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BOARD OF REGISTERED NURSING
DEPARTMENT OF CONSUMER AFFAIRS
STATE OF CALIFORNIA
In the Matter of the Stipulated Settlement and
Disciplinary Order Against: .
CHARLENE MARY ANDERSON
3360 Monroe Street
Carlsbad, CA 92008
Registered Nurse License No. 461728
Respondent.
Case No. 2010-298
STIPULATED SURRENDER OF
LICENSE AND ORDER
DECISION AND ORDER
The attached Stipulated Surrender of License and Order is hereby adopted by the
Board of Registered Nursing, Department of Consumer Affairs, as its Decision in this matter.
It is so ORDERED on Qc:t'of&'""fl- 2tel '2o1 '2--- .
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BEFORE THE
BQARI) OF NURSING
DEPARTMENT OF CONSUMER AFFAIRS
STATE OF CALIFORNIA
In the Matter Qf the Stipulated Settlement and
Disciplinary Order Against:
CHARLENE MARY ANDERSON
3360 Monroe Street
Carlsbad, CA 92Q08
Registered Nurse License Nq. 4(51728
Re$pondent.
Case No. 2010-298
STIPULATED SURRENDER OF
LICENSE AND ORDER
IT IS HEREBY STIPULATED AND AGREED by and between the parties that
the following matters are tme:
PARTIES
1. Louise R. Bailey, M.Ed., R.N. (Complainant) is the Executive Officer of
the Board of Registered Nursing, who brought this action solely in her official capacity.
2. Charlene Mary Anderson (Respondent), is representing herself in this
proceeding and has chosen not to exercise her right to be represented by c.ounsel.
3. On or about March 31, 1991, the Board of Registered Nursing issued
Registered Nurse license No. 461728 to Respondent. The Registered Nurse license expired on
August 31, 2012 and has not been renewed.
JURISDICTION
' ' . .
4. On October 19, 2011, the Board of Registered Nursing adopted Proposed
Decision Case No. 2010-298, which became effective on November 18, 2011. The Disciplinary
Order requires, inter alia, the respondent to serve a 3-year term that includes Probation
Conditions# 1-25. The Disciplinary Order is attached as exhibit A and incorporated herein by
reference.
5. At all times after the effective date of Respondent's probation, Condition
18 states,
"License Surrender. During Respondent's term of probation, if he
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ceases practicing due to retirement, health reasons or is otherwise
unable to satisfy the conditions of probation, Respondent may surrender
her license to the Board. The Board reserves the right to evaluate
Respondent's request and to exercise its discretion whether to grant the
request, or to take any other action deemed appropriate and reasonable
under the circumstances, without further hearing. 1)pon formal
acceptance of the tendered license and wall certificate, Respondent will
no longer be subject to the conditions of probation.
Surrender of Respondent's license shall be considered a disciplinary action
and shall become a part of Respondent's license history with the Board. A
registered nurse whose license has been surrendered may petition the Board for
reinstatement no sooner than the following minimum periods from the effective
date of the disciplinary decision:.
(l) Two years for reinstatement of a license that wassurrendered for
any reason other than a mental or physical illness; or
*(2) One year for a license surrendered for a mental or physical illness."
ADVISEMENT AND WAIVERS
6. Respondent has carefully read and understands Disciplinary Order
Case No. 2010-298. Respondent has carefully read, and understands the effects of this
Stipulated Surrender of License and Order and understands that this Stipulated Surrender, if.
accepted by the Board, is considered as formal discipline of her license.
7. Respondent understands that by signing this stipulation she enables
the Board to accept the surrender of her Registered Nurse License without further process.
CONTINGENCY
8. This stipulation shall be subject to approval by the Board of Registered
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Nursing. The Respondent understands and agrees that py signing this Stipulated Surrender of
License and Order, she may not withdraw her agreement or seek to rescind the stipulation prior
to the date it becomes effective. If the Board declines to accept this stipulation as its Decision
and Order, the Stipulated Surrender of License and Order shall be of no force or effect, except
for this paragraph, it shall be inadmissible in any legal action between the parties, and the Board
shall not be disqualified from further action by having considered this matter.
9. This Stipulated Surrender of License and Order is intended by the parties to
be an integrated writing representing the complete, final, and exclusive embodiment of their
agreement. It supersedes any and all prior or contemporaneous agreements, understandings,
discussions, negotiations, and commitments (written or oral). This Stipulated Surrender of
. License and Order may not be altered, amended, modified, supplemented, or otherwise changed
except by a writing executed by an authorized representative of each of the parties.
10. The parties understand and agree that facsimile copies of this Stipulated
Surrender of License and Order, including facsimile signatures thereto, shall have the same
force and effect as the originals.
11. In consideration ofthe foregoing stipulations, the parties agree that the
Board may; without further notice or formal proceeding, issue and enter the following Order:
ORDER
IT IS HEREBY ORPERED that Registered Nurse License No. 461728, issued to
Respondent, Charlene Mary Anderson, is surrendered and the surrender is accepted by the
Board of Registered Nursing.
12. The surrender of Respondent's Registered Nurse License and the
acceptance of the surrendered license by the Board shall constitute the imposition of discipline
against Respondent. This stipulation constitutes a record of the discipline and shall become a
part of Respondent's license history with the Board.
13. Respondent shall lose all rights and privileges as a Registered Nurse in
California as of the effective date of the Board's l)ecision and Order.
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:----
14. Respondent shall cause to be delivered to the Board both her pocket
license and wall certificate, if one was issued, on or before the effective date of the Decision
and Order.
15. Respondent fully understands and agrees that if she ever files an application for
licensure or a petition for reinstatement in the. State of California, the Board shall treat it as a
petition for reinstatement. Respondent must comply with all the laws, regulations and
procedures for reinstatement of a revoked license in effect at the time the petition is filed, and all
of the charges and allegations contained in Accusation No. 2010-298 shall be deemed to be true,
correct and admitted by Respondent when the Board determines whether to grant or deny the
petition.
16. Respondent shall not apply for licensure or petition for reinstatement for
2 years from the effective date of the Board ofRegistered Nursing's Decision and Order.
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ACCEPTANCE
I have carefully read the Stipulated Surrender of License and Order. I understand
the stipulation and the effect it will have on my Registered Nurse License. I enter into this
Stipulated Surrender of License and Order voluntarily, knowingly, and intelligently, and agree to
be bound by the Decision and Order of the Board of Registered Nursing.
DATED:


Respondent
ENDORSEMENT
The foregoing Stipulated Surrender of License and Order is hereby respectfully
accepted by Louise R. Bailey, M.Ed., R.N. (Complainant) is the Executive Officer for the Board
of Registered Nursing.
Louise R. Bailey, M.Ed., R.N.
Executive Officer
BOARD OF REGISTERED NURSING
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EXHIBIT "A"
Stipulated Settlement and Disciplinary Order No. 2010-298
7
BEFORE THE
BOARD OF REGISTERED NURSING
DEPARTMENT OF CONSUMER AFFAIRS
STATE OF CALIFORNIA
In the Matter of the Accusation Against:
CHARLENE MARY ANDERSON
81 7 N Tremont St
Oceanside, CA 92054
Registered Nurse License No. 461728
Respondent.
Case No. 2010-298
OAH No. 2010010996
DECISION
The attached Proposed Decision of the Administrative Law Judge is hereby adopted by
the Board of Registered Nursing as its Decision in the above-entitled matter.
This Decision shall become effective on November 18, 2011.
IT IS SO ORDERED this 19th day of October, 2011.
Pr
Board of Registered Nursing
Department of Consumer Affairs
State of California
ident
()
BEFORE THE
BOARD OF REGISTERED NURSING
DEPARTMENT OF CONSUMER AFFAIRS
STATE OF CALIFORNIA
In the Matter of the Accusation Against: Case No. 2010-298
CHARLENE MARY ANDERSON, RN
Oceanside, CA
OAH No. 2010010996
Registered Nurse License No. 461728
Respondent.
PROPOSED DECISION
Robert Walker, Administrative Law Judge, Office of Administrative Hearings, State
of California, hearq.this matter in San Diego, California, on June 20 through June 23, 2011,
and July 12, 2011.
Karen L. Gordon, Deputy Attorney General, represented the complainant, Louise R.
Bailey, M.Ed., R.N., Executive Officer of the Board of Registered Nursing.
Richard H. Layon, Attorney at Law, represented the respondent, Charlene Mary
Anderson.
The record was closed on July 12, 2011.
SUMMARY
Respondent is a registered nurse. During a four month period from May through
August of 2006, respondent withdrew 33 narcotic tablets from a medication dispensing
device but failed to account for either administering them to patients or destroying them.
Respondent testified that she pulled out ofPyxis" and
is surprised that the documentation is not complete.
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Complainant does not allege that respondent diverted the drugs. That is, complainant
does not allege that respondent failed to administer the drugs to patients. Also, complainant
does not allege that respondent consumed any of the drugs. The factual allegation is simply
that respondent failed to documentwhat she did with the drugs.
Complainant seeks revocation or suspension of respondent's license.
Complainant also seeks cost recovery, and there are issues concerning cost recovery.
In this decision, it is found and determined that there are grounds to discipline
respondent's license and that the appropriate discipline is a stayed revocation with probation.
FACTUAL FINDINGS
Background
1. On March 31, 1991, the Board of Registered Nursing nurse
license number 461728 to the respondent, Charlene Mary Anderson.
2. Respondent began working at Scripps Memorial Hospital in Encinitas in
August of 2002. She worked in a postpartum unit. In September of 2006, an investigation
disclosed that, in the four month period from May through August of 2006, respondent failed
to document the disposition of 3 3 narcotic tablets. In September of 2006, Scripps terminated
respondent.
3. Pyxis is the trade name of an automated device for dispensing medication. In
order to withdraw a medication, one must enter a personal identification number. The device
maintains a record of the medications dispensed. The record includes the name of the patient
for whom a medication was withdrawn, the date and time the medication was withdrawn, and
the identification code of the person who withdrew it.
4. When a nurse withdraws a medication, he or she has a duty to make a record
of what was done with it. Ordinarily, a nurse administers a medication to the patient for
whom it was withdrawn and makes a record of having administered it. On occasion, part or
all of a medication needs to be destroyed, i.e., wasted. One may need to waste a medication
because, for example, a patient refuses to take it or the order is for less than a full dosage.
When a nurse wastes a narcotic medication, he or she must have another nurse witness the
wastage, and both nurses must document the event.
. 5. In the postpartum unit at nl;lrses usually use a computer system called
Watch Child to document the administration Ofmeaications. One can obtain printed flow
sheets showing the information stored in Watch Child: Nurses can document the
administration of medications in nursing notes.
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Failure to Document
6. Documenting the administration or wastage of medication is a critical
function. It always is important, but it is particularly important in the circumstance in which
the responsibility for a patient shifts from one nurse to another. This happens routinely when
nurses change shifts. It does happen on other occasions, however, as when a nurse becomes
ill or is given a different assignment because ofstaffing problems. If a nurse administers a
medication but does not document having administered it, there is a risk that a nurse who
takes over the patient's care may administer the medication again. And with certain
medications, overmedication can create serious risks. Thus, before a nurse leaves a patient in
the care of another nurse, he or she has a duty to document the administration of all
medications.
7. During a four month period from May through August of 2006, respondent
withdrew narcotic tablets from a Pyxis but failed to account for either administering them to
patients or wasting them. She withdrew but failed to document the disposition of 23 tablets
ofPercocet, which is oxycodone with acetaminophen. She withdrew but failed to document
the disposition of seven tablets of Vi co din, which is hydrocodone. She withdrew but failed
to document the disposition of three tablets ofTylenol3, which is codeine with
acetaminophen.
8. Patients in a postpartum unit commonly experience a high level of pain. All
three of these narcotics are used to relieve pain.
9. In September of 2006, the administrative staff at Scripps concluded that they
could not rely on respondent to practice safely, and they terminated her.
Respondent's Testimony
10. The following is a paraphrased summary ofpart ofrespondent's testimony.
Charting is critical.to a nurse's job. I never knowingly failed to chart. Before it was brought
to my attention, I had not realized there was a problem with my charting. I thought I was
charting everything. I carried a paper on which I kept track of things I needed to chart. This
is a common practice; nurses refer tosuch notes as their "brain." I charted a soon as I could.
At the end of my shift, I pulled a Pyxis report and reconciled my medication charting. This
was my practice and custom, and I do not recall ever failing to follow it. One reason
documentation is important has to do with minimizing the risk of over-medication; other
nurses need to know what has been administered.
11. Respondent testified that she tried to provide safe care. She said her goal
always was to insure safety for her patients.
12. Respondent, with a tone of pride, said her_ former patients who returned to
have another child often asked that respondent be assigned to care for them.
3
Matters in Mitigation
13. Respondent became a Licensed Vocational Nurse in 1969 and became a
registered nurse in 1991. She has been has worked in nursing for42 years. There is no
evidence of respondent's having engaged in unprofessional conduct on any other occasion.
On one prior occasion at Scripps, an audit showed that respondent failed to document
administration or wastage of two tablets ofVicodin. Respondent's supervisor counseled
respo:ndent to be vigilant about documentation. While a nurse has a duty to document the
administration or wastage of all medications, mistakes can occur, and a failure to document
two tablets does not amount to unprofessional conduct.
14. . Respondent testified that, if she did fail to document, there was a combination
of circumstances that may have contributed to her failure. It is difficult to anticipate staffing
needs in a postpartum uriit because one cannot schedule when babies will be born. At times,
a postpartum unit can become extremely busy without anyone having anticipated that. When
that happens, supervisors call in other nurses. Also, supervisors often lend a hand and
provide direct patient care. Nevertheless, there are times when postpartum nurses carry very
heavy loads. Respondent testified that she often had a very heavy load at Scripps. She
testified that, in the postpartum unit at Scripps, "they barely met state standards" for staffing
ratios, and as things c h a n g ~ d during a shift, they frequently failed to meet state standards.
She implied that that may have accounted for some. failures to document.
15. It was difficult to chart at the end of a shift because it was difficult to access a
computer terminal. Respondent did not want to disturb patients by using the terminals in
their rooms, and nurses coming on duty needed to use the other terminals.
Expert Opinion that Respondent Engaged in Gross Negligence
16. Respondent called Cathy Horowitz as an expert witness. Ms. Horowitz holds
a nursing degree and a public health nurse degree. She began her nursing career in 1971 in
private practice as a childbirth nurse. She has held numerous nursing and public health nurse
positions. From 2008 to the present she has been a staff nurse at the Vallejo campus of the
St. Helena Center for Behavioral Health, where she cares for .mental health patients confined
to a secured facility. She has been a guest lecturer at a number of colleges and universities.
Her background and experience are such that she is very familiar with the requirement to
document the administration of medications.
17. Ms. Horowitz testified that respondent's repeated failures to document her
disposition of narcotics constituted an extreme depruiure from the standard of care. Ms.
Horowitz said respondent's repeated failures to document her disposition of narcotics
constituted gross negligence that rose to the level of incompetence and constituted an
extreme departure from what is required of a nurse. - .:
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18. Ms. Horowitz testified that failing to document the administration of
medications can result in over-medication, which can cause serious negative consequences.
If a nurse administers a medication but fails to document the administration, another nurse
may assume the medication was not administered and act on that assumption.
19. Ms. Horowitz testified that if a nurse is put in a situation in which she cannot
document the disposition of medications, he or she should report that to a supervisor. If the
supervisor fails to provide a satisfactory solution, the nurse should report to an independent
authority.
Expert Opinion that Respondent's Conduct did not Fall Below the Standard ofCare.
20. Respondent called Laura Mitchell as an expert witness. Ms. Mitchell holds a
Masters of degree in nursing with an emphasis in computer applications. She has
been licensed as a registered nurse in California since 1989, and she is as a public
health nurse. In the 1998 - 1999 school year, Ms. Mitchell taught surgical nursing and
obstetrics at Palomar College. She testified that she is a legal nurse consultant. Her
background and experience are such that she is very familiar with the requirement to
document the administration of medications.
21. Ms. Mitchell testified that the postpartum unit at Scripps was always busy and
that staffing was either borderline or inadequate.
22. When Ms. Mitchell initially reviewed the evidence in this case, she
that respondent failed to document the disposition of medications. Subsequently, however,
she changed her mind and concluded that, based on the quality of the evidence, she could not
determine whether respondent documented the disposition of medications. The following is
a paraphrased summary of part of Ms. Mitchell's testimony. A number of things caused her
to change her mind. The Watch Child flow sheets that are in evidence as records of the
administration of medications contain no vial signs, no information regarding consciousness,
no place for a narrative, and no place for a signature. Also, the flow sheets do not bear the
name of Scripps; they could have come from any hospital. Scripps policies require
documentation but do not specify where one should document. It is possible that respondent
. documented in nurses notes. The flow sheets in evidence have time-specific columns, but
time sheets should not be organized that way. They should be organized with one column
for each hour. The columns on the' flow sheets in evidence are not of uniform width. The
flow sheets do not have places for entries that specifically concern postpartum. It appears
that whoever pulled the records was very selective in choosing which patient records to pull.
Ms. Mitchell said that, based on all of these things her conclusion changed, and she cannot
confirm that respondent failed to document the disposition of medications.
23. Ms. Mitchell's reasons for changing her conclusion are not persuasive. If
respondent had documented the administration of medications in nursing notes, she should
have obtained those notes and put them in evidence. She has said, however, that she
documented,theadministration of medications in Watch Child, and there are numerous
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examples of her having done that correctly. There was no evidence that the Watch Child
flow sheets were from some other hospital or that they did not concern respondent's patients.
A good number of the things that caused Ms. Mitchell to change her conclusion could not
have been more irrelevant.
24. Ms. Mitchell testified that, based on all of the things she reviewed, she
concluded that respondent's conduct did not fall below the standard of care. Ms. Mitchell
appeared to be hesitant to express this opinion, and her opinion was not convincing.
Rehabilitation
25. Respondent testified that she was sorry about the whole incident. She said
that, when she was confronted with computer records that showed a failure to chart, she was
appalled. In presenting her testimony, respondent was appropriately contrite.
26. There is no evidence that respondent's attitude about charting has changed, but
it is significant that she testified that she recognizes the importance of charting and
understands what needs to be done to minimize the risk of failing to chart. As noted above,
respondent testified that charting is critical, and she never knowingly failed to chart. She.
said she carried a "brain" on which she kept track of things and charted a soon as she could.
She said she pulled a Pyxis report and reconciled her medication charting. Respondent's
clear understanding of these things is a double edged sword. The fact that she understood
these things but, nevertheless, failed to chart raises a question as to whether there is some
other problem. On the other hand, the very real risk of losing her license is likely to have
caused her to redouble her efforts and be more careful to cio what she clearly understands she
is required to do.
Testimonial
27. Madeline Rodriguez, M.D., practices obstetrics and gynecology. Before
respondent began working at Scripps in2002, she worked at Tri-City Medical Center in
Oceanside. Dr. Rodriguez testified that she recalls respondent's having worked in the
postpartum unit at Dr. Rodriguez said she always thought of respondent as being
caring and compassionate. Dr. Rodriguez found respondent to be competent.
COSTS
28. Complainant submitted a certification of costs for work performed by the
Division of Investigation, Department of Consumer Affairs (Division of Investigation) and
for "Expert." Regarding the Division of Investigation, the certification concerns work
performed in June of2007, July of2008, and Augustof2009 at a cost of$7,821. Regarding
"Expert," the certification concerns work performed in September of 2010 at a cost of
$1,425. .
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29. Complainant also submitted a certification of costs for work performed by the
Office of the Attorney General. The certification concerns work performed by an attorney
and by a paralegal in 2009 through 2011 at a cost of $3 7,210. Attached to that certification is
a form entitled "Matter Time Activity Summary." The certification says that the "summary .
. . sets forth the tasks undertaken [and] the amount oftime billed for the activity ...." But
that is not true; neither the summary nor the certification contains a description of the tasks
performed or the time spent on the tasks.
30. The total cost recovery sought is $46,456.
31. Business and Professions Code section 125.3, subdivision (a) provides, in part:
. .
[T]he administrative law Judge may direct a licentiate found to
have committed a violation or violations ofthe licensing act to
pay a sum not to exceed the reasonable costs of the investigation
and enforcement of.the case.
32. California Code ofRegulations, title 1, section 1042, subdivisions (b)(3),
provides, in part:
[An affidavit] should contain sufficient information by which
the ALI can determine the costs incurred in the matter and the
reasonableness of such costs, for example, a general description
of the tasks performed, the time spent on such tasks, and the
hourly rate or other form of compensation.
33. In an award for costs, an essential finding is that the costs incurred were
reasonable. Subdivision (b )(3), in providing that a certification should contain the time spent
on such tasks, is not referring to the total time spent. It is referring to an enumeration of the
time spent on various tasks so that the ALI can make some assessment as to whether the time
spent on various tasks was reasonable.
34. In this case, neither certification contains a description of the tasks performed
or the time spent on various tasks.
35. There is no doubt that the board incurred some reasonable costs. And no
doubt the reasonable costs were substantial. But.neither of the certifications contains
sufficient information to support a finding as to the amount of reasonable costs .
. 36. It is found that complainant failed to prove, within the terms of Business and
Professions Code section 125.3, subdivision (a), the amount of the reasonable costs.
7
LEGAL CONCLUSIONS
CAUSE TO DISCIPLINE RESPONDENT'S LICENSE
1. By reason of the matters set forth in Findings 6, 7, and 17, it is determined that
respondent engaged in unprofessional conduct in that she withdrew narcotics but failed to
document how she disposed of them. Thus, pursuant to Business and Professions Code
section 2761, subdivision (a), there is cause to suspend or revoke her license.
2. Complainant alleges that respondent engaged in unprofessional conduct within
the terms of Business and Professions Code section 2762, subdivision (e). That subdivision,
however, concerns making improper entries. It does not concern a failure to make entries. It
concerns falsifying entries or making grossly incorrect, grossly inconsistent, or unintelligible
entries. There was no evidence that respondent did any ofthose things.
3. By reason of the matters set forth in Findings 6, 7, and 17, it is determined that
respondent engaged in unprofessional conduct in that she engaged in gross negligence by
repeatedly failing to provide nursing care as required. Thus, pursuant to Business and
Professions Code section 2761, subdivision (a)(l), and California Code of Regulations, title
16, section 1442, there is cause to suspend or revoke her license.
4. By reason ofthe matters set forth in Findings 6, 7, and 17, it is determined that
respondent engaged in unprofessional conduct in that she engaged in incompetence by failing
to exercise that degree of learning, skill, care, and experience ordinarily possessed and .
exercised by a competent registered nurse. Thus, pursuant to Business and Professions Code
section 2761, subdivision (a)(l), and California Code of Regulations, title 16, section 1443,
there is cause to suspend or revoke her license.
DISCIPLINARY GUIDELINES
5. The board's disciplinary guidelines recommend various levels of discipline.
For a violation of Business and Professions Code section 2761, subdivision (a), the
recommendation depends on what the transgression was, and the descriptions of
transgressions are not exhaustive. That is, there are transgressions .that fall within section
2761, subdivision (a), but are not covered by the descriptions oftransgressions in the
guidelines. Indeed, that is the circumstance with respondent's transgression. There is no
guideline for a failure to document.
6. The guideline that is most analogous to a failure to document is guideline (b)
for section 2761, subdivision (a). That guideline incorporates section 2762, subdivision (e),
through section 2761, subdivision (a). As noted above, section 2762, subdivision (e),
concerns falsifying entries or making grossly incorrect,. grossly inconsistent, or unintelligible
entries. The guideline for making those improper e ~ t r i e s recommends discipline of a stayed
revocation with three years of probation.
8
PROBATION IS ANAPPROPRIATE DISCIPLINE
7. In this case, that guideline identifies the appropriate discipline- a revocation
of respondent's license with the revocation stayed and a probationary license issued for three
years subject to appropriate conditions.
8. Respondent's failure to document the disposition of narcotics is a very serious
matter. If she did not administer the medications to patients, she created a potential for harm
by depriving them of prescribed medications. If she did administer the medications to
patients, she created a potential for harm by creating a risk of over-medication. On the other
hand, there is no evidence that respondent actually harmed any patient. There is no record of
any prior disciplinary action against respondent and no evidence that she has departed from
the standard of care on any other occasion. And it has been almost five years since the .
incidents of misconduct.
9. Respondent testified that she recognizes the importance of charting and
understands what needs to be done to minimize the risk of failing to chart. She testified that
charting is critical, and she never knowingly failed to chart. She said she carried a "brain" on
which she kept track of things and charted a soon as she could. She said she pulled a Pyxis
report and reconciled her medication charting. Thus, respondent understood these things and
had appropriate safeguards in place but, nevertheless, failed to chart. This raises a question
as to whether there is some problem other than simply a need to be more careful. For
example, is there a medical problem that caused respondent not to do things she thought she
was doing? Is there a medical problem that caused her to forget to do things she intended to .
do? Because the evidence suggests these concerns, protection of the public requires that
there be a professional assessment of respondent's ability to practice safely. As one
condition of probation, respondent will be required to have a mental health examination,
including psychological testing as appropriate, to determine her capability to perform the
duties of a registered nurse.
10. No evidence was presented that respondent has practiced nursing since she
was terminated from Scripps in September of2006. Because of that, protection of the public
requires that respondent's probationary license be suspended until representatives of the
board determine whether respondent should be required to enroll in and successfully
complete a refresher course or courses as approved by representatives of the board;
Protection of the public further requires that, in the event representatives of the board
determine that respondent should be required to enroll in and successfully complete a
refresher course or courses, the suspensionofrespondent's probationary license be continued
. until respondent successfully completes the required cours.e work.
COST RECOVERY
11. By reason ofthe matters set forth in Findings 28 through 36, the prayer for
cost recovery must be denied.
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ORDER
License number 461 728 issued to the respondent is revoked. The revocation,
however, is stayed for a period of three years, and respondent is placed on probation.
Respondent's probationary license is immediately suspended until representatives of the
board determine whether respondent should be required to enroll in and successfully
complete a refresher course or courses. In the event representatives of the board determine
that respondent should be required to enroll in and successfully complete a refresher course
or courses, the suspension of respondent's probationary license shall continue until
respondent successfully completes the required course work. The probationary license will
be subject to the following conditions.
1. Each condition of probation is a separate and distinct condition. If any
condition, or any application thereof, is declared unenforceable in whole, in part, or to any
extent, the remainder of this order, and all other applications thereof, shall not be affected.
Each condition of this order shall separately be valid and enforceable to the fullest extent
permitted by law.
2. Respondent shall obey all federal, state, and local laws. Respondent shall
comply with all court orders and all conditions of probation or parole. Respondent shall
make a full and detailed account of any violation of law to the board in writing within 72
hours of the violation. To permit monitoring cif compliance with this term, respondent shall
submit completed fingerprint cards arid fingerprint fees within 45 days of the effective date
of this decision unless she previously submitted those as part of a license application.
3. Respondent shall fully comply with the terms and conditions of the board's
probation program and shall cooperate with representatives of the board in all matters,
including monitoring and investigation of respondent's compliance. Respondent shall
inform the board in writing within no more than 15 days of any address change. At all times,
including during any period of suspension, respondent shall maintain an active, current
license.
4. Respondent shall appear in person for interviews or meetings as directed by the
board or its representatives.
5. Periods of residency or practice outside of California will not apply to the .
reduction of the probationary terni. Respondent must provide written notice to the board
within 15 days of any change of residency or practice outside the state. Respondent must
provide written notice to the board within 30 days prior to reestablishing residency or
returning to practice in California.
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6. Respondent shall submit a list of all states and territories in which she has ever
been licensed as a registered nurse, vocational nurse, or practical nurse. Respondent shall
advise the board of the status of each license she has ever held as a registered nurse,
vocational nurse, or practical nurse. If, at any time during the period of probation, the status
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of any such licep.se changes, respondent immediately shall advise the board of the change.
If, at any time during the period of probation, respondent applies for or obtains a license as a
nurse, vocational nurse, or practical nurse, she immediately shall advise the board of the
application or license.
7. Respondent shall submit or cause to be submitted such written reports,
declarations, and verifications as the board requires. These shall contain statements relative
to respondent's compliance with the terms and conditions o f t h ~ board's probation program.
Respondent shall immedi(:ltely execute all release of information forms that the board or its
representatives require.
8. Respondent shall provide a copy of this decision to the nursing regulatory
agency in every state or territory in which she has a registered nurse license.
9. Respondent, at some time during the period of probation, shall engage in the
practice of registered nursing in California for a minimum of 24 hours per week for 6
consecutive months or as directed by the board. For purposes of compliance with this
condition, "engage in the practice of registered nursing" may include, when approved by the
board, volunteer work as a registered nurse or work in any non-direct patient care position
that requires licensure as a registered nurse. The board may require that advanced practice
nurses engage in advanced practice nursing for a minimum of 24 hours per week for 6
consecutive months or as directed by the board. Ifrespondent has not complied with this
condition during the probationary term but has presented documentation of her good faith
efforts to comply, the board, in its discretion, may grant an extension of the probation period
up to one year in order to provide respondent with a further opportunity to comply with this
condition.
10. Respondent shall obtain prior approval from the board before commencing or
continuing any employment, paid or voluntary, as a registered nurse. Respondent shall cause
to be submitted to the board all performance evaluations and other employment related
reports on the board's request.
11. Respondent shall provide a copy of this decision to her employer and
immediate supervisor prior to commencement or continuation of any nursing or other health
care related employment.
12. Respondent shall notify the board in writing within 72 hours after she obtains
any r1ursing or other health care related employment. Respondent shall notify the board in
writing within 72 hours after she is terminated from any nursing or health care related
employment with a full explanation of the circumstances surrounding the termination.
13: Respondent shall obtain prior approval f r ~ m the board regarding respondent's
level of supervision or collaboration before commencing or continuing any employment as a
registered nurse.
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14. Respondent shall practice only under the direct supervision of a registered
nurse in good standing and with no current discipline, unless the board approves of
alternative methods of supervision or collaboration. Examples of the levels of supervision or
collaboration that the board may require are the following:
(a) The individual providing supervision or collaboration must be present in
the patient care area or in any other work setting at all times.
(b) The individual providing supervision or collaboration must be present in
the patient care unit or in any other work setting at least one-half of the hours
respondent works.
(c) The individual providing supervision or collaboration must have person-to
person communication with respondent at least twice during each shift
worked.
(d) If respondent is approved to work in the home health care setting, the
individual providing supervision or collaboration shall have person-to-person
communication with respondent as required by the board each workday.
Respondent shall maintain telephone or other telecommunication contact with
the individual providing supervision or collaboration as required by the board
during each workday. The individual providing supervision or collaboration
shali conduct, as required by the board, periodic, on-site visits to patients'
homes visited by respondent.
15. Respondent shall not work for a nurse's registry, a temporary nurse placement
agency, or an in-house nursing pool. Respondent shall not work as a traveling nurse or in
any private duty position as a registered nurse. Respondent shall not work for a licensed
home health agency as a visiting nurse unless the board has approved the registered nursing
supervision and other protections for home visits. Respondent shall not work in any other
registered nursing occupation in which home visits are required. Respondent shall not work
in any health care setting as a supervisor of registered nurses. The board may restrict
respondent from supervising licensed vocational nurses or unlicensed assistive personnel.
Respondent shall not work as a faculty member in an approved school of nursing or as an
instructor in a board approved continuing education Respondent shall work only
ori a regularly assigned, identified, and predetermined work site and shall not work in a float
capacity. Ifrespondent is working or intends to work in excess of 40 hours per week, the
board may require documentation to determine whether there should be restrictions on the
hours of work.
16. Respondent shall provide of the board with complete
information concerning respondent's practice of nursing after September of2006.
Representatives of the board shall determine whether respondent can practice safely without
enrolling in and completing a refresher course or courses. Respondent's probationary license
shall be suspended until representatives of the board have .made this determination. If the
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representatives determine that a refresher course is not required, the suspension shall be lifted
immediately. If, however, representatives of the board determine that respondent should be
required to enroll in and successfully complete a refresher course or courses, the suspension
of respondent's probationary license shall continue until respondent, at her expense,
successfully completes the required course work. Respondent's completion of a course will
satisfy this condition only if, prior to enrolling in the course, she obtained the board's
approval of the course. Respondent shall submit to the board the original transcripts or
certificates of completion for the course or courses. The board shall return the original
documents to respondent after photocopying them for its records.
17, Respondent, at her expense, shall successfully complete a course relative to
the practice of registered nursing no later than six months prior to the end of her probationary
term. Respondent's completion of a course will satisfy this condition only if, prior to
enrolling in the course, she obtained the board's approval of the course. Respondent shall
submit to the board the original transcripts or certificates of completion for the course. The
board shall return the original documents to respondent after photocopying them for its.
records.
18. If respondent ceases to practice due to retirement, health reasons, or because
she otherwise is unable to satisfy the conditions of probation, respondent may request
permission to surrender her license to the board. The board may evaluate the request and
exercise its discretion in deciding whether to grant the request, deny it, or take other action
the board deems appropriate. Ifthe board formally accepts respondent's tender ofher license
and wall certificate, respondent no longer will be subject to the conditions of probation.
Surrender of respondent's license will be considered a disciplinary action and shall become
part of respondent's license history. A registered nurse whose license has been surrendered
may petition the board for reinstatement no sooner than the following minimum periods from
the effective date oftheboard's decision to accept the surrender: Two years for reinstatement
of a license that was surrendered for any reason other t4an a mental or physical illness or one
year for a license surrendered because of a mental or physical illness.
19. Respondent, within 45 days oftheeffective date of this decision, shall have a
mental health examination, including psychological testing as appropriate, to determine her
capability to perform the duties of a registered nurse. The examination will be performed by
a psychiatrist, psychologist, or other licensed mental health practitioner whom the board has
approved. The examining mental health practitioner will submit a written report of the
assessment and recommendations tothe board. All costs are the responsibility of the
respondent. Respondent shall institute and follow all recommendations for treatment,
therapy, or counseling.
20. If the examining mental health practitioner determines that respondent is
unable to practice safely as a registered nurse, the practitioner shall immediately notify the
board and respondent by telephone, and the board shall-request that the Attorney General's
office prepare a petition to revoke probation or an accusation. Respondent shall immediately
cease practice and may not resume practice unless the .board notifies respondent in writing
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that, based on a mental health determination, respondent is permitted to resume practice.
During the period of suspension, respondent shall not engage in any practice for which a
license issued by the board is required. The period of suspension will not apply to the
reduction of the probationary term.
21. If respondent fails to have the above assessment submitted io the board within
the 45-day requirement, respondent shall immediately cease practice and shall not resume
practice unless the board authorizes that in writing. The period of suspension will not apply
to the reduction of the probationary term. The board may waive or postpone this suspension
only if significant, documented evidence of mitigation is provided. Such evidence must
establish respondent's good faith efforts to obtain the assessment, and respondent must
provide a specific date for compliance. Only one such waiver or extension will be granted.
22. If respondent violates the conditions of her probation, the board after giving
respondent notice and an opportunity to be heard, may set aside the stay order a ~ d impose
the stayed discipline.
23. If, during the period of probation, a petition to revoke probation or an
accusation is filed against respondent's license or the Attorney General's. Office is requested
to prepare a petition to revoke probation or an accusation, the probationary period shall not
expire until the board has acted on the petition or accusation.
24. If respondent successful completes probation, her license will be fully
restored.
25.. The prayer for cost recovery is denied.
DATED: July 28, 2011
ROBERT WALKER
Administrative Law Judge
Office of Administrative Hearings
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KAMALA D. HARRIS
Attorney General of California
LINDA K. SCHNEIDER
Supervising Deputy Attorney General
KAREN L. GORDON
Deputy Attorney General
State Bar No. 137969
110 West "A" Street, Suite 1100
San Diego, CA 92101
P.O. Box 85266
San Diego, CA 92186-5266
Telephone: (619) 645-3037
Facsimile: (619) 645-2061
Attorneysfor Complainant
BEFORE THE
BOARD OF REGISTERED NURSING
DEPARTMENT OF CONSUMER AFFAIRS
STATE OF CALIFORNIA
In the Matter of the Accusation Against:
CHARLENE MARY ANDERSON
817 N. Tremont Street
Oceanside, CA 92054
Registered Nurse License No. 461728
Respondent.
Case No. 2010 298
FOURTH AMENDED ACCUSATION
Louise R. Bailey, M.Ed., RN ("Complainant") alleges:
PARTIES
1. Complainant brings this Fourth Amended Accusation solely in her official capacity as
the Executive Officer of the Board ofRegistered Nursing (Board), Department of Consumer
Affairs.
2. On or about March 31, 1991, the Board ofRegistered Nursing issued Registered
Nurse License Number 461728 to Charlene Mary Anderson (Respondent). The Registered Nurse
License was in full force and effect at all times relevant to the charges brought herein and will
expire on August 31, 2012, unless renewed.
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JURISDICTION
3. This Accusation is brought before the Board ofRegistered Nursing (Board),
Department of Consumer Affairs, under the authority of the following laws. All section
references are to the Business and Professions Code unless otherwise indicated.
4. Section 2750 ofthe Business and Professions Code (Code) 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.
5. Section 27 64 of the Code provides, in pertinent part, that the expiration of a license
shall not deprive the Board ofjurisdiction to proceed with a disciplinary proceeding against the
licensee or to render a decision imposing discipline on the license.
STATUTORY PROVISIONS
6. Section 2761 of the Code states:
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, which includes, but is not limited to, the
following:
(1) Incompetence, or gross negligence in carrying out usual certified or
licensed nursing functions.
7. Section 2762 of the Code states:
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 any of the following:
(a) Obtain or possess in violation oflaw, or prescribe, or except as
directed by a licensed physician and surgeon, dentist, or podiatrist administer to
himself or herself, or furnish or administer to another, any controlled substance as
defmed in Division 10 (commencing with Section 11000) ofthe Health and Safety
Code or any dangerous drug or dangerous device as defmed in Section 4022.
(e) Falsify, or make grossly incorrect, grossly inconsistent, or
unintelligible entries in any hospital, patient, or other record pertaining to the
substances described in subdivision (a) of this section.
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REGULATORY PROVISIONS
8. California Code ofRegulations, title 16, section 1442, states:
As used in Section 2761 ofthe code, "gross negligence" includes an
extreme departure from the standard of care which, under similar circumstances,
would have ordinarily been exercised by a competent registered nurse. Such an
extreme departure means the repeated failure to provide nursing care as required or
failure to provide care or to exercise ordinary precaution in a single situation which
the nurse knew, or should have known, could have jeopardized the client's health or
life.
9. California Code of Regulations, title 16, section 1443 states:
As used in Section 2761 of the code, "incompetence" means the lack of
possession of or the failure to exercise that degree of learning, skill, care, and
experience ordinarily possessed and exercised by a competent registered nurse as
described in Section 1443.5.
10. California Code ofRegulations, title 16, section 1443.5 states:
A registered nurse shall be considered to be competent when he/ she
consistently demonstrates the ability to transfer scientific knowledge from social,
biological and physical sciences in applying the nursing process, as follows:
(1) Formulates a nursing diagnosis through observation of the client's
physical condition and behavior, and through interpretation of information obtained
from the client and others, including the health team.
(2) Formulates a care plan, in collaboration with the client, which
ensures that direct and indirect nursing care services provide for the client's safety,
comfort, hygiene, and protection, and for disease prevention and restorative measures.
(3) Performs skills essential to the kind of nursing action to be taken,
explains the health treatment to the client and family and teaches the client and family
how to care for the client's health needs.
(4) Delegates tasks to subordinates based on the legal scopes ofpractice
of the subordinates and on the preparation and capability needed in the tasks to be
delegated, and effectively supervises nursing care being given by subordinates.
(5) Evaluates the effectiveness ofthe care plan through observation of
the client's physical condition and behavior, signs and symptoms of illness, and
reactions to treatment and through communication with the client and health team
members, and, modifies the plan as needed.
(6) Acts as the client's advocate, as circumstances require, by initiating
action to improve health care or to change decisions or activities which are against the
interests or wishes of the client, and by giving the client the opportunity to make
informed decisions about health care before it is provided.
II!
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COST RECOVERY
11. Section 125.3 of the Code provides, in pertinent part, that the
Board/Registrar/Director 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 ofthe investigation and enforcement ofthe case.
DRUGS
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12. "Percocet" is a Schedule II controlled substance pursuant to Health and Safety Code
section 11055, subdivision ((b)(1)(N), and a dangerous drug per Business and Professions Code
section 4022. Percocet is a brand name for the generic drug oxycodone with acetaminophen
and is used to treat pain.
13. "Vicodin" is a Schedule III controlled substance pursuant to Health and Safety Code
section 11 056( e)( 4) and a dangerous drug per Business and Professions Code section 4022.
Vicodin is a brand name for the generic drug hydrocodone. It is also known as
dihydrocodeinone with the non-narcotic substance acetaminophen and is used to treat pain.
14. "Tylenol3" is a Schedule III controlled substance pursuant to Health and Safety
Code section 11055 and a dangerous drug per Business and Professions Code section 4022.
Tylenol 3 is a generic name for codeine with acetaminophen and is a narcotic pain reliever
(analgesic).
FIRST CAUSE FOR DISCIPLINE
(Incorrect and/or Inconsistent Entries in Hospital and/or Patient Records)
15. Respondent is subject to disciplinary action under Code section 2761, subdivision (a),
on the grounds ofunprofessional conduct, as defmed in Code section 2762, subdivision (e), based
upon the following:
Scripps Memorial Hospital
16. Respondent was employed as a registered nurse at Scripps Memorial Hospital from
August of2002 until her termination in September of2006. Between or about May 4, 2006, and
August 29, 2006, while on duty as a registered nurse at Scripps Memorial Hospital, Respondent
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made grossly incorrect or grossly inconsistent entries in hospital and/or patient records, as
follows:
Patient 1 BP
a. On May 4, 2006, at 1028 hours, Respondent removed two Percocet tablets from the
Pyxis
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machine for this patient. No Medication Administration Record (MAR), Nursing Notes,
nor wastage were charted by Respondent. Two Percocet tablets were unaccounted for.
Patient 2 SM
b. On May 16, 2006, at 1828 hours, Respondent removed one Percocet tablet from the
Pyxis machine for this patient. No MAR, Nursing Notes, nor wastage were charted by
Respondent. One Percocet tablet was unaccounted for.
Patient 3 JLH
c. On July 10, 2006, at 0027 hours, Respondent removed one Percocet tablet from the
Pyxis machine for this patient. There was no Physician Order for Percocet for this patient. No
MAR, Nursing Notes, nor wastage were charted by Respondent. One Percocet tablet was
unaccounted for.
Patient 4 KH
d. On July 18, 2006, at 0048 hours, Respondent removed one Percocet tablet from the
Pyxis machine for this patient. No MAR, Nursing Notes, nor wastage were charted by
Respondent. One Percocet tablet was unaccounted for.
Patient 4 KH
e. On July 18, 2006, at 0436 hours, Respondent removed two Percocet tablets from the
Pyxis machine for this patient. No MAR, Nursing Notes, nor wastage were charted by
Respondent. Two Percocet tablets were unaccounted for.
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Pyxis is a trade name for the automated single-unit does medication dispensing system
that records information such as patient name, physician orders, date and time medication was
withdrawn, and the name of the licensed individual who withdrew and administered the
medication. Each user/operator is given a "user ID" code to operate the control panel. The user
is required to enter a second code "PIN" number, similar to an ATM machine, to gain access to
the medications. Sometimes only portions of the withdrawn narcotics are given to the patient.
The portions not given to the patient are referred to as wastage. This waste must be witnessed by
another authorized user and is also recorded by the Pyxis machine
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Patient 5 AC

On August 2, 2006, at 2002 hours, Respondent removed one Percocet tablet from the
Pyxis machine for this patie:pt. No MAR, Nursing Notes, nor wastage were charted by
Respondent. Two Percocet tablets were unaccounted for.
Patient 5 AC
g. On August 2, 2006, at 2315 hours, Respondent removed Two Percocet tablets from
the Pyxis machine for this patient. No MAR, Nursing Notes, nor wastage were charted by
Respondent. Two Percocet tablets were unaccounted for.
Patient 5 AC
h. On August 3, 2006, at 0139 hours, Respondent removed two Percocet tablets from the
Pyxis machine for this patient. No MAR, Nursing Notes, nor wastage were charted by
Respondent. Two Percocet tablets were unaccounted for.
Patient 5 AC
i. On August 3, 2006, at 0524 hours, Respondent removed two Percocet tablets from the
Pyxis machine for this patient. No MAR, Nursing Notes, nor wastage were charted by
Respondent. Two Percocet tablets were unaccounted for.
Patient 6 AP
j. On August 28, 20906, at 1223 hours, Respondent removed two Percocet tablets from
the Pyxis machine for this patient. No MAR, Nursing Notes, nor wastage were charted by
Respondent. Two Percocet tablets were unaccounted for.
Patient 6 AP
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On August 28, 2006, at 1531 hours, Respondent removed two Percocet tablets from
the Pyxis machine for this patient. No MAR, Nursing Notes, nor wastage were charted by
Respondent. Two Percocet tablets were unaccounted for.
Patient 6 AP
1. On August 29, 2006, at 1023 hours, Respondent removed two Percocet tablets from
the Pyxis machine for this patient. No MAR, Nursing Notes, nor wastage were charted by
Respondent. Two Percocet tablets were unaccounted for.
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Patient 6 AP
m. On August 29, 2006, at 1317 hours, Respondent removed two Percocet tablets from
the Pyxis machine for this patient. No MAR, Nursing Notes, nor wastage were charted by
Respondent. Two Percocet tablets were unaccounted for.
Patient 7 AS
n. On July 13, 2006, at 502 hours, Respondent removed two Hydrocodone tablets from
the Pyxis machine for this patient. No MAR, Nursing Notes, nor wastage were charted by
Respondent. Two Percocet tablets were unaccounted for.
Patient 7 AS
0. On July 13, 2006, at 2112 hours, Respondent removed two Hydrocodone tablets from
the Pyxis machine for this patient. No MAR, Nursing Notes, nor wastage were charted by
Respondent. Two Hydrocodone tablets were unaccounted for.
Patient 7 AS
p. On July 14, 2006, at 0046 hours,. Respondent removed two Hydrocodone tablets from
the Pyxis machine for this patient. Respo1;1dent charted in this patient's Medication Chart that one
(1) tablet was administered. There were no Nursing Notes and no wastage charted by
Respondent. One tablet ofHydrocodone was unaccounted for.
Patient 8 LCW
q. On August 8, 2006, at 0018 hours, Respondent removed two Hydrocodone tablets
from the Pyxis machine for this patient. There were no MAR, Nursing Notes nor wastage charted
by Respondent. Two tablets ofHydrocodone were unaccounted for.
Patient .9 SB
r. On July 6, 2006, at 0437 hours, Respondent removed one Tylenol with Codeine tablet
from the Pyxis machine for this patient. There was no Physician Order for Tylenol with Codeine
for this patient. There were no MAR, Nursing Notes nor wastage charted by Respondent. One
tablet of Tylenol with Codeine was unaccounted for.
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Patient 1 0 MM
s. On August 20, 2006, at 1626 hours, Respondent removed two Tylenol with Codeine
tablets from the Pyxis machine for this patient. There were no MAR, Nursing Notes nor wastage
charted by Respondent. Two tablets of Tylenol with Codeine were unaccounted for.
SECOND CAUSE FOR DISCIPLINE
(Gross Negligence)
17. Respondent is subject to disciplinary action under Code section 2761, subdivision (a),
on the grounds of gross negligence, as defmed by California Code of Regulations, title 16, section
1442, in that she repeatedly failed to provide nursing care as required or failed to provide care or
to exercise ordinary precaution in a single situation which she knew, or should have known, could
have jeopardized the client's health or life, in that between or about May 4, 2006 and August 29,
2006, while employed as a registered nurse, Respondent failed to chart the administration of or
account for thirty-three (33) narcotic tablets in patients' MARs, Nursing Notes, or wastage as is
more fully described in paragraph 16, above.
TIDRD CAUSE FOR DISCIPLINE
(Incompetence)
18. Respondent is subject to disciplinary action under Code section 2761, subdivision (a),
on the grounds of incompetence as defmed by California Code ofRegulations, title 16, section
1443, in that she lacked possession of or failed to exercise that degree of learning, skill, care and
experience ordinarily possessed and exercised by a competent registered nurse, in that between or
about May 4, 2006 and August 29, 2006, while employed as a registered nurse, Re$pondent failed
to chart the administration of or account for thirty-three (33) narcotic tablets in patients' MARs,
Nursing Notes, or wastage as is more fully described in paragraph 16, above.
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PRAYER
WHEREFORE, Complainant requests that a hearing be held on the matters herein alleged,
and that following the hearing, the Board ofRegistered Nursing issue a decision:
1. Revoking or suspending Registered Nurse License Number 461728, issued to
Charlene Mary Anderson Charlene Mary Anderson;
2. Ordering Charlene Mary Anderson to pay the Board of Registered Nursing the
reasonable costs of the inv.estigation and enforcement of this case, pursuant to Business and
Professions Code section 125.3;
3. Taking such other and further action as deemed necessary and proper.
DATED: ---,--{Q_'
UISE R. BAILEY, M.ED., RN
E ecutive Officer
Board of Registered Nursing
Department of Consumer Affairs
State of California
Complainant
SD2009804891
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