dependency professional to obtain any information deemed appropriate and necessary for the evaluation, The chemical dependency professional shall submit a written opinion to the Board that includes diagnoses,

Dara L. Romans, R. N. Page 6 recommendations for treatment and monitoring, and any additional restrictions to be placed on MS. ROMANS's license to practice, and stating whether MS. ROMANS is capable of practicing nursing according to acceptable and prevailing standards of safe nursing care." Your chemical dependency evaluation was due in April 2010, Despite this provision, you have failed to submit to the Board documentation of a complete chemical dependency evaluation, 5, Item 12. on Pages 4-5 of the January 2010 Consent Agreement states, "Unless otherwise approved by the Board or its designee, MS. ROMANS shall continue to participate in individual mental health counseling at intervals deemed appropriate by her current counselor, Gene Coll na, USW, or another Board, approved mental health provider. MS. ROMANS shall provide her mental health counselor or another. Board approved mental health, counselor with a copy of this Consent Agreement and the attached March 2009 Notice. MS. ROMANS shall have her mental health professional provide the Board with quarterly reports beginning within thirty (30) days following the effective date of this Consent Agreement documenting compliance with all aspects of her current mental health treatment plan developed by her mental health professional until released. Further, MS, ROMANS agrees that the Board may use the professional's recommendations and conclusion from the reports as a basis for additional terms, conditions, and limitations on MS. ROMANS' license and that the terms, conditions, and limitations may be incorporated by an addendum to this Consent Agreement," Despite this provision, you have failed to submit to the Board quarterly mental health counseling reports from your mental health provider since May 10, 2010. 6.. Item 13., on Page 5 of the January 2010 Consent Agreement states, "Within three (3) months of the effective date of this Consent Agreement, MS. ROMANS shall, at her own expense, obtain a comprehensive physical examination by a Board approved physician for the purposes of evaluating MS. ROMANS's fitness for duty and safety to practice nursing as a registered nurse. This Board approved physician shall provide the Board with complete documentation of MS. ROMANS's comprehensive physical examination and with a comprehensive assessment regarding MS. ROMANS's fitness for duty and safety to practice nursing as a registered nurse. Prior to the examination, MS. ROMANS shall provide the Board approved physician with a copy of this Consent Agreement and the attached March 2009 Notice. Further, MS. ROMANS shall execute releases to permit the Board approved physician performing the comprehensive physical examination and assessment to obtain any information deemed appropriate and necessary for the assessment, The evaluating physician shall submit a written opinion to the Board that includes diagnoses, recommendations for treatment and monitoring, any additional restrictions that should be placed on MS. ROMANS's license to practice, and

Mara L. Romans, RN. Page 7 stating whether MS. ROMANS is capable of practicing nursing according to acceptable and prevailing standards of safe nursing care." YoUr comprehensive physical examination was due in April 2010. Despite this provision, you have failed to submit to the Board documentation of a complete comprehensive physical examination. Section 4723.28(8)(17), Ohio Revised Code, ORC, authorizes the Hoard to discipline a licensee for violation of any restrictions placed on a nursing license by the Board. Accordingly, the Board is authorized to impose one or more of the sanctions as cited in Section 4723.28, ORC, in accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing in this matter. If you wish to request such hearing, the request must be made in writing and must be received in the Board office within thirty (30) days of the time of mailing of this notice. You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in writing. At the hearing you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to: Lisa Ferguson-Ramos, Compliance Unit Manager, Ohio Board of Nursing,17 South High Street, Suite 400, Columbus, Ohio 43215.7410, or to the e-mail address, hearing(Onursing..ohio.gov. If the Board fails to receive a request for a hearing within thirty (30) days of the time of Mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Automatic Suspension and Opportunity for Hearing, deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500,00) per violation. Sincerely,

a..
Judith A. Church, RN., C.N.F. Supervising Member Certified Mail Receipt No. 7011 0110 0001 5953 7526 Attorney Mail Receipt No. 7011 0110 0001 5953 7533 cc: F. Harrison Green, Esq. Melissa L, Wilburn, Assistant Attorney General

Case # 07-0984; 07-2651

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CONSENT AGREEMENT BEEN DARA L. ROMANS, R.N. AND OHIO BOARD OF NURSING
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This Consent Agreement is entered into by. and between.DARA L ROMANS, R.N. (MS. ROMANS) and the Ohio Board of Nursing (Board), the state agency charged with enforcing Chapter 4723. of the Ohio Revised Code (ORC), and all arlmtnistrative rules promulgated thereunder. MS. ROMANS voluntarily enters into this Consent Agreement being fully informed of her rights under Chapter 119, ORC, including the right to representation by legal counsel and the right to a formal adjudicative hearing on the issues considered herein. This Consent Agreement contains the entire agreement between the parties, there being no other agreement of any kind, verbal or otherwise, which varies the terms of this Consent Agreement, AASIS FOR. ACTJON This Consent Agreement is entered into on the basis of the following stipnlations, admissions and understandings; A. The Board is empowered by Section 4723.28, ORC, to deny, penramently revoke, revoke, suspend, or place restrictions on any license issued by the Board; reprimand OT otherwise. discipline a licensee; or impose a fine of eve hundred dollars ($500.00) or less per violation. Section 4723.28(B)(8), ORC, authorizes the Board to discipline a licensee for self-administering or otherwise, taking into the body any dangerous drug, as defined Section 4729,01, ORC, in any way not in accordance with a legal, valid prescription issued for that individual. Section 4723.28(13)(10), ORC, authorizes the Board to discipline a licensee for impairment of the ability to practice according to acceptable and prevailing standards of safe nursing care because of habitual or excessive use, of drugs, alcohol, or other chemical substances that impair the ability to practice. Section 4723.28(13)(16), ORC, authorizes the Board to discipline a licensee for violation of Chapter 4723, ORC, or any roles adopted under it, Specifically, Ohio Adra ii trative Code Rule 4723-4-06(P), states that a licensed nurse shall not submit or cause to be submitted any false, znisleading, or deceptive statements, information, or documentation to the board, to muzent employers, or to any future employers for positions requiring a nursing license.

Data L, Rornans, R.N. Page 2 B. C. MS. ROM26,,NS's license to practice m sing as a registered muse in the State of obi, RN-192133, was initially issued in September L9S4. On March 20, 2009, the Board issued a Notice of Opponamity for Hearing (March 2009 Notice) against MS. ROMANS's license. A copy of de March 2009 Notice is attached hereto and incorporated herein, MS. ROMANS knowingly and voluntarily arhnits to the factual and legal allegations set forth the March 2009 Notice, except in paragraph 2, MS. ROMANS acknowledges a. positive drug screen for Morphine, but MS,_ ROMANS is for want of loiowiedge as to the origin of the positive screen, MS. ROMANS states that with respect to paragraph 1 of the March 2009 Notice, her employer insisted that she report to work even though she told them she was suffer:Mg from pain related to injuries. MS. ROMANS states she did not recognize that she was under any impahment MS. ROMANS stAti's that her employer did not require her to submit to drag testing at that time and that she informed her employer that she was taking prescribed pain medication.

D.

E.

MS. ROMANS states that although she reported to the Board that she was
diagnosed with Bi-Polar Disorder, she, does not suffer from Bi..Polar Disorder, but is diagnosed with and is being treated for Depression. MS. ROMANS reports the seeks counseling, on an as needed basis, from Gene Cana, USW, Cincinnati, Ohio, and has her medication monitored and reviewed every three months by Dr. Chandan Gupta, Monroe, Ohio. MS. ROMANS reports that her current treatment for Depression is effective.

F.

MS. ROMANS states she is working as a nurse for Otterbein Retirement Living Community, Lebanon, Ohio (Otterbein Lebanon) since January 200/3 as a nursing supervisor. MS. ROMANS reports that her employer is informed of the March 2009 Notice and that the employer is walling to continue to employ her as a nurse.
AGREED COND/TIONS

Wherefore, in consideration of the foregoing and mutual promises hereinafter set forth, and in lieu of any formal proceedings at this time, S. ROMANS knowingly and voluntarily agrees with the Board to the following terms, conditions, and limitations: MS. ROMANS'S license to practice nursing as a registered nurse shall be suspended indefinitely. Such suspension shall be. stayed, subject to the following PROBATIONARY terms, conditions, and limitations for a minimum. period of three (3) years: 1. MS. ROMANS shall obey all federal, state, and local laws, all laws and rules governing the practioe of musing in Ohio.

Dora L. Romans, R.N. Page 3 2, M.S. ROWINS shall appear in person for interviews before the full Board or its designated representative as requested by the Board or its designee. 3. MS. ROMANStagrees that she will submit a request to the Bureau of Criminal Identification and Investigation (BC11) to conduct a criminal records check of MS. ROMANS, including a cheek of Federal Bureau of Investigation (FBI) records, and request BOI to submit M.S. ROMAIsIS's criminal records check reports to the Board.. MS. ROMANS's completed criminal records check, including the eel check, must be received by the Board within six (6) months following the effective date of the Consent Agreement 4, Within six (6) months of the effective date of this Consent Agreement, MS. ROMANS shall, in addition to the requirements of licensure renewal, successfully complete and submit satisfactory documentation of successful completion of the following continuing nursing education taken subsequent to the effective date of this Consent Agreement; ten (10) hours of Patient Safety; ten (10) hours of Chemical Dependency; five (5) hours of Professionalism; and. three (3) hours of Ethics. Restrietad Employment 5, MS. ROMANS's employment as a registered nurse is RESTRICTED to working as a nurse at Otterbein Lebanon for a minimum period of six (6) months. 6, After the minimum period of six (6) months, MS. ROMANS may request modification of this employment restriction, in writing, by the Board or its designee, as long as MS; ROMANS is in full compliance with this Agreement The Board may, as a condition of employment approval, impose, additional monitoring terms, including but not limited to, a refresher course or an extensive orientation, psychiatric evaluation, and licensure restdations. Such terms shall be set forth in an addendum to this Consent Agreement Monitoring of Rehabilitation and Treatment 7. MS. ROMANS shall abstain completely from the personal rise or possession of drags, except those prescribed, administered, or dispensed to her by another so authorized by law who has full knowledge of MS. ROMANS's history, MS. ROMANS shall self-ad, ulster the prescribed drugs only hi the manner prescribed. g. MS. ROMANS shall abstain completely from the use of alcohol. 9. Within three (3) months of the effective FiAfr of this Consent Agreement, MS. ROMANS shall, at her own expense, obtain a chemical dependency evaluation by a Board approved Chemical dependency professional and shall provide the Board with complete documentation of this evaluation. Prior to the evaluation, MS. R.OMANS shall provide the chemical dependency professional with a copy of this Consent Agreement and. the March 2009 Notice. Further, M.S. R.QMANS shall execute releases to permit the chemical dependency professional to obtain any information deemed appropriate and necessary for the evaluation. The chemical dependency professional shall submit a written opinion to the Board that

Darn L. Romans, Page 4 includes diagnoses, recommendations for treatment and monitoring, and any additional restrictions to be placed on MS. ROMANS's license to practice, and staling whether MS. ROMANS is capable of practicing musing according to acceptable and prevailing standards of safe nursing care.
4 10, MS. ROMANS shall provide. the Board with satisfactory doci/MantatiP7a of compliance with.

all aspects of the treatment plan developed by the chemical dependency professional described above until released, Further, MS. ROMANS agrees that the. Board may utilize the professional's recommendations and conclusions from the evalnatiOn as a basis for additional terms, conditions, and limitations on MS. ROMANS's license and that the terms, conditions, and limitations may be incorporated in an adder:dere to this Consent Agreement 11 Within. forty-five (45) days of the effective date of the Consent Agreement and confirming throughout the probationary period, MS. ROMANS shall submit, at her expense and on the day selected, blood or urine specimens for drug and/or alcohol analysis at a collection site specified by the Board at such times as the Board may request. Upon and after MS. ROMANS's initiation of drug screening, refusal to submit such speeimen, or failure to submit such specimen on the day she is selected, or in such a manner as the Board may request, shall constitute a violation of a restriction placed on a license for purposes of Section 472328(B), ORC. This screening shall require a daily call-i process. The specimens submitted by MS. ROMANS shall be negative, except for substances prescribed, administered, or dispensed to her by another so authorized by law who has full knowledge of M.S. ROMANS's history. a, Prior to MS. ROMANS initiating drug screening, MS. ROMANS shall provide a copy of this Consent Agreement and the attached March 2009 Notice to all treating practitioners and shall provide to the Board a list of all, treating practitioners, including addresses and telephone numbers and cause all treating practitioners to complete a medication prescription report that is to be mailed by the practitioner directly to the Board. The medication report is to be completed for any and all substances prescribed, administered, or dispensed to MS. ROMANS. b. After initiating drug screening, M.S. ROMANS shall be under a continuing duty to provide a copy of this Consent Agreement and the attached March 2009 Notice, prior to initiating treatment, to additional treating practitioners, and to update the list of treating practitioners with the Board within forty-eight (48) hours of being treated by another practitioner. Further, MS. ROMANS shall notify the Board of any and all medication(s) or prescription(s) received within twenty-four (24) hours of release from hospitalization or medical treatment Psychiatric Treatment 12. Unless otherwise approved by the Board or Its designee,. M.S. ROMANS shall. confine to participate in individual mental health counseling at intervals deemed appropriate by her

Dara L. Romans, R.N. Page 5 current counselor, Gene Celina, USW, or another Board approved mental health provider. MS. ROMANS shall provide her mental health counselor or another Board approved mental health counselor with a copy of this Consent Agreement and the attached March 2009 Notice. MS. ROMANS shall have her mental health professional provide the Board with quarterly reports beginn&g within thirty (30) days following the effective date of this Consent Agreement documenting compliance with all aspects of her current mental health treatment plan developed by her mental health professional until. released. Further, MS. ROMANS agrees that the Board may use the professional's recommendations and conclusion from the reports as a basis for additioogt terms, conditions, and limitations on MS. ROMANS' license and that the terms, conditions, and limitations may be incorporated by an addendum to this Consent Agreement, Fitness for Duty Evaluation 13. Within three (3) months of the effective date of this Consent Agreement, MS. ROMANS shall, at her own expense, obtain a comprehensive physical examination by a Board approved physician for the purposes of evaluating MS, ROMANS's fatness for duty and safety to practice nursing as a registered nurse. This Board approved physician shall provide the Board with complete documentation of MS. ROMANS's comprehensive physical examination and with .a comprehensive assessment regarding MS. ROMANS's Etness for duty and safety to practice nursing as a registered nurse. Prior to the examination, MS. ROMANS shall provide the Board approved physician with a copy of this Consent Agreement and the attached March 2009 Notice, Further, MS. ROMANS shall execute releases to permit the Board approved physician performing the comprehensive physical examination and assessment to obtain any information deemed appropriate and necessary for the assessment. The evaluating physician shall submit a written opinion to the Board that includes diagnoses, recommendations for treatment and monitoring, any additional restrictions that should be placed on MS. ROMANS's license to practice, and stating whether MS. ROMANS is capable of practicing nursing according to acceptable and prevailing standards of safe nursing care. 14.14S. ROMANS agrees that the Board may use the physician's recommendations and conclusions from the evaluation as a. basis for additional terms, conditions, and JirrlitatiOtt$ M.S. ROMANS's license and that the terms conditions, and /imitations may be incorporated in an addendum to this Consent Agreement Employer Reporting 15.Prior to accepting employment as a nurse, each time and with every employer, MS. ROMANS shall notify and obtain approval from the. Board or its designee., 16.MS. ROMANS, within fifteen (15) days of the effective date of the Consent Agrennent, shall provide her employer, Otterbein. Lebanon, with a copy of this Consent Agreement and the March 2009 Notice. Further, MS. ROMANS is tinder a continuing duty to provide a copy of this Consent Agreement and the March 2009 Notice to any new employer prior to accepting employment. M.S. ROMANS shall have her employer(s), if workbag in a.

Dara L. Romans, R.N. Page 6 position where a nursing license is requirea, submit written reports regarding job perforator= on a quarterly basis beginning March 1, 2010. MS. ROMANS shall have. her employer(s) send documentation to the Board, along with ihe first employer report, of receipt of a copy of this Consent Agreement and the Mai-oh 2009 Notice, including the date they were receive-. Reporting Requirements of Licensee 17, S. ROMANS shall report to the Board, in writing, any violation. of this Consent Agreement within thirty (30) days of the occurrence of the violation.. lg. MS. ROMANS shall sign release of information forms allowing health professionals and other organizations to submit the requested documentation directly to the Board. 19.MS. ROMANS shall submit any and all information that the Board may request regarding hex ability to practice aceording to acceptable and prevailing standards of s e nursing practice.

20.MS. ROMANS shall not submit or cause to be submitted any false, misleading, or deceptive
statements, information, or documentation to the Board or to employers or potential employers. 21. MS. ROMANS shall submit the reports and docum- ntation required by this Consent Agreement on forms speciffed by the Board. All reporting and communications required by this Consent Agreement shall be made to the Compliance Unit of the Board. 22. MS. ROMANS shall submit the reports and documentation required by this Consent Agreement or any other documents required by the Board to the attention of the Compliance Unit, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, Ohio 43215-7410, 23. MS. ROMANS shall verify that the reports and documentation required by this Consent Agreement are received in the Board ofEce,

2A. MS. ROMANS shall inform the Board within five (5) business days, in writing, of any
change in. employment status or of any change in residential or home address or telephone number. Nw:n_lZnft shi Course or

Upon. request of the Board or its designee, MS. ROMANS shall, prior to working in a position where a nursing license is required, complete and submit satisfactory documentation of completion of a nursing refresher course or an extensive orientation approved in advance by the Board or its designee,

Dare. L. Romans, R.I. Page 'empora y Na MS. ROMANS shall not wirainizte.r, have access to, or possess (except as prescribed for MS. R.OMANS's use by another so authorized by law who has full knowledge of MS. ROM4S's history) any narcotics, other controlled substances, or mood altering drugs In addition, MS. ROMANS shall not possess or carry any work keys for locked medication carts, cabinets, drawers, or containers. MS. ROMANS shall not count narcotics. MS, ROMANS shall not call in or order prescriptions or prescription refills for narcotics, other controlled substances, or mood altering dregs. PERMANENT PRACTICE RESTRICTIONS: MS. ROMANS further 1,lowingly and voluntarily agrees with the Board to the following PERMANENT LICENSURE RESTRICTIONS: Unless otherwise approved in advance by the Board or its designee, MS. ROMANS shall not practice nursing as a registered nurse (1) for agencies providing home care in the patient's residence; (2) for hospice care programs providing hospice. care in the patient's residence; (3) for staffing agencies or pools; (4) as an independent provider where the nurse provides nursing care and is reimbursed for services by the State of Ohio through State agencies or agents of the State; or (S) for an individual or group of individuals who directly engage MS. ROMANS to provide nursing services for fees', compensation, or other consideration or as a volunteer. Unless otherwise approved in advance by the Board or its designee, MS. ROMANS shall not function in a position or employment where the job duties or requirements involve management of nursing and nursing responsibilities, or supervising and evaluating nursing practice, EXCEPT in her present position at Otterbehi Retirement Living Community, Lebanon, Ohio. Such positions include, but are not ihnited to, the following: Director of Nursing, Assistant Director of Nursing, Nurse Manager, Vice President of Nursing. FAILURE TO COMP Y M.S. ROMANS agrees that her license to practice nursing as a registered nurse will be automatically suspended if it appears to the Board that MS. ROMANS has violated or breached any terms or conditions of the Consent Agtreement. Following the automatic suspension, the Board shall notify MS. ROMANS via certified mall of the specific nature of the charges and automatic suspension of her license. Upon receipt of this notice, M.S. ROMANS may request a hearing regarding the charges. The above described terms and. conditions shall constitute "restricdons placed on a license" for purposes of Section 4723,28(B), ORC, If, in the discretion of the Board, MS. ROMANS appears to have violated or breached anx terms or conditions of this Consent Agreement, the Board reserves the right to institute final disciplinary proceedings for any and all possible

Dana L. Rorn Ras, P...K Page. 8 violations or breaches, including, but not limited to, alleged violations of ttbe laws, of Ohio occurring before the effective date of this Consent Agreement pcORATION/7141)_DIFICATION Or TERMS The terms, 3irnitations, and conditions of this Consent Agreement, other than the permanent licensors rear iefices, may be. modified or terminatM, in writing, at any time. upon the agneement of both MS. ROMANS and the Board. The Board may only alter the probationary period imposed by this Consent Agreement if: (1) the 'Board determines that It ROMANS has complied with all aspects of this Consent Agreement; and (2) the Board determines that MS. ROMANS is able to practice according to acceptable and prevailing- standards of safe nursing care without Board monitoring, based upon an interview with MS. ROMANS and review of the reports as required herein. Any period during which MS. ROMANS does not work in a position for which a nursing license is required shall not count toward fulfilling the probationary period imposed by this Consent Agreement, C ASE

MS. ROMANS acknowledges that she. has had an opportunity to ask questions concerning the terms of this Consent Agreement and that all questions asked have been answered in a satisfactory manner, MS. ROMANS waives all of her rights under Chapter 119, ORC, as they relate to matirrs that are the subject of this Consent Agreement. MS. ROMANS waives any and all claims or causes of action she may have against the Board, and its members, officers, employees and/or agents arising out of matters, which are the subject of this Consent Agreement. This Consent Agreement shall be considered a public record as that term is used in Section 149.43, ORC. The information contained herein may be reported to appropriate organizations, data banks, and governmental bodies. This Consent Agreement is not an adjudication order as discussed in Chapter 119, ORC. Any action initiated by the Board based on alleged violations of this Consent Agreement shall comply with, the Administrative Procedures Act, Chapter 119, ORC.

Dara L. Romans, R.N. Page 9

,RECD DAIS.
MS. ROMANS understands that this Consent Ag=meat is subject to raffication by the Board prior to signature by the. Board. President and shall become effective upon the last date of signaInre

DARA L. ROIVLAN

ATE

ON GREEN, ESQ. Attonkey for Darn L. Romans, R.N.

&Eh, ikbehdo., 581MAIJor RiJ

BERTHA. LOVELACE, President Ohio Doard of Nursing

DATE

Case #07-0984; 07-2-651

4

011130 DOU4 . .
17 South High Street, Suite 400

NU.T$1,-n,

www.rtursing.ohlo.gov (614) 466-3947 Columbus, Ohio 43215-7410

March 2.0, 20(19

NOTICE OF OPPORTUNITY FOR IINARING

Dan. L. Romans, R.N. 115 Winesap Lane. Middletown, Ohio 45044 Dear Ms. Romans.. In accordance with Chapter 119, Ohio Revised Code (ORC), you are hereby notified that the Ohio Board of Nursing (Board) proposes under authority of Section 4723.28, ORC, to deny, revoke, permanently revoke, suspend or place restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons:' 1On or about March 17, 2007, you. reported for work, as a registered nurse at willow Knoll Retirement Coninninity, Middletown Ohio, at approximately 12:33 pm (over five hours late). While working on that date, staff reported that you demonstrated signs of impaiment, including inability to concentrate and disorganized thought. You were confronted by your employer, and effective March 19, 2007, resigned from employment In a written statement to the Board, you admitted that, "1 gave her my resignation because I felt I. had come to work unknowingly impaired and was ashamed?' In an interview with a Board investigator, on or about June 7, 2007, you stated that on day prior to March 17, 2007, you had been injected with Dilandid during an ER visit, and in addition, had self-medicated with two (2) Pereocet prior to coming to work. You stated to the Board investigator that you made a mistake. in coming to work,

Section 4723.2.8(B)(10), ORC, authorizes the Board to discipline a licensee for impairment of the ability to practice according to acceptable and prevailing standards of safe nursing care because of habitual or excessive use of drugs, alcohol, or other chemical substances that impair the ability to praetice. 2.. On or about August 3, 2007, while working at Middletown Regional Hospital (Hospice of Middletown), Middletown, Ohio, staff observed signs that you were impaired including but not limited to confusion, disorientation regarding documentation, and slow and slurred speech. Your employer required you to submit a urine specimen. The specimen you submitted at approximately 1:25 pm. tested positive for Morphine. You did not have a legal, valid prescription

Data L. Romans, R.N. Page 2 for Morphine. You were terminated from employment on or about August 10, 2007. Section 4723,28(B)(8), ORC, authorizes the Board to discipline a licensee for self-administering or otherwise taking into the body any dangerous drug, as defined in Section 4729.01, ORC, in any way not in accordance with a legal, valid pre-scripticp issued for that individual.. Section 4723.28(B)(10), ORC, authorizes the Board to discipline a licensee for impairment of the ability to practice according to acceptable and prevailing standards of safe nursing care because of habitual or excessive use of drugs, alcohol, or other chemical substances that impair the ability to practice. 3. On or about June 7, 2007, during an interview with a Board Compliance Agent, you stated that you bad been diagnosed with. Bi-Polar Disorder and were being treated both for mental health issues and by a pain management specialist, On or about December 17, 2007, the Board ordered you to an eTamination pursnsut to Section 4723.280), ORC, During the examination, on April 22., 2008, you stated to Dr. Sokolov, that you left your nursing position at Hospice of Middletown, Middletown, Ohio ''after two months because it was gut wrenching." You did not disclose that you were terminated from employment, on or about August 10, 2007, as discussed in paragraph two, above, nor did you disclose the positive screen for Morphine. On or about April 30, 2008, Dr. Sokolov submitted a written report to the Board based on the information you provided, concluding "possible substance abuse."

.Section 472328(B)(16), ORC, authorizes the Board to discipline a licensee for violation of Chapter 4723, ORC, or any rules adopted under it. Specifically, Ohio Administrative Code Rule 47234-0t5{F), states that a licensed nurse shall, not submit or cause to be submitted any false, misleading, or deceptive statements, information, or documentation to the board, to current employers, or to any future employers for positions requiring a nursing license. In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing in this matter, If you wish to request such hearing, the request must be made in 'writing and must be received in. the Board office within thirty (30) days of the time of mailing of this notice, You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in writing. At the hearing you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in. addition to any other correspondence- regarding this matter, to: 'Lisa Ferguson-Ramos, Compliance Unit Manager, Ohio Board of Nursing, 17 South 'Prigh Street, Su,ite 400, Columbus, OH 432157410

Dara L. Romans, RN. Page 3 If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Opportunity for Hearing, deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars t (1500.00) per violation. Sincerely,

Anne Barnett., RN, BSN, CWS Supervising Member Certified Mail Receipt No. 7008 3230 0003 2641 0430 Attorney Certified Mail Receipt No, 7008 3230 0003 2641 0447 cc: Leah O'Carroll, Assistant Attorney General F. Harrison Green, Esq. ,

Case # 12-001553

Ohio Board of Nursing

1

www.nursing.ohio.gov
(614) 466-3947

17 South High Street, Suite 400 * Columbus, Ohio 43215-741Q

March 22, 2013

NOTICE OF OPI1ORTUNITY FOR HEARING

Deborah Lynn Ruggles, L.P.N. 640 Clark Street Elyria, Ohio 44035 Dear Ms. Ruggles: In accordance with Chapter 119, Ohio Revised Code (ORC), you are hereby notified that the Ohio Board of Nursing (Board) proposes under authority of Section 4723.28 ORC, to deny, revoke, permanently revoke, suspend or place restrictions on your license to practice nursing as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: 1. On or about March 22, 2012, while working as a nurse at St. Augustine Manor in Cleveland, Ohio, you stuck a syringe into Patient #1's [See attached Patient Key to remain confidential and not subject to public disclosure] arm. In a signed, written statement, you said, "While I was giving [Patient #1] his meds I got distracted and had a syringe and put it in his arm." Section 4723.28(B)(19), ORC, authorizes the Board to discipline a licensee for failure to practice in accordance with acceptable and prevailing standards of safe nursing care. Section 4723.28(B)(16), ORC, authorizes the Board to discipline a licensee for violation of Chapter 4723, ORC, or any rules adopted under it. Specifically, Rule 4723-4-04(B), Ohio Administrative Code, states that a licensed practical nurse shall maintain current knowledge of the duties, responsibilities, and accountabilities for safe nursing practice. 2. On or about March 22, 2012, following the practice error described in paragraph one above, St. Augustine Manor's staff required you to undergo a drug screen. On the date of the screen, you indicated to a staff member that you smoke pot once in a while. During a May 1, 2012 interview with a Board Compliance Agent, you initially denied using marijuana, but then stated, "I don't do it that much." When asked about the last time you used marijuana, you said, "Months ago." Section 4723.28(B)(8) [as in effect prior to June 8, 2012J, ORC, authorizes the Board to discipline a licensee for self-administering or otherwise taking into the body any dangerous drug, as defined in Section 4729.01, ORC, in any way not in accordance with a legal, valid prescription issued for that individual.

Deborah Lynn Ruggles, L.P.N. Page 2 Accordingly, the Board is authorized to impose one or more of the sanctions cited in Section 4723.28, ORC. in accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing in this matter. If you wish to request such hearing, the request must be made in writing and must be received in the Board office within thirty (30) days of the time of mailing of this notice. You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in writing. At the hearing, you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to Lisa Ferguson-Ramos, Compliance Unit Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, Ohio 432157410 or to the email address, hearingAnursinaoaio,gpv. If the Board fails to receive a request for a hearing within thirty {30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Opportunity for Hearing, deny, revoke, permanently revoke, suspend, or place restrictions on your license to practice nursing as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars {$500.00) per violation. Sincerely, :7Y43-7z.diee., Rhonda S. Barkheimer, R.N., C.N.P. Supervising Board Member Certified Mail Receipt No. 7012 2210 0000 6272 3254 /V z

cc: Henry G. Appel, Senior Assistant Attorney General

Cases #09-3312 & 12-000574

Ohio Board Of Nursing

www,nursing.ohio.gov

17 South. High Street, Suite 400 .0 Columbus, Ohio 43215-74.10 6 (61.4) 466-3947

March 22, 2013

NOTICE OF OPPO TUNITY FOR HEARING

Leigh Anne Smith, L.P.N. 17963 ST RT 73 McDermott, Ohio 45652 Dear Ms. Smith: In accordance with Chapter 119. of the Ohio Revised Code (ORC), you are hereby notified that the Ohio Board of Nursing (Board) proposes under the authority of Section 4723.28, ORC, to deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: 1. On or about April 15, 2009, while interviewing for a nursing position at Hempstead Manor (Liberty Health Care Corporation) in Portsmouth, Ohio you reported to your interviewer that you quit your employment at Edgewood Manor Lucasville II (Edgewood Manor), because there was lots of gossip and you were tired of it. However, your employment with Edgewood Manor was terminated on or about February 16, 2009 for "Gross negligence in performance of assigned duties. Numerous omissions of documentation of administration of PRN narcotics on the MAR."

Section 4723.28(B)(16), ORC, authorizes the Board to discipline a licensee for violation of Chapter 4723, ORC, or any rules adopted under it. Specifically, Rule 4723-4-06(P)(3), Ohio Administrative Code (OAC), states that a licensed nurse shall not make any false, misleading, or deceptive statements, or submit or cause to be submitted any false, misleading or deceptive information, or documentation to prospective employers when applying for positions requiring a nursing license. 2. On or about October 19, 2011, you submitted an Application for Employment (Application) to Hill View Retirement Center in Portsmokith, Ohio. Under the Employment Experience portion of the Application, you were required to provide your employment experience, beginning with your present or most recent job.. You failed to report that in 2009, you were employed as a nurse at Hempstead Manor (Liberty Nursing Center) from in or around March 2009 to in or around June 2009.

Leigh Anne Smith, L.P.N. Page 2 3. On the same Application referenced above in Item 2, although you reported your nursing employment with Edgewood Manor, in the space entitled "Reason for Leaving", you reported "disagreements with other staff," even though you left your employment because you were terminated on or about February 16, 2009 for "Gross negligence in performance of assigned duties. Numerous omissions of documentation of administration of PRN narcotics on the MAR."

Section 4723.28(B)(16), ORC, authorizes the Board to discipline a licensee for violation of Chapter 4723, ORC, or any rules adopted under it. Specifically, Rule 4723-4-06(P)(3), OAC, states that a licensed nurse shall not make any false, misleading, or deceptive statements, or submit or cause to be submitted any false, misleading or deceptive information, or documentation to prospective employers when applying for positions requiring a nursing license. Accordingly, the Board is authorized to impose one or more of the sanctions as cited in Section 4723.28 ORC. You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in writing. At the hearing you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to: Lisa Ferguson-Ramos, Compliance Unit Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, OH 43215-7410, or to the email address, hearing@nursing.ohio.gov. If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Opportunity for Hearing, deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely, A7A//V Rhonda S. Barkheimer, R.N., C.N.P. Supervising Board Member Certified Mail Receipt No. 7012 2210 0000 6272 3322 cc: Henry G. Appel, Senior Assistant Attorney General

Case# 12-007258

Ohjo Board of Nursing

March 22, 2013

www.nursing:ohio.gov

17 South High Street, Suite 400 4 Columbus, Ohio 43215-7410 4, (614) 466-3947

NOTICE OF AUTOMATIC SUSPENSION AND OPPORTUNITY FOR HEARING

Jessica L. Soehnlen, 9411 Briggle Avenue SW East Sparta, Ohio 44626 Dear Ms. Soehnlen: You are hereby notified that, on or about September 21, 2012, you entered into an Addendum to Consent Agreement (September 2012 Addendum) with the Ohio Board of Nursing (Board), a copy of which is attached hereto and incorporated herein, in which you agreed with the Board that your license to practice nursing as a licensed practical nurse in the State of Ohio would be subject to additional probationary terms, conditions and limitations, in addition to the terms, conditions and limitations set forth in the November 2011 Consent Agreement. Attached to and incorporated within the September 2012 Addendum is a Consent Agreement entered into between you and the Board on November 18, 2011 (November 2011 Consent Agreement), in which you agreed with the Board that your license to practice nursing as a licensed practical nurse in the State of Ohio would be suspended indefinitely and that such suspension would be stayed subject to probationary terms, conditions, and limitations for a minimum period of one (1) year.. A. Item 1. of the September 2012 Addendum states, "MS. SOEHNLEN is hereby fined five hundred dollars ($500.00). By January 1, 2013, MS. SOEHNLEN shall pay the fine of five hundred dollars ($500.00), by certified check, cashier check, or money order, made payable to the "Treasurer, State of Ohio," to the Board. Payment shall be mailed to the attention of the Compliance Unit, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, OH 43215-7410." Despite this provision, as of February 13, 2013, you have failed to submit to the Board a payment of five hundred dollars ($500.00). B. Item 6. of the November 2011 Consent Agreement states, "MS. SOEHNLEN shall abstain' completely from the use of alcohol or products containing alcohol." Item 7. of the November 2011 Consent Agreement states, "Within forty-five (45) days of the effective date of this Consent Agreement and continuing throughout the probationary period MS. SOEHNLEN shall submit, at her expense and on the day selected, blood, breath, hair, or urine specimens for drug and/or alcohol analysis at a collection site specified by the Board at such times as the Board may request. Upon and after MS.

Jessica L. Soehnlen, L.P.N. Page 2 SOEHNLEN's initiation of drug screening, refusal to submit such specimen, or failure to submit such specimen on the day she is selected, or in such a manner as the Board may request, shall constitute a violation of a restriction placed on a license for purposes of Section 4723.28(B), ORC. This screening shall require a daily call-in process. The specimens submitted by MS. SOEHNLEN shall be negative, except for substances prescribed, administered, or dispensed to her by another so authorized by law who has received a complete copy of this Consent Agreement prior to prescribing for MS. S OEHNL EN." Despite this provision, on the dates set forth in Attachment A, attached hereto and incorporated herein, you failed to call FirstLab, the Board's random drug/alcohol screen program administrator, to determine if you had been selected to provide a specimen for analysis. In addition, on the following dates, you were selected to provide a specimen for analysis and failed to do so: January 24, 2012; December 21, 2012; and January 28, 2013. Furthermore, on November 28, 2012, you provided a specimen for analysis to Firstlab that tested positive for Ethyl Glucuronide (Alcohol). In a statement received by the. Board on December 17, 2012, you stated "I do not consume large amounts of alcohol and I am aware that part of my consent agreement is not to drink alcohol, but I am human. I had a large glass of wine on thanksgiving with my family at dinner." Section 4723.28(B)(17), Ohio Revised Code, ORC, authorizes the Board to discipline a licensee for violation of any restrictions placed on a nursing license by the Board. In accordance with the paragraph under "FAILURE TO COMPLY" of the September 2012 Addendum, you are hereby notified that it appears to the Board that you have violated Item 1. of the September 2012 Addendum, and Items 6. and 7. of the November 2011. Consent Agreement. YOU ARE FURTHER NOTIFIED THAT YOUR LICENSE TO PRACTICE NURSING AS A LICENSED PRACTICAL NURSE, PN-130187, IS HEREBY AUTOMATICALLY SUSPENDED. Continued practice after receipt of this notice of suspension shall be considered engaging in the practice of nursing as a licensed practical nurse without a current, valid license, which is a violation of Section 4723.03(B), ORC. You are further notified that in accordance with Chapter 119, ORC, the Board proposes under authority of Section 4723.28, ORC, to deny 4 permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: 1. On or about September 21, 2012, you entered into an Addendum to Consent Agreement (September 2012 Addendum) with the Ohio Board of Nursing (Board), a copy of which is attached hereto and incorporated herein, in which

Jessica L. Soehnlen, L.P.N. Page 3 you agreed with the Board that your license to practice nursing as a licensed practical nurse in the State of Ohio would be subject to additional probationary terms, conditions and limitations, in addition to the terms, conditions and limitations set forth in the November 2011 Consent Agreement. Attached to and incorporated within the September 2012 Addendum is a Consent Agreement entered into between you and the Board on November 18, 2011 (November 2011 Consent Agreement), in which you agreed with the Board that your license to practice nursing as a licensed practical nurse in the State of Ohio would be suspended indefinitely and that such suspension would be stayed subject to probationary terms, conditions, and limitations for a minimum period of one (1) year. 2. Item 1. of the September 2012 Addendum states, "MS. SOEHNLEN is hereby fined five hundred dollars ($500.00). By January 1, 2013, MS. SOEHNLEN shall pay the fine of five hundred dollars ($500.00), by certified check, cashier check, or money order, made payable to the "Treasurer, State of Ohio," to the Board. Payment shall be mailed to the attention of the Compliance Unit, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, OH 43215-7410." Despite this provision, as of February 13, 2013, you have failed to submit to the Board a payment of five hundred dollars ($500.00). C. Item 6. of the November 2011 Consent Agreement states, "MS. SOEHNLEN shall abstain completely from the use of alcohol or products containing alcohol." Item 7. of the November 2011 Consent Agreement states, "Within forty-five (45) days of the effective date of this Consent Agreement and continuing throughout the probationary period MS. SOEHNLEN shall submit, at her expense and on the day selected, blood, breath, hair, or urine specimens for drug and/or alcohol analysis at a collection site specified by the Board at such times as the Board may request. Upon and after MS. SOEHNLEN's initiation of drug screening, refusal to submit such specimen, or failure to submit such specimen on the day she is selected, or in such a manner as the Board may request, shall constitute a violation of a restriction placed on a license for purposes of Section 4723.28(B), ORC. This screening shall require a daily call-in process. The specimens submitted by MS. SOEHNLEN shall be negative, except for substances prescribed, administered, or dispensed to her by another so authorized by law who has received a complete copy of this Consent Agreement prior to prescribing for MS. SOEHNLEN." Despite this provision, on the dates set forth in Attachment A, attached hereto and incorporated herein, you failed to call FirstLab, the Board's random drug/alcohol screen program administrator, to determine if you had been selected to provide a specimen for analysis. In addition, on the following

Jessica L. Soehnlen, Page 4 dates, you were selected to provide a specimen for analysis and failed to do so: Januhry 24, 2012; December 21, 2012; and January 28, 2013. Furthermore, on November 28, 2012, you provided a specimen for analysis to Firstlab that tested positive for Ethyl Glucuronide (Alcohol). In a statement received by the Board on December 17, 2012, you stated "1 do not consume large amounts of alcohol and I am aware that part of my consent agreement is not to drink alcohol, but I am human. I had a large glass of wine on thanksgiving with my family at dinner." Section 4723.28(B)(17), Ohio Revised Code, ORC, authorizes the Board to discipline a licensee for violation of any restrictions placed on a nursing license by the Board. Accordingly, the Board is authorized to impose one or more of the sanctions as cited in Section 4723.28, ORC. In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing in this matter. If you wish to request such hearing, the request must be made in writing and must be received in the Board office within thirty (30) days of the time of mailing of this notice. You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in writing. At the hearing you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to: Lisa Ferguson-Ramos, Compliance Unit Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, Ohio 432157410, or to the e-mail address, hearinggnursing.ohio.gov. If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Automatic Suspension and Opportunity for Hearing, deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely,

Rhonda S. Barkheimer, R.N., C.N.P. Supervising Board Member Certified Mail Receipt No. 7012 2210 0000 6272 3711 cc: Henry G. Appel, Senior Assistant Attorney General

Case #12-003665

Ohio Board of Nursing

ADDENDUM TO CONSENT AGREEMENT BETWEEN JESSICA L. SOEHNLEN, L.P.N. AND OHIO BOARD OF NURSING

www.nursing.ohio.gov

17 South High Street, Suite 400 6 Columbus, Ohio 43215-7410 0 (614) 466-3947

This Addendum to the Consent Agreement (Addendum) is entered into by and between JESSICA L. SOEHNLEN, L.P.N. (MS. SOEHNLEN) and the Ohio Board of Nursing (Board), the state agency charged with enforcing Chapter 4723. of the Ohio Revised Code (ORC), and all administrative rules promulgated thereunder. For purposes of this Agreement, "Addendum" shall be defined as this Agreement and the following record attached hereto and incorporated herein: November 18, 2011 Consent Agreement (November 2011 Consent Agreement). This Addendum and the attached November 2011 Consent Agreement contain the entire agreement between the parties, there being no other agreement of any kind, verbal or otherwise, which varies the terms. BASIS FOR ACTION This Addendum is entered into on the basis of the following stipulations, admissions and understandings: A. The Board is empowered by Section 4723.28, ORC, to deny, permanently revoke, revoke, suspend, or place restrictions on any license issued by the Board; reprimand or otherwise discipline a licensee; or impose a fine of five hundred dollars ($500.00) or less per violation. Section 4723.28(B)(17), ORC, authorizes the Board to discipline a licensee who violates any restrictions placed on a nursing license by the Board. Section 4728.28(8)(19), ORC, authorizes the Board to discipline a licensee for failure to practice in accordance with acceptable and prevailing standards of safe nursing care. Section 4723.28(8)(16), ORC, authorizes the Board to discipline a licensee for violation of this chapter or any rules adopted under it. Specifically, Rule 4723-4-06(E), Ohio Administrative Code (OAC), states that a licensed nurse shall, in a complete, accurate, and timely manner, report and document nursing assessments or observations, the care provided by the nurse for the client, and the client's response to that care. Rule 4723 4 06(J)(2), OAC, states that at all times when a licensed nurse is providing direct nursing care to a client the licensed nurse shall: treat each client with courtesy, respect, and with full recognition of dignity and individuality. MS. SOEIMEN has an active license to practice nursing as a licensed practical nurse, PN-130187, in the State of Ohio. MS. SOEHNLEN was initially licensed as a licensed practical nurse in May 2008.

B.

Jessica L. Soehnle L.P.N. Page 2

MS. SOEHNLEN knowingly and voluntarily admits to the following: 1. On November 18, 2011, MS. SOEHNLEN entered into a Consent Agreement with the Board (November 2011 Consent Agreement), under which MS. SOEHNLEN's license to practice nursing as a licensed practical nurse was subject to probationary terms, conditions, and limitations for a minimum period of one (1) year. Item 1. of her November 2011 Consent Agreement states, "MS. SOEHNLEN shall obey all federal, state, and local laws, and all laws and rules governing the practice of nursing in Ohio." On or about June 4, 2012, while working as a nurse at Hennis Care Centre (Hennis Care) in Boliver, Ohio, MS. SOEHNLEN received a final warning and three (3) day suspension for failing to assess a resident after being informed that the resident was vomiting and there was a concern of aspiration. On or about June 18, 2012, MS. SOEHNLEN was terminated from nursing employment at Hennis Care for using profanity in front of residents, while at the nurse's station. MS. SOEHNLEN apologizes and states that her lack of sleep led to her using poor judgment and unprofessional language. MS. SOEHNLEN is willing to cooperate with the Board to resolve the issues described herein and acknowledges that she is fully responsible for each and every obligation imposed by this Addendum and the attached November 2011 Consent Agreement. AGREED CONDITIONS Wherefore, in consideration of the foregoing and mutual promises hereinafter set forth, and in lieu of any formal proceedings at this time, MS. SOEHNLEN's license to practice nursing as a licensed practical nurse is hereby REPRIMANDED. MS. SOEHNLEN knowingly and voluntarily agrees with the Board to the following terms, conditions and limitations, in addition to the terms, conditions, limitations set forth in the November 2011 Consent Agreement: 1. MS. SOEHNLEN is hereby fined five hundred dollars ($500.00). By January 1, 2013, MS. SOEHNLEN shall pay the fine of five hundred dollars ($500.00); by certified check, cashier check, or money order, made payable to the "Treasurer, State of Ohio," to the Board. Payment shall be mailed to the attention of the Compliance Unit, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, 01143215-7410. 2. By January 1, 2013, in addition to the requirements for licensure renewal, MS. SOEHNLEN shall successfully complete and submit documentation of satisfactory completion of the following continuing nursing education taken subsequent to the effective date of this Addendum: Eight (8) hours of Professionalism; six (6) hours of Patient Assessment; four (4) of Critical

2.

3.

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5. 6.

Jessica L. Soehnlen, L.P.N. Page 3 Thinking; and two (2) hours of Laws and Rules Governing the Practice of Nursing in Ohio. 3. Upon request by the Board or its designee and within ninety (90) days of such a request, MS. SOEHNLEN shall, at her expense, obtain a psychiatric evaluation from a Board approved psychiatrist and shall provide the Board with complete documentation of this evaluation. Prior to the evaluation, MS. SOEHNLEN shall provide the psychiatrist with a copy of this Addendum and the attached November 2011 Consent Agreement and shall execute releases to permit the psychiatrist to obtain any information deemed appropriate and necessary for the evaluation. The psychiatrist shall submit a written opinion to the Board that includes diagnoses, recommendations for treatment and monitoring, any additional restrictions that should be- placed on MS. SOEHNLEN's license, and whether MS. SOEHNLEN is capable of practicing nursing according to acceptable and prevailing standards of safe nursing care. 4. If a psychiatric evaluation is requested, MS. SOEHNLEN shall provide the Board with satisfactory documentation of compliance with all aspects of the treatment plan developed by the psychiatrist until released. Further, MS. SOEHNLEN agrees that the Board may use the psychiatrist's recommendations and conclusions from the evaluation as a basis for additional terms, conditions, and limitations on MS. SOEHNLEN's license and that the terms, conditions, and limitations may be incorporated by an addendum. 5. In addition to the requirements in Item 11. of the November 2011 Consent Agreement, MS. SOEHNLEN shall provide a copy of this Addendum and the attached November 2011 Consent Agreement to her employer(s). MS. SOEHNLEN shall have her empIoyer(s) send documentation to the Board of receipt of this Addendum and the attached November 2011 Consent Agreement, including the date they were received. FAILURE TO COMPLY MS. SOEHNLEN agrees that her license to practice nursing as a licensed practical nurse will be automatically suspended if it appears to the Board that MS. SOEHNLEN has violated or breached any terms or conditions of this Addendum or the attached November 2011 Consent Agreement. Following the automatic suspension, the Board shall notify MS. SOEHNLEN via certified mail of the specific nature of the charges and automatic suspension of her license. Upon receipt of this notice, MS. SOEHNLEN may request a hearing regarding the charges. The above described terms and conditions shall constitute "restrictions placed on a license" for purposes of Section 4723,28(B), ORC. If, in the discretion of the Board, MS. SOEHNLEN appears to have violated or breached any terms or conditions of this Addendum or the attached November 2911 Consent Agreement, the Board reserves the right to institute formal disciplinary proceedings for any and all possible violations or breaches, including, but not limited to, alleged violations of the laws of Ohio occurring before the effective date of this Addendum to the Consent Agreement.

Jessica L. Soehnlen, L.P.N. Page 4 DURATION/ MODIFICATION OF TERMS The terms, limitations, and conditions of this Addendum and the attached November 2011 Consent Agreement, may be modified or terminated, in writing, at any time upon the agreement of both MS. SOEHNLEN and the Board. The Board may only alter the probationary period imposed by this Addendum and the November 2011 Consent Agreement it (1) the Board determines that MS. SOEHNLEN has complied with all aspects of this Addendum and the November 2011 Consent Agreement; and (2) the Board determines that MS. SOEHNLEN is able to practice according to acceptable and prevailing standards of safe nursing care without Board monitoring, based upon an interview with MS. SOEHNLEN and review of the reports as required herein. Any period during which MS. SOEHNLEN does not work in a position for which a nursing license is required shall not count toward fulfilling the probationary period imposed by this Addendum and by the November 2011 Consent Agreement. ACKNOWLEDGMENTS/LIABILITY RELEASE Except as modified above, all terms of the November 2011 Consent Agreement remain in effect. MS. SOEHNLEN acknowledges that she has had an opportunity to ask questions concerning the terms of this Addendum and that all questions asked have been answered in a satisfactory manner. MS. SOEHNLEN waives all of her rights under Chapter 119, ORC, as they relate to matters that are the subject of this Addendum. MS. SOEHNLEN waives any and all claims or causes of action she may have against the Board, and its members, officers, employees and/or agents arising out of matters, which are the subject of this Addendum. This Addendum shall be considered a public record as that term is used in Section 149.43, ORC. The information contained herein may be reported to appropriate organizations, data banks and governmental bodies. This Addendum is not an adjudication order as discussed in Chapter 119, ORC. Any action initiated by the Board based on alleged violations of this Addendum shall comply with the Administrative Procedures Act, Chapter 119, ORC.

Jessica L.. Soehnlen, 1. ,P.N. Page 5 EFFECTIVE DATE M.S. SOEiINLEN understands that this Addendum is subject to ratification by di to signature by the Board President and shall become effective upon the last date below. ard prior signature

x,ATE

BERTRA LOVELACE, resident Ohio Board of Nursing

DATE

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Case #09-4998

Ohio Board of Nursing

CONSENT AGREEMENT BETWEEN JESSICA L. SOEHNLEN, L.P.N. AND OHIO BOARD OF NURSING

www.nursing.ohio.gov
614) 466-3947

17 South High Sir:-et. Suik 40(1 0 Columbus. Ohio 4321.5-7410

This Consent Agreement is entered into by and between JESSICA L. SOEHNLEN, L.P.N. (MS. SOEHNLEN) and the Ohio Board of Nursing (Board), the state agency charged with enforcing Chapter 4723. of the Ohio Revised Code (ORC), and all administrative rules promulgated thereunder. MS. SOEHNLEN voluntarily enters into this Consent Agreement being fully informed of her rights under Chapter 119, ORC, including the right to representation by legal counsel and the right to a formal adjudicative hearing on the issues considered herein. This Consent Agreement contains the entire agreement between the parties, there being no other agreement of any kind, verbal or otherwise, which varies the terms of this Consent Agreement. $ASIS FOR ACTION This Cunsent Agreement is entered into on the basis of the following stipulations, admissions and understandings: A. The Board is empowered by Section 4723.28, ORC, to deny, permanently revoke, revoke, suspend, or place restrictions on any license issued by the Board; reprimand or otherwise discipline a licensee; or impose a fine of five hundred dollars ($500.00) or less per violation. Section 4723.28(B)(8), ORC, authorizes the Board to discipline a licensee for self-administering or otherwise taking into the body any dangerous drug, as defined in Section 4729.01, ORC, in any way not in accordance with a legal, valid prescription issued for that individual. B. MS. SOEHNLEN has been licensed to practice nursing as a licensed practical nurse in the State of Ohio, PN-130187, since May 2008. MS. SOEHNLEN has an active license as a licensed practical nurse. C. In MS, SOEFINLEN's November 2009 correspondence to the Board, MS, SOEHNLEN states that she was at a party in October 2009 where Marijuana was being smoked and she participated because she was not scheduled to work for a few days. MS. SOEHNLEN states that after a random work screen requested by her employer, Bennis Care Centre (Bennis), Dover, Ohio, she tested positive for Marijuana.

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Jessica L. Soehnlen, L.P.N . Page 2 D. MS. SOEHNLEN states and acknowledges the following: I. As a result of her positive screen, her employer, Bennis, suspended her for four weeks and required an assessment by Chrysalis Counseling Center. MS. SOEHNLEN participated in four weeks of counseling and was allowed to return to work subject to drug random screens for two years. MS. SOEHNLEN continued to participate in counseling for a total of nine weeks to work on additional "life issues." After MS, SOEHNLEN returned to work for Bennis, her nursing practice was scrutinized by her employer for a period of time. B.. Bennis has submitted a letter in support of MS. SOEHNLEN stating Bennis intends to continue to employ MS. SOEHNLEN and that she is an asset to Bennis Care Centre of Bolivar. AGREED CONDITIONS Wiierefore, in consideration of the foregoing and mutual promises hereinafter set forth, and in lieu of any formal proceedings at this time, MS. SOEHNLEN knowingly and voluntarily agrees with the Board to the following terms, conditions, and limitations: MS. SOEHNLEN's license to practice nursing as a licensed practical nurse shall be suspended indefinitely. Such suspension shall be stayed, subject to the following PROBATIONARY terms, conditions, and limitations for a minimum period of one (1) year: I. 2. M.S. SOEHNLEN shall obey all federal, state, and local laws, and all laws and rules governing the practice of nursing in Ohio. MS. SOEHNLEN shall appear in person for interviews before the full Board or its designated representative as requested by the Board or its designee. MS. SOEKNLEN shall, in addition to the requirements of licensure renewal, successfully complete and submit satisfactory documentation of successful completion of the following continuing nursing education taken subsequent to the effective date of this Consent Agreement: five (5) hours of Professionalism; five (5) hours of Chemical Dependency; and one (1) hour of Ohio Law and Rules. MS. SOEHNLEN agrees that she will submit a request to the Bureau of Criminal Identification and Investigation (BCII) to conduct a criminal records check of MS. SOEHNLEN, including a check of Federal Bureau of Investigation (FBI) records, and shall request BCII to submit MS. SOEBNLEN's criminal records check reports to the Board. MS. SOEHNLEN's completed criminal records check, including the FBI check, must be received by the Board within six (6) months prior to the release of these probatignary terms.

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Jessica L. Sothnlen, Page 3 Monitoring 5. M.S. SOEHNLEN shall abstain completely from the personal use or possession of drags, except those prescribed, administered, or dispensed to her by another so authorized by law who has received a complete copy of this Consent Agreement prior to prescribing for MS. SOEHNLENA MS. SOEHNLEN shall self-administer the prescribed drugs only in the manner prescribed. MS. SOEHNLEN shall abstain completely from the use of alcohol or products containing alcohol. Within forty-five (45) days of the effective date of this Consent Agreement and continuing throughout the probationary period MS. SOEHNLEN shall submit, at her expense and on the day selected, blood, breath, hair, or urine specimens for drug and/or alcohol analysis at a collection site specified by the Board at such times as the Board may request. Upon and after MS. SOEHNLEN's initiation of drug screening, refusal to submit such specimen, or failure to submit such specimen on the day she is selected, or in such a manner as the Board may request, shall constitute a violation of a restriction placed on a license for purposes of Section 4723.28(B), DEC. This screening shall require a daily call-in process. The specimens submitted by MS. SOEHNLEN shall be negative, except for substances prescribed, administered, or dispensed to her by another so authorized by law who has received a complete copy of this Consent Agreement prior to prescribing for MS. SOEHNLEN. a. Prior to MS, SOEHNLEN initiating drug screening, MS. SOEHNLEN shall provide a copy of this Consent Agreement to all treating practitioners and shall provide to the Board a list of all treating practitioners, including addresses and telephone numbers and cause all treating practitioners to complete a medication prescription report that is to be mailed by the practitioner directly to the Board. The medication report is to be completed for any and all substances prescribed, administered, or dispensed to MS. SOEHNLEN. b. After initiating drug screening, MS. SOEHNLEN shall be under a continuing duty to provide a copy of this Consent Agreement, prior to initiating treatment, to additional treating practitioners, and to update the list of treating practitioners with the Board within forty-eight (48) hours of being treated by another practitioner. Further, MS. SOERNLEN shall notify the Board of any and all rnedication(s) or prescription(s) received within twenty-four (24) hours of release from hospitalization or medical treatment. 8. Upon the request of the Board or its designee and within sixty (60) days oil that request, MS. SOEHNLEN shall, at her expense, obtain a chemical

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Page 4 dependency evaluation by a Board approved chemical dependency professional and shall provide the Board with complete documentation of this evaluation. Prior to the evaluation, MS. SOEHNLEN shall provide the chemical dependency professional with a copy of this Consent Agreement and treatment records from Chrysalis Counseling Center. Further, MS. SOEHNLEN s,laall execute releases to permit the chemical dependency professional to obtain any information. deemed appropriate and necessary for the evaluation. The professional shall submit a written opinion to the Board that includes diagnoses, recommendations for treatment and monitoring, any additional restrictions that should be placed on MS. SOEHNLEN's license to practice, and stating whether M.S. SOEHNLEN is capable of practicing nursing according to acceptable and prevailing standards of safe nursing care. 9. If a chemical dependency evaluation is requested, MS. SOEHNLEN shall provide the Board with satisfactory documentation of compliance with all aspects of the treatment plan developed by the chemical dependency professional described above until released. Further, MS. SOEHNLEN agrees that the Board may utilize the professional's recommendations and conclusions from the evaluation as a basis for additional terms, conditions, and limitations on MS. SOEHNLEN's license and that the terms, conditions, and limitations may be incorporated in an addendum to this Consent Agreement.

Employment Conditions 10. MS. SOEHNLEN shall notify the Board, in writing, of the name and address of any current employer within thirty (30) days following the effective date of this Consent Agreement, or any new employer prior to accepting employment. MS. SOEHNLEN, within fifteen (15) clay of the effective date of the Consent Agreement, if working in a position in which a nursing license is required, shall provide her employer(s) with a copy of this Consent Agreement. Further, MS. SOEHNLEN is under a continuing duty to provide a copy of this Consent Agreement to any new employer prior to accepting nursing employment, MS. SOEHNLEN shall have her employer(s), if working in a position, where a nursing license is required, submit written reports regarding job performance on a quarterly basis beginning within thirty (30) days of the effective date of this Consent Agreement or beginning within thirty (30) days of working in a nursing position. MS. SOEHNLEN shall have her employer(s) send documentation to. the Board, along with the first employer report, of receipt of a copy of this Consent Agreement, including the date Consent Agreement was received,

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Jessica L. Soehnien, L.P.N. Page 3 Reporting Requirements 12, S. SOEHNLEN shall report to the Board, in writing, any violation of this Consent Agreement within thirty (30) days of the occurrence of the violation. MS. SOEHNLEN shall sign release of information forms allowing health professionals and other organizations to submit the requested documentation directly to the Board.

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S. SOEHNLEN shall submit any and all information that the Board may request regarding her ability to practice according to acceptable and prevailing standards of safe nursing practice.
MS. SOEHNLE11 shall not submit or cause to be submitted any false, misleading, or deceptive statements, information, or documentation to the Board or to employers or potential employers. MS. SOEHNLEN shall submit the reports and documentation required by this Consent Agreement on forms specified by the Board. All reporting and communications required by this Consent Agreement shall be made to the Compliance Unit of the Board. MS. SOEHNLEN shall submit the reports and documentation required by this Consent Agreement or any other documents required by the Board to the attention of the Compliance Unit, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, OH 43215-7410. M.S. SOEHNLEN shall verify that the reports and documentation required by this Consent Agreement are received in the Board office. MS. SOEHNLEN shall inform the Board within five (5) business days, in writing, of any change in employment status or of any change in residential or home address or telephone number.

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Temporary Practice Restrictions MS. SOEHNLEN further knowingly and voluntarily agrees with the Board, to the following TEMPORARY LJCENSURE RESTRICTIONS with the exception of MS. SOEHNLEN currently employer, HET,INIS CARE CENTRE, Bolivar, Ohio, or its successors: Unless otherwise approved in advanee, in writing, by the Board or its designee, MS. SOEHNLEN shall not practice nursing as a licensed practical nurse (1) for agencies providing home care in the patient's residence; (2) for hospice care programs providing hospice care in the patient's residence; (3) for staffing agencies or pools; (4) as an independent provider where the nurse provides nursing care and is reimbursed for services by the State of Ohio through State agencies or agents of the State; or (5) for an individual or group of individuals who directly

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#849 P.007/008

Jessica L. Soehnlen, L.P.N. Page. 6 engage MS. SOEHNLEN to provide nursing services for fees, compensation, or other consideration or who engage M.S. SOEHNLEN as a volunteer. Unless otherwise approved in advance, in writing, by the Board or its designee, MS. SOEHNLEN shall not function in a position or employment where the job duties or requirements involve management of nulling and nursing responsibilities, or supervising and evaluating nursing practice. Such positions include, but are not limited to, the following: Director of Nursing, Assistant Director of Nursing, Nurse Manager, Vice President of Nursing. FAILURE TO COMPLY MS. SOEHNLEN agrees that her license to practice nursing as a licensed practical nurse will be automatically suspended if it appears to the Board that MS. SOEHNLEN has violated or breached any terms or conditions of the Consent Agreement. Following the automatic suspension, the Board shall notify MS. SOEHNLEN via certified mail of the specific nature of the charges and automatic suspension of her license. Upon receipt of this notice, MS. SOENNLEN may request a hearing regarding the charges. The above described terms and conditions shall constitute "restrictions placed on a license" for purposes of Section 4723.28(B), ORC. lf, in the discretion of the Board, MS. SOEHNLEN appears to have violated or breached any terms or conditions of this Consent Agreement, the, Board reserves the. right to institute formal disciplinary proceedings for any and all possible violations or breaches, including, but not limited to, alleged violations of the laws of Ohio occurring before the effective date of this Consent Agreement. DURATION/ MODIFICATION OF TERMS The terms, limitations, and conditions, of this Consent Agreement may be modified or terminated, in writing, at any time upon the agreement of both MS. SOEHNLEN and the Board, The. Board may only alter the probationary period imposed by this Consent Agreement if: (I) the Board determines that MS. SOEHNLEN has complied with all aspects of this Consent Agreement; and (2) the Board determines that MS, SOEHNLEN is able to practice according to acceptable and prevailing standards of safe nursing care without Board monitoring, based upon an interview with MS. SOEHNLEN and review of the reports as required herein. Any period during which MS, SOEHNLEN does not work in a position for which a nursing license is required shall not count toward fulfilling the probationary period imposed by this Consent Agreement. AcK.NOWLEDGMENTS/LIABILITY RELEASE MS. SOEHM...EN acknowledges that she has had an opportunity to ask questions concerning the terms of this Consent Agreement and that all questions asked have been answered in a satisfactory manner,

11/01/2011 TUE 10:67 FTX/RX NO 7044) Pt007

From:3308749937

11/01/2011 10:30

#649 P,006/008

Jessica L. Soehnlen, L.P.N. Page 7 MS. SOEHNLEN waives all of her rights under Chapter 1/9, ORC, as they relate to matters that are the subject of this Consent Agreement. MS. SOEHNLEN waives any and all claims or causes of action she may have against the Board, and its members, officers, employees and/or agents arising out of matters, which are the subject of this Consent Agreement. This Consent Agreement shall be considered a public record as that term is used in Section 149.43, ORC. The information contained herein may be reported to appropriate organizations, data banks and governmental bodies. This Consent Agreement is not an adjudication order as discussed in Chapter 119,. ORC. Any action initiated by the Board based on alleged violations of this Consent Agreement shall comply with the Administrative Procedures Act, Chapter 119, ORC. yFFECTIVE DATE MS. SOEHNLEN understands that this Consent Agreement is subject to ratification by the Board prior to signature by the Board President and shall become effective upon the last date of signature below,

JES

A L, SOE

EN, L.P.N.

DATE

$8/4 0/019-1Rd
B RTHA. LOVELACE, President Ohio Board of Nursing DATE

it

4
11/01/2011 TUE 10:57 fTX/RX NO 70441 a008

ATTACHMENT A

Jessica Lynn Soehnlen

Missed Call History: 11/03/2012 11/18/2012 12/02/2012 12/22/2012 12/23/2012 12/24/2012 12/25/2012 12/26/2012 12/27/2012 12/28/2012 12129/2012 12/30/2012 12/31/2012 01/01/2013 01/02/2013 01/03/2013 01/04/2013 01/05/2013 01/06/2013 01/07/2013 01/08/2013 01/09/2013 01/10/2013 01/11/2013 01/12/2013 01/13/2013 Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Cali Missed Call Missed Call Missed Cali Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Details ' '

01/14/2013' Missed Call 01/15/2013 01/16/2013 01/1712013 01/1812013 01/19/2013 01/20/2013 01/21/2013 01/22/2013 01/23/2013 01/24/2013 01/25/2013 01/26/2013 01/27/2013 01/28/2013 01/29/2013 01/30/2013 01/31/2013 Row Count: 44 Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call

Case #2013-000182

Ohio Board of Nursing

March 22, 2013

ww nurs ng . oh i o. gov

17 South High Street, Suite 400 m Columbus, Ohio 43215-7410 (614) 466-3947

N TICE OF OPPORTUNITY R IlkARING

Traci J. Sonney, R.N. 371 Olentange Street Columbus, Ohio 43202 Dear Ms. Sonney: In accordance with Chapter 119. of the Ohio Revised Code (ORC), you are hereby notified that the Ohio Board of Nursing (Board) proposes under the authority of Section 4723.28, ORC, to deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: On or about May 22, 2012, the Arizona State Board of Nursing issued an Order of Denial No. 1112026 (Arizona Board 2012 Order) in which your application for a license to practice as a registered nurse in Arizona was denied and any temporary license issued was revoked. A copy of the Arizona Board 2012 Order is attached hereto and incorporated herein. Section 4723.28(B)(1) [as in effect prior to March 20, 20131, ORC, authorizes the Board to discipline a license for denial, revocation, suspension, or restriction of authority to practice a health care occupation, including nursing, for any reason other than a failure to renew, in Ohio or another state or jurisdiction. 2. The Arizona Board 2012 Order further indicates that on or about April 18, 2012, you underwent an evaluation by licensed psychologist Lynda K. Vaterlaus, Ph.D. and were diagnosed with: (1) Alcohol Dependence, Early Full Remission, Provisional; (2) Major Depressive Disorder, Moderate Recurrent; (3) Oppositional Defiant Disorder: (4) Attention Deficient Hyperactivity Disorder and noted a History of Conduct Disorder as an Adolescent, and you were identified as being at significant risk for relapse. Dr. Vaterlaus opined that you should receive Intensive Outpatient Substance Abuse Treatment, in addition to other terms and conditions, ) before being permitted to practice nursing. You have been convicted of multiple impairment-related crimes including the following: (a) On or about February 26, 2013, in Franklin County Municipal Court Case No. 12TRC144156, you were convicted of OVI, a first-degree misdemeanor violation of Section 4511.19(A), ORC. This incidat occurred on or about May 27, 2012 and involved a BAC reading of .226; (b) On or about July 8, 2011, in Franklin County Municipal Court Case No. 10TRC125876, you were convicted of OVI, a

Traci J. Sonney, R.N. Page 2

first-degree misdemeanor violation of Section 4511.19(A), ORG. This incident occurred on or about April 12, 2010; (c) On or about October 18, 2007, in Franklin County Municipal Court Case No. 2007 TRC 154944, you pled guilty to, and were convicted of, OVI, a first-degree misdemeanor in violation of Reynoldsburg Code of Ordinances 333.01(A)(1). Section 4723.28(B)(11), ORC, authorizes the Board to discipline a licensee for impairment of the ability to practice according to acceptable and prevailing standards of safe nursing care because of a physical or mental disability, Rule 4723-3-02, Ohio Administrative Code (OAC), provides that for purposes of division (0) of section 4723.28 of the Revised Code and division (B)(11) of section 4723.28 of the Revised Code, the following definitions apply: (B) "Impaired" and "impairment" includes inability to practice according to acceptable and prevailing standards of safe nursing care without appropriate treatment, monitoring, or supervision. 3. On or about October 18, 2007, in Franklin County Municipal Court Case No. 2007 TRC 154944, you pled guilty to, and were convicted of, OVI, a first-degree misdemeanor in violation of Reynoldsburg Code of Ordinances 333.01(A)(1). Despite this, on your application to renew your registered nursing license, submitted to the Board online on or about July 31, 2009, you responded "No" to the question whether you had "a misdemeanor in Ohio, another state, commonwealth, territory, province, or country?"

Section 4723.28(B)(16), ORC, authorizes the Board to discipline a licensee for violation of Chapter 4723, ORC, or any rules adopted under it. Specifically, Rule 4723-4-06 (P), OAC, states that a licensed nurse shall not make any false, misleading, or deceptive statements, or submit or cause to be submitted any false, misleading or deceptive information, or documentation to: (1) The board or any representative of the board. Accordingly, the Board is authorized to impose one or more of the sanctions as cited in Section 4723.28 ORC. You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in writing. At the hearing you may also present evidence and examine witnesses appearing for and against you. Should you cl)oose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to: Lisa Ferguson-Ramos, Compliance Unit Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, OH 432157410, or to the email address, hearing@nursing.ohio.00v. If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Opportunity for Hearing, deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a registered nurse;

Traci J. Sonnet, R.N. Page 2

reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely,
; -(7 6c3 , 4/174._) 4 /get.

KA/ e_ v/v,i

Rhonda S. Barkheimer, C.N.P. Supervising Board Member Certified Mail Receipt No. 7012 2210 0000 6272 3247 cc: Henry G. Appel, Senior Assistant Attorney General

Janice K. Brewer
Oovemor

Joey Ride110Ur EAcutive Director

Arizona State BOard of Nursing

4747 North 7th Street, Suite 200 Phoenix AZ 85014-3655 Phone (602) 771-7800 Fax (602) 7714888 t-Mail: arizortaazim.gov Horne Page: http:/iwwvv.azbn.gov CD. r'IrD C::; n:v N.)

AFFIDAVIT OF CUSTODIAN OF RECORDS STATE OF ARIZONA COUNTY OF MARICOPA

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I, Joey Ridenour, Executive Director for the Arizona State Board of Nursing, County of Maricopa, State of Arizona, do hereby certify that I am the officer having the legal custody for the records hereto attached in the office of the Arizona State Board of Nursing, County of Maricopa, State of Arizona, a public office of said State. The attached copies are true copies of the records on TRACI JANE SONNEY. Personnel of the Arizona State Board of Nursing prepared the records during the ordinary course of business. Witness my hand and the seal of the Arizona State Board of Nursing at 4747 N. 7th Street, Suite 200, Phoenix, Arizona 850 l4-3655 on January 14, 2013.

SEAL

Joey Ridenour, R.N., M.N., FA.A.N. Executive Director

BEFORE THE ARIZONA STATE BOARD OF NURSING 1 IN THE MATTER OF APPLICATION FOR LICENSE BY: TRACI JANE SONNEY TO PRACTICE REGIS LURED NURSING IN THE STATE OF ARIZONA

w ORDER. OF DENIAL > NO. 1112026

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On May 22, 2012, the Arizona State Board of Nursing ("Board") considered the a licensure of Traci Jane Sonney ("Applicant"). , OF FACT FINDINS 1,

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On November 16, 2011, Applicant applied to. the Board for licensure as a

registered nurse by Endorsement. As a result of information received during the application process, the Board conducted an investigation. 2. On or about January 18, 2007, according to the Reynoldsburg Police Department

(OH), report # 1-07-00273, Applicant Was arrested and cited with OVI-Operating Under the Influence or Alcohol and/or Drugs, Applicant was uncooperative towards police, and by her own admission to Board staff, "a jerk." The officer wrote that Applicant "was extremely intoxicated and very violent. She was unfit to drive," On or about October 18, 2007, in the Franklin County Municipal Court (OH), case number 2007-TRC154-944a Applicant was convicted pursuant to a guilty plea, of Operating a Motor Vehicle Under the Influence, a misdemeanor. On December 27, 2007 a warrant was issued for failure to pay fines/costs. On May 23, 2008, the account is noted as paid in full and the warrant was canceled, . 3, On or about September 8., 2008, according Applicant, she was arrested and

charged with Assault/Domestic Violence. On ot/ about January 14, 2009, in the Franklin County Municipal Court (MB), case number 2008CRB022170, the. case was dismissed for unknown reasons. However, in her February 16, 2012, written statement to the Board, Applicant admitted

that she was very angry and her husband got into an argument and "1 became more heated and ended up biting his ear. ..both charges were dismissed with in a few days." In addition, during her March 2, 2012, investigative interview with Board staff, Applicant did indicate, when asked, that had she not been drunk, Applicant stated she probably would have controlled her temper better, 4, On or about April 12, 2010, at 0019 hours, according to the Reynoldsburg Police

Department (OH), report number 1-10-002696, Applicant was issued a citation for Fail to Control, Operating a Vehicle While Impaired, (OVI), OVI refusal with prior refusal. Police responded to an accident involving a motorcycle on B. Livingston Ave at Brice Rd. Applicant told the officer that "another vehicle forced her off the road and she drove into the curb." Applicant initially refused to provide a Breath Sample, but changed her mind. When she first blew, the machine quickly showed at .201 BAC. Applicant removed her lips from the tube and failed to follow the officer's instructions and the test went invalid. A witness came forward who saw the accident stating that there was no other vehicle involved and Applicant pulled out of Scotties Bar looping around striking the curb. On or about July 08, 2011, in the Franklin County Municipal Court (OH), case number10-125876, Applicant was convicted of OVI Impaired, a misdemeanor. Applicant is on probation until July 8, 2013, 5. On or about March 2, 2012, Applicant admitted to Board staff that in 2008 or

2009 (she could not recall), Applicant voluntarily admitted her self in to rehab (substance abuse treatment), specifically Parkside in Colun3,bus, OH, where she remained for three days, Applicant admitted to Board staff that she recognized that she was drinking too much. Applicant told Board staff that her alcohol consumption increased after her son's death and that she "did some" AA, in 2010, Applicant estimates that in the last 12 months, she has consumed alcohol to

NO. 1112026 Page 2 of 5

excess, approximately a half a dozen times, most recently "a couple months ago," and that she has experienced 3 or 4 blackouts, as an adult, most recently, a couple years ago. She last consumed alcohol, specifically, bpr, approximately a week ago. Applicant doesn't believe she has a problem with alcohol because she "has cut way back." 6. On or about January 10, 2011, Board Staff mailed Applicant a questionnaire with

instructions to respond by January 25, 2012. Applicant failed to respond by the due date, and on February 16, 2012, Board staff received Applicant's late and incomplete response. Applicant failed to provide any police reports for any case. 7. While employed as a registered nurse with Ohio Health / Riverside Hospital (OH),

from approximately March 2008 though her termination on July 19, 2010, Applicant had a documented pattern of absenteeism, pattern of tardiness, leaving the hospital during her assigned shifts without authorization to do so, unprofessional conduct, and failing to complete her continued education. Corrective action(s) throughout her employment indicates that Applicant's behavior caused increased workload for staff and decreased morale and jeopardized patient safety. 8. On or about October 20, 2008, while employed as a registered muse with Ohio

Health / Riverside Hospital (OH), Applicant mislabeled lab specimens. According to the record, ' to Patients." "Mislabied specimens is a safety issue to patients and can cause harm 9. On April 18, 2012. Applicant underwent an evaluation by licensed psychologist

Lynda K. Yak:11.am, Ph.D. As a result, Applicant was diagnosed with (1) Alcohol Dependence, Early Full Remission, Provisional; (2) Major Depressive Disorder, Moderate Recurrent; (3) Oppositional Defiant Disorder; (4) Attention Deficient Hyperactivity Disorder and noted a History of Conduct Disorder as an Adolescent ,and identified Sonney as being at significant risk

10. 1112026 Page 3 of 6 1 ,

of relapse.

Dr. Vaterlaus, opined that before Sonney should receive Intensive Outpatient

Substance Abuse Treatment, in addition to other terms and conditions, before Sonney is permitted to practice nursing. CONCLUSIONS OF LAW In light of the above Findings of Fact, the Board has cause to deny the application for licensure of Traci Jane Sonney pursuant to A.R.S. 32-1663(A) and (B), as defined in A.R.S. 32-1601(18)(d)(Any conduct or practice that is or might be harmful or dangerous to the health of a patient or the public);(g)(Willfully or repeatedly violating a provision of this chapter or a rule adopted pursuant to this chapter) and Wiolating a rule that is adopted by the Board pursuant to this chapter)(effective September 30, 2009), specifically: A.A.C. R4-19-403(17)(A pattern of using or being under the influence of alcohol, drugs, or a similar substance to the extent that judgment may be impaired and nursing practice detrimentally affected, or while on duty in any health care facility, school, institution, or other work location) (effective January 30, 2009) - A.A.C, R4-19-403 (25)(Failing to: a, Furnish in writing a full and complete explanation of a matter reported pursuant to A.R.S. 32-1664) (effective January 30, 2009) - 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) (effective January 30, 2009)

ORDER NOW THEREFORE, IT IS ORDERED that the application of Traci Jane Sonney for a license to practice as a registered nurse in the State of Arizona is denied and any temporary license issued to Applicant is hereby revoked. Pursuant to A.A.C. R4-19-609, the effective date of the Order of Denial is upon expiration of the time for filing an appeal, 30 days after the date of service of the Order of Denial.

NO. 1112026 Pap 4 of 6

MIS FURTHER ORDERED that Applicant is not eligible to reapply for said license pursuant to A.A.C. R4-19-404 for at minimum, five years from the effective date of the Order of Denial. # IT IS FURTHER ORDERED that Applicant shall immediately cease and desist the practice of nursing in the State of Arizona and is not eligible to practice nursing in Arizona under the privilege of any Compact state without prior approval from the Arizona Board of Nursing. PURSUANT TO A.R.S. 41-1092.03, any person aggrieved by this Order may apply to the Board, in writing, within thirty days of receipt and request a public hearing with respect to this Order. If you request a public hearing with respect to this Order, you also haVe the right to request an informal settlement conference by filing a written request with the Board, pursuant to A.R.S. 41-1092.06, no later than 20 days before the scheduled hearing. The conference will be held within 15 days after receipt of your request. Please note that you waive any right to object to the participation of the Board's representative in the final administrative decision of the matter if it is not settled at the conference. For answers to questions regarding the appeals process, contact Vicky Driver, at (602) 771-7852. DATED this 22nd day of May, 2012. ARIZONA STATE BOARD OF NURSING SEAL
CPU( deM.

Ridenour, RN, M.N., F.A.A.N. key Ridenour, Executive Director

JR/1,1v1

NO. 1112026 Page 5 of 6

 COPY mailed this 29u' day of June 2012, by Certified Mail No, 7009 0080 0000 0431 8060 to: Traci Jane Sonney 3974 Singal Dr COLUMBUS OH 43232

By:

.D, Lindsey
Legal Secretary

Case # 11-003722

Ohio Board of T:fsl'iti sing

www.nursing.ohio. gov
(614) 466-3947

17 South High Street, Suite 400 -4, Columbus, Ohio 4321577410

March 22, 2013

NOTICE OF OPPORTUNITY FOR HEA ING

Ciera Tawaun Swain, L.P.N. 1439 Gurley Avenue Akron, Ohio 44310 Dear Ms. Swain: In accordance with Chapter 119, Ohio Revised Code (ORC), you are hereby notified that the Ohio Board of Nursing (Board) proposes under authority of Section 4723.28 ORC, to deny, revoke, permanently revoke, suspend or place restrictions on your license to practice nursing as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: 1. On or about February 11, 2008, in the Municipal Court of Akron, Summit County Case No. 08CRB1623, you pled "No Contest" to and were subsequently found guilty of Disorderly Conduct, a fourth-degree misdemeanor, amended from an original charge of Assault. On or about July 6, 2011, you submitted to the Board an "Application for Licensure by EXAMINATION to Practice Nursing in Ohio." On that Application you answered "no" to question lb regarding whether you have ever been convicted of, found guilty of, pled guilty to, or pled no contest to "[a] misdemeanor in Ohio, another state, commonwealth, territory, province, or country?" In a written statement to the Board, dated October 5, 2011, you admitted that you were convicted of a "misdemeanor charge of 'disorderly conduct."' Section 4723.28(A) [as in effect prior to March 20, 20131, ORC, authorizes the Board to revoke the license or refuse to grant a license to a person who has been found by the Board to have committed fraud, misrepresentation, or deception in applying for or securing any license issued by the Board. Accordingly, the Board is authorized to impose one or more of the sanctions cited in Section 4723.28, ORC. In accordance with Chtpter 119, ORC., you are hereby informed that you are entitled to a hearing in this matter. If you wish to request such hearing, the request must be made in writing and must be received in the Board office within thirty (30) days of the time of mailing of thiS notice. You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in

Ciera Tawaun Swain, L.P:N. Page 2

writing. At the hearing, you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to Lisa FergusoniRamos, Compliance Unit Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, Ohio 432157410 or to the email address, heari g@nursin .ohio.gov. If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Opportunity for Hearing, deny, revoke, permanently revoke, suspend, or place restrictions on your license to practice nursing as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely,

Rhonda S. Barkheimer, RN., C.N.P. Supervising Board Member Certified Mail Receipt No. 7012 2210 0000 6272 3308 cc: Henry G. Appel, Senior Assistant Attorney General

Case #12-006296

Ohio Board of Nursing

www.nursing.obio.gov
(614) 466-3947

17 South High Street, Suite 400 4, Columbus, Ohio 43215-741Q

March 22,2013

NOTICE OF OPPORTUNITY FOR HEARING

Jennifer R. Tey, L.P.N. Applicant 1235 N. Union St. Fostoria, Ohio 44830 Dear Ms. Tey: In accordance with Chapter 119. of the Ohio Revised Code (ORC), you are hereby notified that the Ohio Board of Nursing (Board) proposes under the authority of Section 4723.28, ORC, to permanently deny or deny your application for licensure to practice nursing as a licensed practical nurse in Ohio; permanently revoke, revoke, suspend or place restrictions a license granted to you to practice nursing as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: 1. In September 2012, you submitted an application (Application) for licensure by examination to practice nursing in Ohio. On or about April 23, 2012, in Seneca County Court of Common Pleas Case No. 11 CR 0249, you were found eligible for Intervention in Lieu of Conviction in regard to one (1) count of Possession of Cocaine, a fifthdegree felony, in violation of Section 2925.11(A)(C)(4)(a), ORC. The events underlying the criminal offense noted above occurred on or about March 11, 2011 in Seneca County, Ohio. Section 4723,28(B)(4) [as in effect prior to March 20, 2013], ORC, authorizes the Board to discipline a licensee for conviction of, a plea of guilty to, a judicial finding of guilt of, a judicial finding of guilt resulting from a plea of no contest to, or a judicial finding of eligibility for intervention in lieu of conviction for, any felony. Section 4723.28(B)(5) [as in effect prior to March 20, 2013], ORC, authorizes the Board to discipline a licensee for conviction of, a plea of guilty to, a judicial finding of guilt of, a judicial finding of guilt resulting from a plea of no contest to, or a judicial finding of eligibility for intervention in lieu of conviction for, violating any municipal, state, county, or federal drug law. 2. Although you answered "yes" to the felony and misdemeanor questions on the Compliance Page of your Application and reported the felony Intervention in Lieu of Conviction (noted above in Paragraph 1) and a related 2011 OVI conviction, you failed to report that on February 10, 2004, in Tiffin Municipal Court Case No. 0303729A, you pled No Contest to and were found Guilty of one (1) count of

Jennifer R. Tey, L.P.N. Applicant Page 2 Operating Vehicle Under Influence of Alcohol or Drugs (DUI / OVI), a firstdegreeknisderneanor, in violation of Section 4511.19(A)(1), ORC. Section 4723.28(A) [as in effect prior to March 20, 2013], ORC, authorizes the Board to revoke the license or refuse to grant a license to a person who has been found by the Board to have committed ifraud, misrepresentation, or deception in applying for or securing any license issued by the Board. Accordingly, the Board is authorized to impose one or more of the sanctions as cited in Section 472328 ORC. You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in writing. At the hearing you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to: Lisa Ferguson-Ramos, Compliance Unit Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, OH 43215-7410, or to the email address, hearin' @nursin ohio ov. If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Opportunity for Hearing, permanently deny or deny your application for licensure to practice nursing as a licensed practical nurse in Ohio; permanently revoke; revoke, suspend or place restrictions a license granted to you to practice nursing as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely,

Rhonda S. Barkheimer, R.N., C.N.P. Supervising Board Member Certified Mail Receipt No. 7012 24210 0000 6272 3261 cc: Henry G. Appel, Senior Assistant Attorney General

Case # 10-004137

Ohio Board
March 22, 2013

of Nursing www.nursing.ohio gov

17 South High Street, Suite 400 6 Columbus, Ohio 43215-74.10 go (614) 406-3947

NOTICE OF OPPORTUNITY FO HEARING

Matthew Emerson Tilley, L.P.N., R.N. 932 Bryden Road Columbus, Ohio 43205 Dear Mr. Tilley: In accordance with Chapter 119, Ohio Revised Code (ORC), you are hereby notified that the Ohio Board of Nursing (Board) proposes under authority of Section 4723.28 ORC, to deny, revoke, permanently revoke, suspend or place restrictions on your licenses to practice nursing as a licensed practical nurse and registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: 1. On or about September 8, 2010, while working as a nurse at Select Specialty Hospital of Columbus in Columbus, Ohio, you tested positive for amphetamines and methamphetamines after being selected for a random drug screen. You did not have a legal, valid prescription for these drugs. Section 4723.28(B)(8), ORC [as in effect prior to June 8, 2012], authorizes the Board to discipline a licensee for self-administering or otherwise taking into the body any dangerous drug, as defined in Section 4729.01, ORC, in any way not in accordance with a legal, valid prescription issued for that individual. Accordingly; the Board is authorized to impose one or more of the sanctions cited in Section 4723.28, ORC. In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing in this matter. If you wish to request such hearing, the request must be made in writing and must be received in the Board office within thirty (30) days of the time of mailing of this notice. You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice bef6re the Board, or you may present your position, arguments, or contentions in writing. At the hearing, you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to Lisa Ferguson-Ramos, Compliance Unit Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, Ohio 432157410 or to the email address, hearing @ nurs ing .ohio .gov

Matthew Emerson Tilley, L.P.N., R.N. Page 2 If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your abseIce and upon consideration of the factual and legal allegations set forth in this Notice of Opportunity for Hearing, deny, revoke, permanently revoke, suspend, or place restrictions on your licenses to practice nursing as a licensed practical nurse and registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars (5500.00) per violation. Sincerely,

Rhonda S. Barkheimer, C.N.P. Supervising Board Member Certified Mail Receipt No. 7012 2210 0000 6272 3223 cc: Henry G. Appel, Senior Assistant Attorney General

Case # 12-001375

Ohio oard of Nursing

17 South High Street, Suite 400

www.nursing.ohio.gov

Columbus, Ohio 43215-7410- 0. (614)466-3947

March 22, 2013

NOTICE OF OPPORTUNITY FOR HEARING

Desrae L. Trout, R.N. 1434 TWP RD 162 Mingo Junction, Ohio 43938 Dear Ms. Trout: In accordance with Chapter 119, Ohio Revised Code (ORC), you are hereby notified that the Ohio Board of Nursing (Board) proposes under authority of Section 4723.28 ORC, to deny, revoke, permanently revoke, suspend or place restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: 1. From in or about May 2011 through October 2011, while working as a nurse for Cardiac Staffing LLC at Select Specialty Hospital in Akron, Ohio, you falsified timesheets in order to receive payment for nursing services that you did not provide. Section 4723.28(B)(16), ORC, authorizes the Board to discipline a licensee for violation of Chapter 4723, ORC, or any rules adopted under it. Specifically, Rule 4723-4-06(G), Ohio Administrative Code (OAC), states that a licensed nurse shall not falsify any client record or any other document prepared or utilized in the course of, or in conjunction with, nursing practice. This includes, but is not limited to, case management documents or reports or time records, reports, and other documents related to billing for nursing services. Accordingly, the Board is authorized to impose one or more of the sanctions cited in Section 4723.28, ORC . In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing in this matter. If you wish to request such hearing, the request must be made in writing and must be received in the Board office within thirty (30) days of the time of mailing of this notice. You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in writing. At the hearing, you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to Lisa Ferguson-Ramos, Compliance Unit

Desrae L. Trout, R.N. Page 2 Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, Ohio 4321S7410 or to the email address,thearing@nursing.ohio.ccov. If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Opportunity for Hearing, deny, revoke, permanently revoke, suspend, or place restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely,

;7=yec,L,
Rhonda S. Barkheimer, R.N., C.N.P. Supervising Board Member

A17./v

Certified Mail Receipt Nol 7012 2210 0000 6272 3216 cc: Henry G. Appel, Senior Assistant Attorney General

Case # 13-001054

Ohio Board of Nursing www.nursing.ohio.gov

- 17 South High Street, Suite 400 .0 Columbus, Ohio 43215-7410 I March 22, 2013 (614) 466-3947

NOTICE OF OPPORTUNITY FOR HEARING

Donna Marie Waers, L.P.N. 17888 Laughman Rd. Lore City, Ohio 43755 Dear Ms. Waers: In accordance with Chapter 119, Ohio Revised Code (ORC), you are hereby notified that the Ohio Board of Nursing (Board) proposes under authority of Section 4723.28 ORC, to deny, revoke, permanently revoke, suspend or place restrictions on your license to practice nursing as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: 1. On or about April 13, 2012, in the Court of Common Pleas, Guernsey County Case No. 11-CR-187, you pled guilty to, and were subsequently found eligible for Intervention in Lieu of Conviction for, Theft, a fifth-degree felony in violation of Section 2913.02, ORC. The acts underlying this offense occurred on or about October 7, 2011, and involve you engaging in theft of monies from Dollar General Store being $1,000.00 or more. Section 4723.28(B)(4) [as in effect prior to March 20, 2013] ORC, authorizes the Board to discipline a licensee for conviction of, a plea of guilty to, a judicial finding of guilt of, a judicial finding of guilt resulting from a plea of no contest to, or a judicial finding of eligibility for intervention in lieu of conviction for, any felony or of any crime involving gross immorality or moral turpitude. 2. On or about August 28, 2012, you renewed your license to practice as a licensed practical nurse. Despite your guilty plea and finding of eligiblity for Intervention in Lieu of Conviction, in the criminal case referenced in item 1., above, you answered the following question on your online renewal application "No": "Have you ever been convicted of, found guilty of, pled guilty to . . received treatment or intervention in lieu of conviction for . . A felony in Ohio, another state, commonwealth, territory, province, or country?" Section 4723.28(B)(16), ORC, authorizes the Board to discipline a licensee for violation of Chapter 4723, ORC, or any rules adopted under it. Specifically, Ohio Administrative Code (OAC), Rule 4723-4-06(P) states a licensed nurse shall not make any false, misleading, or deceptive statements, or submit or cause to be submitted any false, misleading or deceptive information, or documentation to: (1) The board or any representative of the board..

Donna M. Waers, L.P.N. Page 2 Accordingly, the Board is authorized to impose one or more of the sanctions cited in Section 4723.28, ORC, In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing in this matter. If you wish to request such hearing, the request must be made in writing and must be received in the Board Offife within thirty (30) days of the time of mailing of this notice. You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in writing. At the hearing, you may also present evidence and exainine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to Lisa Ferguson-Ramos, Compliance Unit Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, Ohio 432157410 or to the email address, hearing@nursing.ohio.gov. If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Opportunity for Hearing, deny, revoke, permanently revoke, suspend, or place restrictions on your license to practice nursing as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely,

Rhonda S. Barkheimer, C.N.P. Supervising Board Member Certified Mail Receipt No. 7012 2210 0000 6272 3605 cc: Henry G. Appel, Senior Assistant Attorney General

Case # 11-001370, 11-001391

Ohio Board of Nursing

1.7 South High Street, Suite 400

www.nursing.ohio. gov

Columbus, Ohio 43215-7410 Gz (614) 466-3947

March 22, 2013

NOTICE OF OPPORTUNITY FOR HEARING

Susan Ellen Ward, L.P.N. 267 Marlow St. Wadsworth, Ohio 44281 Dear Ms. Ward: In accordance with Chapter 119, Ohio Revised Code (ORC), you are hereby notified that the Ohio Board of Nursing (Board) proposes under authority of Section 4723.28 ORC, to deny, revoke, permanently revoke, suspend or place restrictions on your license to practice nursing as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: 1. On or about April 6, 2011 you reported to the Board that, while working as a nurse at Magnolia Village Retirement Community in Wadsworth, Ohio (Magnolia), you diverted narcotics intended for patients. Section 4723.28(B)(13), ORC, authorizes the Board to discipline a licensee for obtaining or attempting to obtain money or anything of value by intentional misrepresentation or material deception in the course of practice. 2. On or about May 13, 2011, you admitted to a Board Compliance Agent that while working as a nurse at Magnolia, you diverted Oxyfast, and that you substituted Oxyfast prescribed for Patients #1 and #2 [See attached Patient Key to remain confidential and not subject to public disclosure] with Mountain Dew. You further acknowledged that your tampering and substitution of medication could have caused harm to the patients. On or about May 13, 2011 you further admitted that you self-administered three doses of diverted Oxyfast during your shift. Section 4723.28(B)(8) [as in effect prior to June 8, 2012], ORC, authorizes the Board to discipline a licensee for self-administering or otherwise taking into the body any dangerous drug, as defined in Section 4729.01, ORC, in any way not in accordance with a legal, valid prescription issued for that individual. Section 4723.28(B)(13) [as in effect prior to March 20, 2013], ORC, authorizes the Board to discipline a licensee for obtaining or attempting to obtain money or anything of value by intentional misrepresentation or material deception in the course of practice. Section 4723.28(B)(19), ORC, authorizes the Board to discipline a licensee for failure to practice in accordance with acceptable and prevailing standards of safe nursing care.

Susan Ellen Ward, L.P.N. Page 2

3. On or about May 13, 2011, you admitted to a Board Compliancd Agent that you .had ingested your husband's Percocet. Section 4723.28(B)(8) [as in effect prior to June 8, 2012], ORC, authorizes the Board to discipline a licensee for self-administering or otherwise taking into the body any dangerous drug, as defined in Section 4729.01, ORC, in any way not in accordance with a legal, valid prescription issued for that individual. Accordingly, the Board is authorized to impose one or more of the sanctions cited in Section 4723.28, ORC. In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing in this matter. If you wish to request such hearing, the request must be made in writing and must be received in the Board office within thirty (30) days of the time of mailing of this notice. You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in writing. At the hearing, you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to Lisa Ferguson-Ramos, Compliance Unit Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, Ohio 432157410 or to the email address, hearingR nursiag If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Opportunity for Hearing, deny, revoke, permanently revoke, suspend, or place restrictions on your license to practice nursing as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely, A/ Rhonda S. Barkheimer, R.N., C.N.P. Supervising Board Member Certified Mail Receipt No. 7012 2210 0000 6272 3094 cc: Henry G. Appel, Senior Assistant Attorney General

Case # 10-4660

Ohio 13mard of Nursing

1.7 South High Street, Suite 400

www. nursing. ohio gov

Columbus, Ohio 43215-7410 e (614) 466-3947

March 22, 2013

NOTICE OF OPPORTUNITY tOR HEARING

Lora Lee Watters, R.N. 321 E. Dayton Yellow Springs Road Apartment 230 Fairborn, Ohio 45324 And 14 Oakwood Avenue Fairborn, Ohio 45234 Dear Ms. Watters: In accordance with Chapter 119, Ohio Revised Code (ORC), you are hereby notified that the Ohio Board of Nursing (Board) proposes under authority of Section 472328 ORC, to deny, revoke, permanently revoke, suspend or place restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: . On or about October 22, 2010, while seeking employment as a registered nurse at Kettering Health Network in Kettering, Ohio, you submitted a pre-employment drug screen that tested positive for Cocaine Metabolite (Benzoylecgonine). Section 4723.28(B)(8), ORC [as in effect prior to June 8, 2012], authorizes the Board to discipline a licensee for self-administering or otherwise taking into the body any dangerous drug, as defined in Section 4729.01, ORC; in any way not in accordance with a legal, valid prescription issued for that individual. Accordingly, the Board is authorized to impose one or more of the sanctions cited in Section 4723.28, ORC. In accordance with Chapter 119, ORC, you are hereby informed1that you are entitled to a hearing in this matter. If you wish to request such hearing, the request must be made in writing and must be received in the Board office within thirty (30) days of the time of mailing of this notice. You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, . by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in

Lora Lee Watters, R.N. Page 2 writing. At the hearing, you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to Lisa Ferguson-Ramos, Compliance Unit. Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus,' Ohio 432157410 or to the email address, hearin@nursing_.ohlo.gov. If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Opportunity for Hearing, deny, revoke, permanently revoke, suspend, or place restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely, e-A47" . RhOnda S. Barkheimer, R.N., C.N.P. Supervising Board. Member Certified Mail Receipt No. 7012 2210 0000 6272 3537 Second Address Certified Mail Receipt No. 7012 2210 0000 6272 3544 cc: Henry G. Appel, Senior Assistant Attorney General

Case# 12-005833

Ohio Board of Nursing

www.nursing.ohio.gov
(614) 466-3947

17 South High Street, Suite 400 6. Columbus, Ohio 43215-7410

March 22, 2013 NOTICE OF OPPORTUNITY FOR HEARING Jill M. Welling (aka "Jillian Welling"), R.N. 370 Spinning Rd. Dayton, OH 45431 Dear Ms. Welling: In accordance with Chapter 119, Ohio Revised Code (ORC), you are hereby notified that the Ohio Board of Nursing (Board) proposes under authority of Section 4723.28 ORC, to deny, revoke, permanently revoke, suspend or place restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: I On or about September 4, 2012, while working as a nurse at Miami Valley Hospital in Dayton, Ohio (Miami Valley), hospital staff observed a syringe lying on the floor next to you. Shortly thereafter, staff noticed you had slurred speech, small pupils, and an unsteady gait. You were sent for a fitness for duty exam and submitted a specimen for drug testing that tested positive for Cannabinoid, Lorazepam, and Oxazepam. You did not have legal, valid prescriptions for these drugs.

Section 4723.28 (B)(8), ORC, authorizes the Board to discipline a licensee for selfadministering or otherwise taking into the body any dangerous drug, as defined in Section 4729.01, ORC, in any way not in accordance with a legal, valid prescription issued for that individual, or self-administering or otherwise taking into the body any drug that is a schedule I controlled substance. Section 4723.28(B)(10) [as in effect prior to March 20, 2013], ORC, authorizes the Board to discipline a licensee for impairment of the ability to practice according, to acceptable and prevailing standards of safe nursing care because of habitual or excessive use of drugs, alcohol, or other chemical substances that impair the ability to practice. 2. On or about December 5, 2012, you told a Board Compliance Agent that beginning in or about July 2012, while working as a nurse at Miami Valley, you began smoking marijuana with friends, taking and consuming Ativan and Percocet fron family members, and purchasing prescription medication for self-administration illegally from an acquaintance. Further, you admit in a written statement that you had "selfmedicated" yourself arid had worked while impaired. Section 4723.28 (B)(8), ORC, authorizes the Board to discipline a licensee for self-administering or otherwise taking into the body any dangerous drug, as defined in Section 4729.01, ORC, in any way not in accordance with a legal, valid prescription issued for that individual, or self-

Jill M. Welling (aka "JiIlian Welling"), R.N. Page 2 administering or otherwise taking into the body any drug that is a schedule I controlled subAance. Section 4723.28(3)(10) [as in effect prior to March 20, 2013], ORC, authorizes the Board to discipline a licensee for impairment of the ability to practice according to acceptable and prevailing standards of safe nursing care because of habitual or excessive use of drugs, alcohol, or other chemical substances that impair the ability to practice. Accordingly, the Board is authorized to impose one or more of the sanctions cited in Section 4723.28, ORC. In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing in this matter. If you wish to request such hearing, the request must be made in writing and must be received in the Board office within thirty (30) days of the time of mailing of this notice. You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in writing. At the hearing, you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to Lisa Ferguson-Ramos, Compliance Unit Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, Ohio 432157410 or to the email address, head ng @ nurs .ohio.gov If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Opportunity for Hearing, deny, revoke, permanently revoke, suspend, or place restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely, .4! Rhonda S. Barkheimer, C.N.P. Supervising Board Member Certified Mail Receipt No. 7012 2210 0000 6272 3186 cc: Henry G. Appel, Senior Assistant Attorney General

Case # 12-002068

Ohio Board of Nursing

www.nursing.ohio..gov
(614) 466-3947

17 South High Street, Suite 400 4, Columbus, Ohio 43.215-7410

March 22, 2013

NOTICE OF OPPORTUNITY FOR HEARING

Angela Jane Whiting, L.P.N. 4022 Mill Run Road Lexington, Ohio 44904 Dear Ms. Whiting:

In accordance with Chapter 119, Ohio Revised Code (ORC), you are hereby notified that the Ohio Board of Nursing (Board) proposes under authority of Section 472328 ORC, to deny, revoke, permanently revoke, suspend or place restrictions on your license to practice nursing as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: 1. On or about May 26, 2012, you admitted to a Board Compliance Agent that on or about May 2, 2012 through May 10, 2012 while working as a nurse with Mid-Ohio Home Health in Mansfield, Ohio, you stole approximately ten (10) to twenty (20) Oxycodone tablets from a home care patient. This patient was identified by you in a May 15, 2012 statement to a Mansfield Police Department officer as Patient #1 [see Attached Patient Keyto Remain Confidential and Not Subject to Public Disclosure]. You further admitted to the Board Compliance Agent that you self-administered the stolen medication. Section 4723 .28(B)(8) [as in effect prior to June 8, 2012], ORC, authorizes the Board to discipline a licensee for self-administering or otherwise taking into the body any dangerous drug, as defined in Section 4729.01, ORC, in any way not in accordance with a legal, valid prescription issued for that individual. Section 4723.28(B)(13) [as in effect prior to March 20, 2013], ORC, authorizes the Board to discipline a licensee for obtaining or attempting to obtain money or anything of value by intentional misrepresentation or material deception in the course of practice. Section 4723.28(B)(16), ORC, authorizes the Board to discipline a licensee for violation of Chapter 4723, ORC, or any rules adopted under it. Specifically, Rule 4723-4-06(L), Ohio Administrative Code, states, in pertinent part, that a licensed nurse shall not misappropriate a client's property or: (1) Engage in behavior to seek or obtain personal gain at the client's expense; (2) Engage in behavior that may reasonably be interpreted as behavior to seek or obtain personal gain at the client's expense. Accordingly, the Board is authorized to impose one or more of the sanctions cited in Section 4723.28,,ORC.

Angela Jane Whiting, L.P.N. Page 2 In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing in this matter. If y6u wish to request such hearing, the request must be made in writing and must be received in the Board office within thirty (30) days of the time of mailing of this notice. You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments; or contentions in writing. At the hearing, you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to Lisa Ferguson-Ramos, Compliance Unit Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, Ohio 432157410 or to the email address, hearirw@nursing.ohio.00v. If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Opportunity for Hearing, deny, revoke, permanently revoke, suspend, or place restrictions on your license to practice nursing as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely, H/V Rhonda S. Barkheimer, R.N., C.N.P. Supervising Board Member Certified Mail Receipt No. 7012 2210 0000 6272 3353 cc: Henry G. Appel, Senior Assistant Attorney General

Case# 13-000243

Ohio Board of Nursmg

March 22, 2013

www.nursing,ohip.gov .
(614) 466-3947

17 South High Street, Suite 400 0 Columbus, Ohio 43215-741.0 4

NOTICE OF AUTOMATIC SUSPENSION AND OPPORTUNITY FOR. HEARING

Lisa Ann Wiget, L.P.N. 1981 Andover Road Columbus, Ohio 43212 Dear Ms. Wiget: You are hereby notified that, on or about September 24, 2010, you entered into a Consent Agreement (September 2010 Consent Agreement) with the Ohio Board of Nursing (Board), a copy of which is attached hereto and incorporated herein, in which you agreed with the Board that, upon meeting the requirements for licensure, your license to practice nursing as a licensed practical nurse in the State of Ohio would be granted and suspended indefinitely, and that such suspension would be stayed subject to probationary terms, conditions, and limitations until at least September 2012. Documents are redacted according to Section 295332, ORC. A. Item 6. of the September 2010 Consent Agreement states, "For a minimum, continuous period of three (3) months immediately prior to working as a nurse and continuing throughout the probationary period, MS. WIGET shall begin to submit, at her expense and on the day selected, blood or urine specimens for drug and/or alcohol analysis at a collection site specified by the Board at such times as the Board may request. Upon the initiation of drug screening, refusal to submit such specimen, or failure to submit such specimen on the day MS. WIGET is selected, or in such a manner as the Board may request, shall constitute a violation of a restriction placed on a license for purposes of Section 4723.28(B), ORC. This screening shall require a daily call-in process. The specimens submitted by MS. WIGET shall be negative, except for substances prescribed, administered, or dispensed to her by another so authorized by law who has full knowledge of MS. WIGET's history of chemical dependency and recovery status." Despite this, provision, on .the dates, set forth in Attachment A, attached hereto and incorporated herein, you failed to call Firstlab, the Board's random drug/alcohol screen program administrator, to determine if you had been selected to provide a specimen for analysis. Furthermore, on, the following dates, you were selected to provide a specimen for analysis and failed to do so: November 9, 2012; January 3, 2013; and January 15, 2013.

Lisa Ann Wiget, L.P.N. Page 2

Section 4723 28(B)(17), Ohio Revised Code, ORC, authorizes the Board toMiscip Me a licensee for violation of any restrictions placed on a nursing license by the Board. In accordance with the paragraph under "FAILURE TO COMPLY" of the September 2010 Consent Agreement, you are hereby notified that it appears to the Board that you have violated Item 6. of the September 2010 Consent Agreement. YOU ARE FURTHER NOTIFIED THAT YOUR LICENSE TO PRACTICE NURSING AS A LICENSED PRACTICAL NURSE, PN-141766, IS HEREBY AUTOMATICALLY SUSPENDED. Continued practice after receipt of this notice of suspension shall be considered engaging in the practice of nursing as a licensed practical nurse without a current, valid license, which is a violation of Section 4723.03(B), ORC. You are further notified that in accordance with Chapter 1.19, ORC, the Board proposes under authority of Section 4723.28, ORC, to deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: On or about September 24, 2010, you entered into a Consent Agreement (September 2010 Consent Agreement) with the Ohio Board of Nursing (Board), a copy of which is attached hereto and incorporated herein, in which you agreed with the Board that, upon meeting the requirements for licensure, your license to practice nursing as a licensed practical nurse in the State of Ohio would be granted and suspended indefinitely, and that such suspension would be stayed subject to probationary terms, conditions, and limitations until at least September 2012. 2. Item 6. of the September 2010 Consent Agreement states, "For a minimum, continuous period of three (3) months immediately prior to working as a nurse and continuing throughout the probationary period, MS. WIGET shall begin to submit, at her expense and on the day selected, blood or urine specimens for drug and/or alcohol analysis at a collection site specified by the Board at such times as the Board may request. Upon the initiation of drug screening, refusal to submit such specimen, or failure to submit such specimen on the day MS. WIGET is selected, or in such a manner as the Board may request, shall constitute a violation of a restriction placed on a license for purposes of Section 4723.28(B), ORC. This screening shall require a daily call-in process. The specimens submitted by MS. WIGET shall be negative, except for substances prescribed, administered, or dispensed to her by another so authorized by law who has full knowledge of MS. WIGET's history of chemical dependency and recovery status." Despite this provision, on the dates set forth in Attachment A, attached hereto and incorporated herein, you failed to call Firstlab, the Board's random

Lisa Ann Wiget, L.P.N. Page 3 drug/alcohol screen program administrator, to determine if you had been selected to provide a specimen for analysis. Furthermore, on the following dates, you were selected to provide a specimen for analysis and failed to do so: November 9, 2012; January 3, 2013; and January 15, 2013. Section 4723.28(B)(17), Ohio Revised Code, ORC, authorizes the Board to discipline a licensee for violation of any restrictions placed on a nursing license by the Board. Accordingly, the Board is authorized to impose one or more of the sanctions as cited in Section 4723.28, ORC. In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing in this matter. If you wish to request such hearing, the request must be made in writing and must be received in the Board office within thirty (30) days of the time of mailing of this notice. You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in writing. At the hearing you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to: Lisa Ferguson-Ramos, Compliance Unit Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, Ohio 432157410, or to the e-mail address, hearing nursing.ohio.gov. If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Automatic Suspension and Opportunity for Hearing, deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. SinCerely,

Rhonda S. Barkheimer, R.N., C.N.P. Supervising Board Member Certified Mail Receipt No. 7012 2210 0000 6272 3728 cc: Henry G. Appel, Senior Assistant Attorney General

Ohio oard of Nursing

WWW.11111'Sing,ohio.gov

17 South High Street, Suite 400 * CGIumbus, Ohio 43215-7410 (614) 466-3947

To Whom It May Concern:

You recently requested records regarding Lisa Ann Wiget, P.N. #141766. Enclosed are records in response to your request. Information has been redacted, per Section 2953.32 of the Ohio Revised Code. If you have any further questions or concerns, please contact the Compliance Unit Manager or a Supervising Attorney.

Thank you. Compliance Unit Ohio Board of Nursing

Case:#10-2897

Ohio Board of Nursing

CONSENT AGREEMENT BETWEEN LISA A, WIGET, L.P.N. APPLICANT A.K.A. LISA A. WIGIT AND OHIO BOARD OF NURSING

WWW.Ilursing.ohio.gov
(614) 466-3947

17 South High Street, Suite 400 4 Columbus, Ohio 43215-7410

This Consent Agreement is entered into by and between LISA A. WIGET, L.P.N. APPLICANT A.K.A. LISA A. WIGIT (MS. WIGET) and the Ohio Board of Nursing (Board), the state agency charged with enforcing Chapter 4723, of the Ohio Revised Code (ORC), and all administrative rules promulgated thereunder. MS. WIGET voluntarily enters into this Consent Agreement being fully informed of her rights under Chapter 119, ORC, including the right to representation by legal counsel and the right to a formal adjudicative hearing on the issues considered herein. This Consent Agreement contains the entire agreement between. the parties, there being no other agreement of any kind, verbal or otherwise, which varies the terms of this Consent Agreement.

BASIS MLACTION
This Consent Agreement is entered into on the basis of the following stipulations, admissions and understandings: A. The Board is empowered by Section 4723.28, ORC, to deny, permanently revoke, revoke, suspend, or place restrictions on any license issued by the Board; reprimand or otherwise discipline a licensee; or impose a fine of five hundred dollars ($500.00) or less per violation. Section 4723,28(3)(4), ORC, authorizes the Board to deny a license or otherwise discipline a licensee for a conviction of, a plea of guilty to, a judicial finding of guilt of, a judicial finding of guilt resulting from a plea of no contest to, or a judicial finding of eligibility for intervention in lieu of conviction for, any felony or of any crime involving gross immorality or moral turpitude, Section 4723.28(B)(8), ORC, authorizes the Board to deny a license or otherwise discipline a licensee for selfadministering or otherwise. taking( into the body any dangerous drug in any way not in accordance with a legal, valid prescription.

Lisa Ann Wiget, L.P.N. Applicant Page 2

B.

On or about June 1,2010, MS. WIGET submitted to the Board an Application for Licensure by Examination to Practice in Ohio as a Licensed Practical Nurse.

C.

D. stemmed from her prior chemical dependency on Cocaine. MS. WIGET further reported that she has been sober for nearly 5 years and is an active participant in a 12 step recovery program. E. MS. WIGET was permitted to take the NCLEX-PN, and on or about August 11,2010, MS. WIGET passed the NCLEX-PN. AGREED CONDITIONS Wherefore, in consideration of the foregoing and mutual promises hereinafter set forth, and ,in lieu of any formal proceedings at this time, MS. WIGET knowingly and voluntarily agrees with the Board to the following terms, conditions, and limitations: Upon meeting the requirements for licensure, MS. WIGET shall be granted a license to practice nursing as a licensed practical nurse in the State of Ohio. MS. WIGET's license to practice nursing as a licensed practical nurse shall be suspended indefinitely. Such suspension shall be stayed, subject to the following PROBATIONARY terms, conditions, and limitations until at least September 2012: 1. MS. WIGET shall obey all federal, state, and local laws, and all laws and rules governing the practice of nursing in Ohio. MS. WIGET shall appear in person for interviews before the full Board or its designated representative as requested by the Board or its designee.

2.

Continuing Education Hours 3, By January 1, 2011, KS. WIGET shall, in addition to the requirements of licensure renewal, successfully complete and submit satisfactory documentation of successful completion of the following continuing education taken subsequent to the effective date of this Consent Agreement: four (4) hours of professionalism and twelve (12) hours of chemical dependency.

1. Applicant Lisa Ann Wiget, L.P.1`, Page 3

Monitoring and Chemical Dependency Evaluation 4. MS. WIGET shall abstain completely from the personal use or possession of drugs, except those prescribed, administered, or dispensed to her by another so authorized by law who has full knowledge of MS. WIGET's history of chemical dependency and recovery status. MS. WIGET thall self-administer prescribed drugs only in the manner prescribed. MS. WIGET shall abstain completely from the use of alcohol, 6. For a minimum, continuous period of three (3) months immediately prior to working as a nurse and continuing throughout the probationary period, MS. WIGET shall begin to submit, at her expense and on the day selected, blood or urine specimens for drug andfor alcohol analysis at a collection site specified by the Board at such times as the Board may request. Upon the initiation of drug screening, refusal to submit such specimen, or failure to submit such specimen on the day MS. WIGET is selected, or in such a manner as the Board may request, shall constitute a violation of a restriction placed on a license for purposes of Section 4723.28(B), ORC. This screening shall require a daily call-in process, The specimens submitted by MS. WIGET shall be negative, except for substances prescribed, administered, or dispensed to her by another so authorized by law who has full knowledge of MS. WIGET's history of chemical dependency and recovery status. a. Within thirty (3o) of the effective date of this Consent. Agreement, MS. WIGET shall provide a copy of this Consent Agreement to all treating practitioners and shall proVide to the Board a list of all treating practitioners, including addresses and telephone numbers and cause all treating practitioners to complete a medication prescription report that is to be mailed by the practitioner directly to the Board. The medication report is to be completed for any and all substances prescribed, administered, or dispensed to MS. WIGET. MS. WIGET shall be under a continuing duty to provide a copy of this Consent Agreement, prior to initiating treatment, to additional treating practitioners, and to update the list of treating practitioners with the Board within forty-eight (48) hours of being treated by' anothpr practitioner. Further, MS. WIGET shall notify the Board o any and ail medication(s) or prescription(s) received within twenty-four (24) hours of release from hospitalization or medical treatment.

b.

Lisa Ann Wiget, L.P.N. Applicant Page 4

7.

Within sixty (60) days of the effective date of this Consent Agreement, M. WIGET shall, at her own expense, obtain a chemical dependency evaluation by a Board approved chemical dependency professional and shall provide the Board with complete documentation of this evaluation. Prior to the evaluation, MS. WIGET shall provide the chemical dependency professional with a copy of this Consent Agreement. Further, MS. WIGET shall execute releases to permit the chemical dependency professional to obtain any information deemed appropriate and necessary for thee evaluation. The evaluating professional shall submit a written opinion to the Board that includes diagnoses, recommendations for treatment and monitoring, any additional restrictions that should be placed on MS. WIGET's license to practice, and a statement as to whether MS. WIGET is capable of practicing nursing according to acceptable and prevailing standards of safe nursing care. MS.. WIGET shall provide the Board with satisfactory documentation of compliance with all aspects of the. treatment plan developed by the chemical dependency professional described above. until released. Further, MS. WIGET agrees that the Board may utilize the professional's recommendations and conclusions from the evaluation as a basis for additional terms, conditions, and limitations on MS. WIGET's license and that the terms, conditions, and limitations may be incorporated in an addendum to this Consent Agreement.

8.

Employment Conditions 9. Prior to accepting employment as a nurse, each time with every employer, MS. WIGET shall notify the Board. MS. WIG-ET is under a . continuing duty to provide a copy of this Consent Agreement to any new employer prior to accepting employment in a position in which a nursing license is required, MS. WIGET shall have her employer(s), if working in a position where a nursing license is required, submit written repcirts regarding job performance on a quarterly basis beginning within thirty (30) days of accepting nursing employment. MS. WIGET shall have her employer(s) send documentation to the Board, along with the first employer report, of receipt of a copy of this Consent Agreement, including the date the Consent Agreement was received.

10.

Lisa Ann Wiget, Page 5

Applicant

Reporting Requirements of Licensee 1 1. MS. WIGET shall report to the Board, in writing, arty violation of this Consent Agreement within thirty (30) days of the occurrence of the . violation. MS. WIGET shall sign release of information forms allowing health professionals and other organizations to submit the requested documentation directly to the Board. MS. WIGET shall submit any and all information that the Board may request regarding her ability to practice according to acceptable and prevailing standards of safe nursing practice. MS. MGM' shall not submit or cause to be submitted any false, misleading, or deceptive statements, information, or documentation to the Board or to employers or potential employers. MS. WIGET shall submit the reports and documentation required by this Consent Agreement on forms specified by the Board. All reporting and communications required by. this Consent Agreement shall be Made to the Compliance Unit of the Board. .MS. WIGET shall submit the reports and documentation required by this Consent Agreement or any other documents required by the Board to the attention of the Compliance Unit, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, OH 432154410. MS. WIGET shall verify that the reports and documentation required by this Consent Agreement are received in the Board office. MS. WIGET shall inform the Board within five (5) business days, in writing, of any change in employment status or of any change in residential or home address or telephone number.

12.

13.

14.

15.

16.

17.

18.

Temporary Practice Restrictions WIGET shall not practice nursing as a licensed practical nurse (I) for agencies providing home care in the patient's residence; (2) for' hospice care programs providing hospice care in the patient's residence; (3) for staffing agencies or pools; (4) as an independent provider where the nurse provides nursing care and is reimbursed for services by the State of Ohio through State agencies or agents of the State; or (5) for an individual or group of individuals who directly engage MS. -wiGEIr to provide nursing services for fees, compensation, or other consideration or as a volunteer.

MS.

Lisa Ann Wiget, L.P.N. Applicant Page 6

.MS. WIGET shall not function in a position or employment Where the job duties or requirements involve management of. nursing and nursing responsibilities, or supervising and evaluating nursing practice. Such positions include, but are not limited 'to, the following: Director of Nursing, Assistant Director of Nursing, Nurse Manager, Vice President of Nursing. FAILURE TO COMPLY MS. WIGET agrees that her license to practice nursing as a licensed practical nurse will be automatically suspended if it appears to the Board that MS. WIGET has violated or breached any terms or conditions of the Consent Agreement. Following the automatic suspension, the Board shall notify MS. WIGET certified mail of the specific nature of the charges and automatic suspension of her license. Upon receipt of this notice, MS. WIGET may request a hearing regarding the charges. The above described terms and conditions shall constitute "restrictions placed on' a license" for purposes of Section 4723.28(B), ORC, If, in the discretion of the Board, MS. WIGET appears to have violated or breached any terms or. conditions of this Consent Agreement, the Board reserves the right to institute formal disciplinary proceedings for any and all possible violations or breaches, including, but not limited to, alleged violations of the laws of Ohio occurring before the effective date of this Consent Agreement. DURATION/ MODIFICATION OF TERMS The terms, limitations, and conditions, of this Consent Agreement may be modified or terminated, in writing, at any time upon the agreement of both MS. WIGET and the Board, The Board may only alter the probationary period imposed by this Consent Agreement if: (1) the Board determines that MS. WIGErhas complied with all aspects of this Consent Agreement; and (2) the Board determines that MS. WIGET is able to practice according to acceptable and prevailing standards of safe nursing care without Board monitoring, based upon an interview with MS. WIGET and review of the reports as required herein. Any period during which MS. WIGET does not work in a position for which a nursing license is required shall not count toward fulfilling the probationary period imposed by this Consent Agreement. ACKNOWLEDGMENTS/LIABILITY RELEASE MS. WIGET acknowledges that she has had an opportunity to ask questions concerning the terms of this Consent Agreement and that all questions asked have been answered in a satisfactory Manner,

Ann Wiget, L.P.N. Applicant Page 7

MS. WIGET waives all of her rights under Chapter 1195 ORC, as they relate to matters that are the subject of this Consent Agreement.
MS. WXGET waives any and all claims or causes of action she/he may have against the Board, and its members, officers, employees and/or agents arising out of matters, which are the subject of this Consent Agreement. This Consent Agreement shall be considered a public record as that term is used in Section 149,43, ORC. The information contained heroin may be reported to appropriate organizations, data banks and governmental bodies. This Consent Agreement is not an adjudication order as discussed in Chapter 119, ORC. Any action initiated by the Board based on alleged violations of this Consent Agreement shall comply with the Administrative Procedures Act, Chapter 119, ORC,

EFEEcnyaDATE ,
MS. WIGET understands that this Consent Agreement is subject to ratification by the Board prior to signature by the Board President and shall become effective upon the last date of signature below.

LISA A. . APPLICANT A.K.A. LISA A. WIGIT

DATE

dvIte&G, efi

**IN
DATE

BERTHA LOVELACE, President Ohio Board of Nursing

Lisa Ann Wiget

ATTACHMENT A

Missed Call History: Date 10/31/2010 12/24/2010 01/092011 01/02/2011 01/30/2011 02/27/2011 07/24/2011 11/26/2011 12/14/2011 01/01/2012 01/14/2012 02/18/2012 03/31/2012 Missed Call Missed Cali Missed Call Missed Call Missed Cali Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Details

05/02/2012, Missed Call 05/09/2012 05/13/2012 06/01/2012 06/19/2012 Missed Call Missed Call Missed Call Missed Call

06/30/2012 07/09/2012 07/22/2012 07/29/2012 08/04/2012 08/26/2012 09/01/2012 09/08/2012 09/13/2012 09/15/2012 09/20/2012 09/22/2012 09/30/2012 10/18/2012 10/31/2012 11/02/2012 11/03/2012 11/11/2012 11/17/2012 11/23/2012 11/24/2012 12/02/2012 12/04/2012 12/08/2012 12/15/2012 12/22/2012

Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missedd, Call Missed Call Missed Call

01/01/2013 01/05/2013 01/13/2013 01/15/2013 01/19/2013 01/27/2013 02/01/2013 Row Count: 51

Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call

Case #12-003081

Ohio Board of Nursing

17 South High Street, Suite 400 March 22, 2013

www.nursing.ohi.o.gov
(614) 466-3947

Columbus, Ohio 43215-7410

NOTICE OF IMMEDIATE SUSPENSION AND OPPORTUNITY FOR HEARING

DeWanda Gwenise Wise (aka "DaWanda Wise"), L.P.N. 2381 Vera Avenue Cincinnati, Ohio, 45237 Dear Ms. Wise: In accordance with Sections 2929.42 and/or 3719.12 of the Ohio Revised Code (ORC), the Ohio Board of Nursing (Board) has been notified that, on or about January 22, 2013, in Hamilton County Court of Common Pleas Case Number B 1205132, you pled guilty to Theft of DrugS, felonies of the fourth degree, in violation of Section 2913.02(A)(1), ORC, and were found eligible for Intervention in Lieu of Conviction. Section 3719.121(C), ORC, states in pertinent part as follows: On receiving notification pursuant to Section 2929.42 or 3719.12 of the Revised Code, the board under which a person has been issued a license, certificate or evidence of registration immediately shall suspend the license, certificate, or registration of that person on a plea of guilty to, a finding by a jury or court of the person's guilt of, or conviction of a felony drug abuse offense; a finding by a court of the person's eligibility for intervention in lieu of conviction; a plea of guilty to, or a finding by a jury or court of the person's guilt of, or the person's conviction of an offense in another jurisdiction that is essentially the same as a felony drug abuse offense; or a finding by a court of the person's eligibility for treatment or intervention in lieu of conviction in another jurisdiction. Theft of Drugs, felonies of the fourth degree, in violation of Section 2913.02(A)(1), ORC, constitute "felony drug abuse offenses" as defined in Section 2925.01, ORC. WHEREFORE, PURSUANT TO SECTION 3719.121(C), ORC, YOU ARE HEREBY NOTIFIED THAT YOUR LICENSE TO PRACTICE NURSING AS A LICENSED PRACTICAL NURSE, PN-119337, IS HEREBY SUSPENDED. eontinued practice after receipt of this notice of suspension shall be considered engaging in the practice of nursing without a current, valid license, which is a violation of Section 4723.03(B), ORC. You are further notified that in accordance with Chapter 119, ORC, the Board proposes under authority of Section 4723.28, ORC, to deny, permanently revoke, revoke, suspend or place restrictions on your license to practice as a licensed practical nurse; reprimand or otherwise

DeWanda Gwenise Wise (aka "DaWanda Wise"), L.P.N. Page 2 discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: 1. On or about January 22, 2013, in Hamilton County Court of Common Pleas Case Number B 1205132, you pled guilty to Theft of Drugs, felonies of the fourth degree, in violation of Section 2913.02(A)(1), ORC, and were found eligible for Intervention in Lieu of Conviction. The acts underlying this case occurred in or about June 2012 and involve you obtaining or exerting control over Hydrochlorothiazide belonging to St. Margaret Hall without the consent of the owner or person authorized to give consent. Section 4723.28(B)(4) [as in effect prior to March 20, 2013], ORC, authorizes the Board to discipline a licensee for conviction of, a plea of guilty to, a judicial finding of guilt of, a judicial finding of guilt resulting from a plea of no contest to, or a judicial finding of eligibility for intervention in lieu of conviction for, any felony. Section 4723.28(B)(5) [as in effect prior to March 20, 2013], ORC, authorizes the Board to discipline a licensee for conviction of, a plea of guilty to, a judicial finding of guilt of, a judicial finding of guilt resulting from a plea of no contest to, or a judicial finding of eligibility for intervention in lieu of conviction for, violating any municipal, state, county, or federal drug law. 2.. On or about July 10, 2012, you met with a Board Compliance Agent. You admitted to the Board Compliance Agent that while working as a nurse at St. Margaret Hall, Cincinnati, Ohio, on dates in June, 2012, you diverted Hydrochlorothiazide from four (4) different patients and self-administered the diverted Hydrochlorothiazide. You submitted a written statement to the Board, dated July, 10, 2012, in which you wrote, "I am admitting to taking hydrochlorthizide from facility... In a lapse of judgment I decided to self medicate... ." [sic] Section 4723.28 (B)(8), ORC, authorizes the Board to discipline a licensee for selfadministering or otherwise taking into the body any dangerous drug, as defined in Section 4729.01, ORC, in any way not in accordance with a legal, valid prescription issued for that individual, or self-administering or otherwise taking into the body any drug that is a schedule I controlled substance. Section 4723.28(B)(13) [as in effect prior to March 20, 2013], ORC, authorizes the Board to discipline a licensee for obtaining or attempting to obtain money or anything on value by intentional misrepresentation or material deception in the course of practice. Accordingly, the Board is authorized to impose one or more of the sanctions as cited in Section 4723.28, ORC. In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing in this matter. If you wish to request such hearing, the request must be made in

DeWanda Gwenise Wise (aka "DaWanda Wise"), L.P.N. Page 3 writing and must be received in the Board office within thirty (30) days of the time of mailing of this notice. As required by Section 3719?121(C), ORC, the suspension ordered herein shall remain in effect until -this hearing is held. You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, on, by such other representative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in writing. At the hearing you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to: Lisa Ferguson-Ramos, Compliance Unit Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus OH 43215-7410, or to the email address, hearing@nursing ov. If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Immediate Suspension and Opportunity for Hearing, deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely, ,y45, /. Hsu_)

Rhonda S. Barkheimer, R.N., C.N.P. Supervising Board Member Certified Mail Receipt No. 7012 2210 0000 6272 3636 cc: Henry G. Appel, Senior Assistant Attorney General

t.

Case# 13-000268

Ohio Board of Nttr$11:1g www.nursing.ohio.gov

17 South High Street, Suite 400 March 22, 2013 Columbus, Ohio 43215-7410 0, (614) 466-3947.

NOTICE OF AUTOMATIC SUSPENSION AND OPPORTUNITY FOR HEARING

Lee Alexander Young, TC1 /1/100 Melrose Drive, Lot #207 Wooster, Ohio 4/1691 Dear Mr. Young: You are hereby notified that, on or about November 16, 2012, you entered into a Consent Agreement (November 2012 Consent Agreement) with the Ohio Board of Nursing (Board), a copy of which is attached hereto and incorporated herein, in which you agreed with the Board that, upon completion of the application process, your temporary dialysis certificate one to practice as a dialysis technician (TC1) in the State of Ohio would be granted, and suspended indefinitely and that such suspension would be stayed subject to the following probationary terms, conditions and limitations for a minimum period of one (1) year. A. You were issued a TC1 in the State of Ohio on November 20, 2012. B. Item 7. of the November 2012 Consent Agreement states, "Within forty-five (45) days of the effective date of this Consent Agreement and continuing throughout the probationary period, MR. YOUNG shall begin submitting, at his expense and on the day selected, breath, hair, blood or urine specimens for drug and/or alcohol analysis at a collection site specified by the Board at such times as the Board may request. Upon and after MR. YOUNG's initiation of drug screening, refusal to submit such specimen, or failure to submit such specimen on the day he is selected, or in such a manner as the Board may request, shall constitute a violation of a restriction placed on a license for purposes of Section 4723.28(B), ORC. This screening shall require a daily call-in process. The specimens submitted by MR. YOUNG shall be negative, except for substances prescribed, administered, or dispensed to him by another so authorized by law and who has received a complete copy of this Consent Agreement prior to prescribing for MR. YOUNG." Despite the above provision, as of February 26, 2013, you have failed to initiate drug screening with Firstlab, the Board's random drug/alcohol screen program administrator. C. Item 10. of the November 2012 Consent Agreement states, "Within sixty (60) days of the effective date of this Consent Agreement, MR. YOUNG shall provide a copy of this Consent Agreement to all treating practitioners and shall provide to the Board a list of all treating practitioners, including

Lee Alexander Young, TC1 Page 2 addresses and telephone numbers. Further, MR. YOUNG shall be under a continuing duty to provide a copy of this Consent Agreement, prior to initiating treatment, to additional treating practitioners, and to update the list of treating practitioners with the Board within forty-eight (48) hours of being treated by another practitioner." Despite the above provision, as of February 26, 2013, you have failed to provide a list of treating practitioners to the Board. Section 4723.28(B)(17), Ohio Revised Code, ORC, authorizes the Board to discipline a certificate holder for violation of any restrictions placed on a dialysis technician certificate by the Board. In accordance with the paragraph under "FAILURE TO COMPLY" of the November 2012 Consent Agreement, you are hereby notified that it appears to the Board that you have violated Items 7. and 10. of the November 2012 Consent Agreement. YOU ARE FURTHER NOTIFIED THAT YOUR TEMPORARY DIALYSIS ONE CERTIFICATE TO PRACTICE AS A DIALYSIS TECHNICIAN, TC 1-03956, IS HEREBY AUTOMATICALLY SUSPENDED. Continued practice after receipt of this notice of suspension shall be considered engaging in dialysis care without a current, valid certificate, which is a violation of Section 4723.73(C) [as in effect prior to March 20, 2013], ORC. You are further notified that in accordance with Chapter 119, ORC, the Board proposes under authority of Section 4723.28, ORC, to deny, permanently revoke, revoke, suspend or place restrictions on your temporary dialysis one certificate to practice as a dialysis technician; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: 1. On or about November 16, 2012, you entered into a Consent Agreement (November 2012 Consent Agreement) with the Ohio Board of Nursing (Board), a copy of which is attached hereto and incorporated herein, in which you agreed with the Board that, upon completion of the application process, your temporary dialysis certificate one to practice as a dialysis technician (TC1) in the State of Ohio would be granted, and suspended indefinitely and that such suspension would be stayed subject to the following probationary terms, conditions and limitations for a minimum period of one (1) year. 2. You were issued a TC1 in the State of Ohio on November 20, 2012. 3. Item 7. of the November 2012 Consent Agreement states, "Within forty-five (45) days of the effective date of this Consent Agreement and continuing throughout the probationary period, MR. YOUNG shall begin submitting, at his expense and on the day selected, breath, hair, blood or urine specimens for drug and/or alcohol analysis at a collection site specified by the Board at such times as the Board may request. Upon and after MR. YOUNG's

Lee Alexander Young, TC1 Page 3 initiation of drug screening, refusal to submit such specimen, or failure to submit such specimen on the day he is selected, or in such a manner as the Board may request, shall constitute a violation of a restriction placed on a license for purposes of Section 4723.28(B), ORC. This screening shall require a daily call-in process. The specimens submitted by MR. YOUNG shall be negative, except for substances prescribed, administered, or dispensed to him by another so authorized by law and who has received a complete copy of this Consent Agreement prior to prescribing for MR. YOUNG." Despite the above provision, as of February 26, 2013, you have failed to initiate drug screening with Firstlab, the Board's random drug/alcohol screen program administrator. 4. Item 10. of the November 2012 Consent Agreement states, "Within sixty (60) days of the effective date of this Consent Agreement, MR. YOUNG shall provide a copy of this Consent Agreement to all treating practitioners and shall provide to the Board a list of all treating practitioners, including addresses and telephone numbers. Further, MR. YOUNG shall be under a continuing duty to provide a copy of this Consent Agreement, prior to initiating treatment, to additional treating practitioners, and to update the list of treating practitioners with the Board within forty-eight (48) hours of being treated by another practitioner." Despite the above provision, as of February 26, 2013, you have failed to provide a list of treating practitioners to the Board. Section 4723.28(B)(17), Ohio Revised Code, ORC, authorizes the Board to discipline a certificate holder for violation of any restrictions placed on a dialysis technician certificate by the Board. Accordingly, the Board is authorized to impose one or more of the sanctions as cited in Section 4723.28, ORC. In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing in this matter. If you wish to request such hearing, the request must be made in writing and must be received in the Board office within thirty (30) days of the time of mailing of this notice. You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representativd as is permitted to practice before the Board, or you may present your position, arguments, or contentions in writing. At the hearing you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to: Lisa Ferguson-Ramos, Compliance Unit

Lee Alexander Young, TC1 Page 4 Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, Ohio 432157410, or to the e-mail address, hearing(&,nursing.ohio.gov. If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Automatic Suspension and Opportunity for Hearing, deny, permanently revoke, revoke, suspend or place restrictions on your temporary dialysis one certificate to practice as a dialysis technician; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars (S500.00) per violation. Sincerely,

Rhonda S. Barkheimer, R.N., C.N.P. Supervising Board Member Certified Mail Receipt No. 7012 2210 0000 6272 3742 cc: Henry G. Appel, Senior Assistant Attorney General

Case #12-003488

Ofaid Board of Nursing .

17 South High Street, Suite 400

www.nursing.ohia.gov

Columbus, Ohio 43215-7410 0, (614) 466-3947

CONSENT AGREEMENT BETWEEN LEE ALEXANDER YOUNG, TCI APPLICANT, OCDT APPLICANT AND OHIO BOARD OF NURSING
This Consent Agreement is entered into by and between LEE ALEXANDER YOUNG, TC1 APPLICANT, OCDT APPLICANT (MR. YOUNG) and the Ohio Board of Nursing (Board), the state agency charged with enforcing Chapter 4723. of the Ohio Revised Code (ORC), and all administrative rules promulgated thereunder. BASIS FOR ACTION This Consent Agreement is entered into on the basis of the following stipulations, admissions and understandings: A. The Board is empowered by Section 4723.28, ORC, to deny, permanently revoke, revoke, suspend, or place restrictions on any certificate issued by the Board; reprimand or otherwise discipline a certificate holder; or impose a fine of five hundred dollars ($500.00) or less per violation. Section 4723.28(B)(4), ORC, authorizes the Board to deny a certificate or otherwise discipline a certificate holder for a conviction of, a plea of guilty to, .a judicial finding of guilt of, a judicial finding of guilt resulting from a plea of no contest to, or a judicial finding of eligibility for intervention Iieu of conviction for, any felony or of any crime involving gross immorality or moral turpitude. Section 4723.28(B)(5); ORC, authorizes the Board to deny a certificate or otherwise discipline a certificate holder for conviction of, a plea of guilty to, a judicial finding of guilt of, a judicial finding of guilt resulting from a plea of no contest to, or a judicial finding of eligibility for intervention in lieu of conviction for, violating any municipal, state, county, or federal drug law. On or about July 2, 2012, MR. YOUNG submitted to the Board an Application for a Temporary Certificate and Certificate to Practice as a Dialysis Technician in Ohio. MR. YOUNG knowingly and voluntarily admits that in Wayne County Municipal Court (Ohio), in 2009, he was convicted of one (1) minor misdemeanor count of Possession of Marijuana.

B.

C.

Lee Alexander Young, TCI Applicant, OCDT Applicant Page 2

AGREED CONDITIONS Wherefore, in consideration of the foregoing and mutual promises hereinafter set forth, and in lieu of any formal proceedings at this time, MR. YOUNG knowingly and voluntarily agrees with the Board to the following terms, conditions, and limitations: Upon completion of the application process, MR. YOUNG's temporary certificate one and any future certificates to practice as a dialysis technician(in Ohio shall be granted and that certificate(s) shall be suspended indefinitely. Such suspensions shall be stayed, subject to the following probationary terms, conditions, and limitations for a minimum period of one (I) year: 1, MR. YOUNG shall obey all federal, state, and local laws, and all laws and rules governing the practice of dialysis technicians in Ohio. R. YOUNG shall appear in person for interviews before the full Board or its designated representative as requested by the Board or its designee.

2.

Criminal Records Check 3. Within ninety (90) days prior to submitting a request for release from the probationary terms, conditions and limitations of this Consent Agreement, MR. YOUNG agrees that he will submit a request to the Bureau of Criminal Identification and Investigation (BCH) to conduct a criminal records check of MR. YOUNG, including a check of Federal Bureau of Investigation (FBI) records, and shall cause BCII to submit MR. YOUNG's criminal records check reports to the Board, MR. YOUNG agrees that a request for release from the probationmy terms of this Consent Agreement will not be considered by the Board until the completed criminal records check, including the FBI check, has been received by the Board.

Continuing Education Requirements 4. Within ninety (90) days from the effective date of this Consent Agreement, MR. YOUNG, in addition to fulfilling the requirements necessary to maintain a certificate to practice as a dialysis technician, shall successfully complete and submit satisfactory documentation of successful completion of the following continuing education or other comparable course(s) approved in advance by the Board, taken subsequent to the effective date of this Consent Agreement: two (2) hours of Critical Thinking; and two( (2) hours of Professionalism/Ethics,

Lee Alexander Young, TCI Applicant, OCDT Applicant Page 3

Monitoring and Chemical Dependency Evaluation 5. MR. YOUNG shall abstain completely from the personal use or possession of drugs, except those prescribed, administered, or dispensed to him by another so authorized by law and who has received a complete copy of this Consent Agreement prior to prescribing for MR. YOUNG. MR. YOUNG shall self-administer the prescribed drugs only in the manner prescribed. MR. YOUNG shall abstain completely from the use of alcohol, if recommended by a chemical dependency professional, as referenced in Paragraph 8. below. Within forty-five (45) days of the effective date of this Consent Agreement and continuing throughout the probationary period, MR. YOUNG shall begin submitting, at his expense and on the day selected, breath, hair, blood or urine specimens for drug and/or alcohol analysis at a collection site specified by the Board at such, times as the Board may request. Upon and after MR. YOUNG's initiation of drug screening, refusal to submit such specimen, or failure to submit such specimen on the day he is selected, or in such a manner as the Board may request, shall constitute a violation of a restriction placed on a license for purposes of Section 4723.28(B), ORC. This screening shall require a daily call-in process. The specimens submitted by MR. YOUNG shall be negative, except for substances prescribed, administered, or dispensed to him by another so authorized by law and who has received a complete copy of this Consent Agreement prior to prescribing for MR. YOUNG. Within ninety (90) days of the effective day of this Consent Agreement, MR. YOUNG shall, at his expense, obtain a chemical dependency evaluation by a Board approved chemical dependency professional and shall provide the Board with complete documentation of this evaluation. Prior to the evaluation, MR. YOUNG shall provide the chemical dependency professional with a copy of this Consent Agreement. Further, MR. YOUNG shall execute releases to permit the chemical dependency professional to obtain any information deemed appropriate and necessary for the evaluation. The evaluating professional shall submit a written opinion to the Board that includes diagnoses, recommendations for treatment and monitoring, any additional restrictions that should be placed on MR. YOUNG's certificate to practice as a dialysis technician, and a statement as to whether M.R. YOUNG is capable of practicing as a dialysis technician according to acceptable and prevailing standards of safe dialysis care.

6,

7.

8.

Lee Alexander Young, TC1 Applicant, OCDT Applicant Page 4

9.

MR. YOUNG shall provide the Board with satisfactory documentation of"compliance with all aspects of the treatment plan developed by the chemical dependency professional described above until released. Further, MR. YOUNG agrees that the Board may utilize the chemical dependency professional's recommendations and conclusions from the evaluation as a basis for additional terms, conditions, and limitations on MR. YOUNG's certificate to practice as a dialysisltechnician and that the terms, conditions, and limitations may be incorporated in an addendum to this Consent Agreement.

Treating Practitioners and Reporting 10. Within sixty (60) days of the effective date of this Consent Agreement, MR. YOUNG shall provide a copy of this Consent Agreement to all treating practitioners and shall provide to the Board a list of all treating practitioners, including addresses and telephone numbers. Further, MR. YOUNG shall be under a continuing duty to provide a copy of this Consent Agreement, prior to initiating treatment, to additional treating practitioners, and to update the list of treating practitioners with the Board within forty-eight (48) hours of being treated by another practitioner. MR. YOUNG shall cause all treating practitioners to complete a medication prescription report that is to be mailed by the practitioner directly to the Board. The medication report is to be completed for any and all substances prescribed, administered, or dispensed to MR. YOUNG throughout the duration of this Consent Agreement. Within twenty-four (24) hours of release from hospitalization or medical treatment, MR. YOUNG shall notify the Board of any and all medication(s) or prescription(s) received.

11.

12.

Employment Conditions 13. Prior to accepting employment as a dialysis technician, each time with every employer, MR. YOUNG shaft notify the Board of the name and address of the dialysis technician employer in writing. Within thirty (30) days following the effective date of this Consent Agreement, MR. YOUNG shall provide his employer(s) with a copy of this Consent Agreement. MR. YOUNG is under a continuing duty to provide a copy of this Consent Agreement to any nev employer prior to accepting employment in a position in which a dialysis technician, certificate is required. MR. YOUNG shall have his employer(s), if working in a position where a certificate to practice as a

14.

Lee Alexander Young, TC1 Applicant, OCDT Applicant Page 5

dialysis technician is required, submit written reports regarding job performance on a quarterly basis beginning January 1, 2013 or within thirty (30) days of accepting employment as a dialysis technician. MR. YOUNG shall have his employer(s) send documentation to the Board, along with the first employer report, of receipt of a copy of this Consent Agreement, including the date the Consent Agreement was received. Reporting Requirements of Certificate Holder 15. MR. YOUNG shall report to the Board,, in writing, any violation of this Consent Agreement within thirty (30) days of the occurrence of the violation. MR. YOUNG shall sign release of information forms allowing health professionals and other organizations to submit the requested documentation directly to the Board. MR. YOUNG shall submit any and all information that the Board may request regarding his ability to praCtice according to acceptable and prevailing standards of safe dialysis care, MR. YOUNG shall not submit or cause to be submitted any false, misleading, or deceptive statements, information, or documentation to the Board or to employers or potential employers. MR. YOUNG shall submit the reports and documentation required by this Consent Agreement on forms specified by the Board. AlI reporting and communications required by this Consent Agreement shall be made to the Compliance Unit of the Board. MR. YOUNG shall submit the reports and documentation required by this Consent Agreement or any other documents required by the Board to the attention of the Compliance Unit, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, OH 43215-7410. MR. YOUNG shall verify that the reports and documentation required by this Consent Agreement are received in the Board office. MR. YOUNG shall inform the Board within five (5) business days, in writing, of any change in employment status or of any change in residential or home address or telephone number.

16.

17.

18.

19.

20.

21.

22.

Lee Alexander Young, TCI Applicant, OCDT Applicant Page 6

Temporary Practice Restrictions MR. YOUNG further knowingly and voluntarily agrees with the Board to the following TEMPORARY CERTIFICATE RESTRICTIONS: MR. YOUNG shall not practice as a dialysis technician (I) for agencies providing home care in the patient's residence; (2) for hospice care programs providing hospice care in the patient's residence; (3) for staffing agencies or pools; (4) as an independett provider where the dialysis technician provides dialysis care and is reimbursed for services by the State of Ohio through State agencies or agents of the State. MR. YOUNG shall not function as a supervisor or as a manager while working in a position for which a certificate to practice as a dialysis technician is required. FAILURE TO COMPLY MR. YOUNG agrees that his temporary certificate one and any future certificates to practice as a dialysis technician will be automatically suspended if it appears to the Board that MR. YOUNG has violated or breached any terms or conditions of the Consent Agreement. Following the automatic suspension(s), the Board shall notify MR. YOUNG via certified mail of the specific nature of the charges and automatic suspension of his temporary certificate one and any future certificates. Upon receipt of this notice, MR. YOUNG may request a hearing regarding the charges. The above described terms and conditions shall constitute "restrictions placed on a dialysis technician certificate" for purposes of Section 4723.28(B), ORC. If, in the discretion of the Board, MR. YOUNG appears to have violated or breached any terms or conditions of this Consent Agreement, the Board reserves the right to institute formal disciplinary proceedings for any and all possible violations or breaches, including, but not limited to, alleged violations of the laws of Ohio occurring before the effective date of this Consent Agreement. DURATION/ MODIFICATION OF TERMS The terms, limitations, and conditions, of this Consent Agreement may be modified or terminated, in writing, at any time upon the agreement of both MR. YOUNG and the Board. The Board may only alter the probationary period imposed by this Consent Agreement if: (1) the Board determines that MR. YOUNG has complied with all aspects of this Consent Agreement; and (2) the Board determines that M.R. YOUNG is able to practice according to acceptable and prevailing standards of safe dialysis technician care without Board monitoring, based upon an interview with MR. YOUNG and review of the repRrts as required herein. Any period during which MR. YOUNG does not work in a position for which a certificate as a dialysis technician is required shall not count toward fulfilling the probationary period imposed by this Consent Agreement. 4

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614 995 3686. P 9/9

Lee Alexander Young, TC1 Applicant, OCDT Applicant Page 7 MIEIDGMHISLLIABILITY RELEASE MR. YOUNG acknowledges that he has had an opportunity to ask questions concerning the terms of this Consent Agreement and that all questions asked have been answered in a satisfactory manner. MR, YOUNG waives all of his rights under Chapter 119, ORC, as they relate to matters that are the subject of this Consent Agreement, MR, YOUNG waives any and all claims or causes of action he may have against the Board, and its members, officers, employees andior agents arising out of matters, which are the subject of this Consent Agreement, This Consent Agreement shall be considered a public record as that term is used in Section 14943, ORC, The information contained herein may be reported to appropriate organizations, data banks and governmental bodies, This Consent Agreement Is not an adjudication order as discussed in Chapter 11.9, ORC. Any action initiated by the Board based on alleged violations of this Consent Agreement shall comply with the Administrative Procedures Act, Chapter ) 19, ORC.

EITECTIVE DATE
MR. YOUNG understands that this Consent Agreement is subject to ratification by the Board prior to signature by the Board President and shall become effective upon the last date of signature below,

LEE ALEXIS, ER. UNG, TCI APPLICANT, D E OCDT APPLICAN

,M/ 06-Pi
BERTHA LOVELACE, President Ohio Board of Nursing

Li( DATE

10/30/2012 TUE 14:37 [TX/RX NO 8740] a009

Case # 11-002511

Ohio Board of Nursing www.nursing.ohio.gov

17 South High Street, Suite 400 .6' Columbus, Ohio 43215-7410 (614) 466-3947

March 22, 2013

NOTICE OF OPP RTIJNITY Fd

Beverly H. Zimmerman, R.N. 12680 Putnam Rd. Saint Paris, Ohio 43072 Dear Ms. Zimmerman:

HEA ING

In accordance with Chapter 119, Ohio Revised Code (ORC), you are hereby notified that the Ohio Board of Nursing (Board) proposes under authority of Section 4723.28 ORC, to deny, revoke, permanently revoke, suspend or place restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: 1. On or about March 14, 2011, while working as a nurse at Lima Memorial Hospital, in Lima, Ohio, you determined that Patient #1's [See attached Patient Key to remain confidential and not subject to public disclosure] risk of falling was high. You did not implement appropriate fall risk interventions to address Patient #1's risk of fall. At approximately 9:00 P.M. you documented finding Patient #1 on the floor. You did not timely notify Patient #1's physician about the fall, and did not document whether you had notified the physician. X-rays later revealed that Patient #1 had broken a rib. Section 4723.28(B)(16), ORC, authorizes the Board to discipline a licensee for violation of Chapter 4723, ORC, or any rules adopted under it. Specifically, Rule 4723-4-06(H), Ohio Administrative Code (OAC), states that a licensed nurse shall implement measures to promote a safe environment for each client. Rule 4723-4-03(C), OAC, states that a registered nurse shall demonstrate competence and accountability in all areas of practice in which the nurse is engaged which includes, but is not limited to, the following: (1) Consistent performance of all aspects of nursing care; and (2) Appropriate recognition, referral or consultation, and intervention, when a complication arises. Accordingly, the Board is authorized to impose one or more of the sanctions cited in Section 4723.28, ORC . In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing in this matter. If you wish to request such hearing, the request must be made in writing and must be received in the Board office within thirty (30) days of the time of mailing of this notice. You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to

Beverly H. Zimmerman, R.N. Page 2 practice before the Board, or you may present your position, arguments, or contentions in writing. At the hearing, you may also present evidence and examine witnesses appearing for and Iv against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to Lisa Ferguson-Ramos, Compliance Unit Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, Ohio 432157410 or to the email address, hearing@ nursing.ohio.gov. If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Opportunity for Hearing, deny, revoke, permanently revoke, suspend, or place restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely,

Rhonda S. Barkheimer, R.N., C.N.P. Supervising Board Member Certified Mail Receipt No. 7012 2210 0000 6272 3285 Attorney Certified Mail Receipt No. 7012 2210 0000 6272 3292 cc: Henry G. Appel, Senior Assistant Attorney General Elizabeth Y. Collis, Esq.