State action against Webb

8/18/2019 State action against Webb

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ty Agency Clerk

Final Order No. DOH-16-0536-RD -MQA

M

ILED DATE

MAR

0 2016

Department of Health

STATE OF FLORIDA

DEP RTMENT OF HE LTH

In Re: Emergency Restriction of the License of

Megann E. Webb, L.P.N.

License Number PN 902331

Case Number 2015-30441

ORDER OF EMERGENCY RESTRICTION OF LICENSE

John H. Armstrong, M.D., F.A.C.S., State Surgeon General and Secretary

of Health, ORDERS the emergency restriction of the license of Megann

E

Webb, L.P.N., (Ms. Webb) to practice as a practical nurse in the State of Florida.

Ms. Webb holds license number PN 902331. Ms. Webb's address of record is

2702 39th Street West, Bradenton, Florida 34205. The following Findings of

Fact and Conclusions of Law support the emergency restriction of Ms. Webb's

license to practice as a practical nurse in the State of Florida.

FINDINGS OF FACT

1.

At all times material to this Order, Ms. Webb was licensed to

practice as a practical nurse in the State of Florida, pursuant to chapter 464,

Florida Statutes, having been issued license number PN 902331.

2.

At times material to this Order, Ms. Webb worked as a practical

nurse at Cooper Family Medical, in Bradenton, Florida.

3.

On or about November 5, 2015, Ms. Webb returned to work after

three days off.


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License No. PN902331

Case No. 2015-30441

4.

A.K., L.P.N., Ms. Webb's co-worker and sister-in-law, witnessed Ms.

Webb's slurred speech, unsteady gait, and inability to stay awake.

5.

B.R., the office manager at Cooper Family Medical, also witnessed

Ms. Webb's behavior. In an interview with a Department Investigator, B.R.

described Ms. Webb as obliterated[,] due to her slurred speech, unsteady

gait, and crossed eyes. B.R. noted that Ms. Webb complained of not being able

to login to Cooper Family Medical's computer system. B.R. watched Ms. Webb

attempt to login on an incorrect screen.

6.

Due to the concern that Ms. Webb was impaired, Cooper Family

Medical relieved Ms. Webb of her shift duties and requested that A.K. drive Ms.

Webb home. A.K. reported that Ms. Webb dozed off several times on the way

home, attributed her behavior to an over-the-counter cough syrup, and made

nonsensical statements.

7.

Upon Ms. Webb's return to work, C.C., D.O., the medical director

of Cooper Family Medical, informed Ms. Webb that her recent behavior was

unacceptable and would not be tolerated again. Ms. Webb explained that she

was sick and took over-the-counter cough syrup before work on November 5,

2015.

8.

On or about November 30, 2015, Ms. Webb presented for her shift

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Case No. 2015-30441

at Cooper Family Medical and was observed to be exhibiting similar signs of

impairment.

9.

A.K. observed that Ms. Webb had slurred speech, an unsteady gait,

and an inability to have a sensible conversation.

10.

S.M.R., L.P.N., a co-worker of Ms. Webb, also observed that Ms.

Webb had slurred speech, a glossy-eyed appearance, and was talking in

circles, not making sense.

11.

S.A., medical assistant at Cooper Family Medical, observed similar

indications of Ms. Webb's impairment.

12.

Ms. Webb's co-workers relayed their observations and concerns to

Cooper Family Medical management. B.R.'s subsequent observations of Ms.

Webb corroborated the staff's concerns.

13.

Based on these observations, Cooper Family Medical terminated

Ms. Webb's employment.

14.

In an interview with a Department Investigator, Dr. C.C. stated that

he believed Ms. Webb was impaired and needed help.

15.

On or about February 2, 2016, D.B., M.D., a board-certified

physician in addiction psychiatry and a medical review officer, evaluated Ms.

Webb pursuant to Department Order.

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Case No. 2015-30441

16.

Ms. Webb denied that she was impaired while working at Cooper

Family Medical. Ms. Webb admitted she may have 'nodded off' a few times on

the way home from work. Ms. Webb further explained that the office computer

was difficult to login to.

17. Ms. Webb explained that her physician had recently prescribed her

trazodonel and alprazolam

around the time of the November 5, 2015, incident

at Cooper Family Medical. Ms. Webb disclosed that she was also prescribed

Tramado1.

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18.

Concerning the November 5, 2015, incident at Cooper Family

Medical, Ms. Webb alleged that she was sick and out from work for two or

three days. Ms. Webb explained that she took antibiotics, cough suppressant

and steroids.

19.

Ms. Webb admitted that she was hungover on November 30,

2015. Ms. Webb speculated that Cooper Family Medical was trying to find a

1

Trazodone is a tetracyclic antidepressant used to treat depression and anxiety disorders. Trazodone is a

legend drug.

2

Alprazolam is prescribed to treat anxiety. According to Section 893.03(4), Florida Statutes (2015),

alprazolam is a Schedule IV controlled substance that has a low potential for abuse relative to the

substances in Schedule III and has a currently accepted medical use in treatment in the United States.

Abuse of alprazolam may lead to limited physical or psychological dependence relative to the substances in

Schedule III.

3

Tramadol, commonly known by the brand name Ultram, is an opioid-class narcotic medication prescribed

to treat pain. According to Title 21, Section 1308.14, Code of Federal Regulations, tramadol is a Schedule IV

controlled substance. Tramadol, like all opioid-class drugs, can affect mental alertness, is subject to abuse,

and can be habit forming.

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Case No. 2015-30441

reason to terminate her employment.

20.

Regarding the November 5, 2015, incident, Dr. D.B. noted that Ms.

Webb's impairment was likely caused by the combination of new medications.

Dr. D.B. noted that Ms. Webb should have known about the effects of these

medications on her on November 30, 2015.

21.

As part of the evaluation, Ms. Webb underwent hair and urine drug

and alcohol screens.

22.

Ms. Webb's drug and alcohol hair screen was positive for the

presence of oxycodone

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and tramadol.

23.

In analyzing the drug screens performed by Ms. Webb in

connection with the evaluation, Dr. D.B. opined that the drug screens revealed

that Ms. Webb had used oxycodone in the previous ninety days. However, Ms.

Webb was not prescribed oxycodone.

24.

Dr. D.B. opined that Ms. Webb lacks insight regarding the nature

of her substance use. Dr. D.B. opined that Ms. Webb has diminished problem

solving ability, diminished judgment, diminished ability to cope with stressful

situations, and diminished decision-making abilities in a crisis.

Oxycodone is commonly prescribed to treat pain. According to Section 893.03(2), Florida Statutes (2015),

oxycodone is a Schedule II controlled substance that has a high potential for abuse and has a currently

accepted but severely restricted medical use in treatment in the United States. Abuse of oxycodone may

lead to severe psychological or physical dependence.

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Case No. 2015-30441

25.

Dr. D.B. diagnosed Ms. Webb with opioid abuse rule out

dependence, and insomnia disorder.

26.

Dr. D.B. opined that Ms. Webb is not currently able to practice as

a practical nurse with reasonable skill and safety to patients.

27.

Dr. D.B. recommended Ms. Webb undergo monitoring by the

Intervention Project for Nurses (IPN)

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and undergo day treatment, due to Ms.

Webb's severity of intoxication at work, the presence of oxycodone in her hair

drug screen without justification, and the low level of insight Ms. Webb has

regarding her problems.

28.

Dr. D.B. opined that after treatment and with monitoring, Ms.

Webb may be able to return to the profession of practical nursing.

29.

As of the date of this Order, Ms. Webb has not complied with Dr.

D.B.'s recommendations.

30.

Licensed practical nurses are placed in a special position of trust in

the community. Licensed practical nurses are entrusted to observe and

effectuate treatment for the health, safety, and welfare of their patients.

Licensed practical nurses are often faced with stressful and life-threatening

5

IPN is the impaired practitioner program for the Board of Nursing, pursuant to Section 456.076, Florida

Statutes (2015). IPN monitors the evaluation, care, and treatment of impaired nurses. IPN oversees

random drug screens and provides for the exchange of information between treatment providers, evaluators,

and the Department for the protection of the public.

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Case No. 2015-30441

situations regarding their patients, and must be able to quickly observe and

assess potentially life-threatening symptoms or conditions which may befall

their patients.

31.

Additionally, a licensed practical nurse must be relied upon to

present fit for work and free from mind-altering substances so that they may

have lucid thought processes and sound perceptive and decision-making

abilities while caring for patients.

32. An independent medical expert determined that Ms. Webb is not

presently able to practice nursing with reasonable skill and safety to patients

due to her opioid abuse with possible dependence. The independent medical

expert concluded that Ms. Webb's presentation to work while intoxicated and

denial of her opioid use without a valid prescription indicates her impairment

is likely to continue without treatment and monitoring. Based on that

assessment, there is no lesser restriction than the terms outlined in this Order

that will adequately protect the public.

33.

Ms. Webb's continued unrestricted practice as a licensed practical

nurse while impaired by her above diagnoses constitutes such a threat to the

public health, safety, or welfare that the safety of Ms. Webb's patients cannot

be assured.

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Case No. 2015-30441

CONCLUSIONS OF LAW

Based on the foregoing Findings of Fact, the State Surgeon General

concludes as follows:

1.

The State Surgeon General has jurisdiction over this matter

pursuant to Sections 20.43 and 456.073(8), Florida Statutes (2015), and

Chapter 464, Florida Statutes (2015), as set forth above.

2. Section 464.018(1)(j), Florida Statutes (2015), subjects a practical

nurse to discipline, including restriction, for being unable to practice nursing

with reasonable skill and safety to patients by reason of illness or use of alcohol,

drugs, narcotics, or chemicals or any other type of material or as a result of

any mental or physical condition.

3.

Ms. Webb violated Section 464.018(1)(j), Florida Statutes (2015),

by being unable to practice nursing with reasonable skill and safety to patients

due to her presenting to work intoxicated and diagnosis of opioid abuse, rule

out dependence and insomnia disorder.

4.

Section 120.60(6), Florida Statutes (2015), authorizes the State

Surgeon General to summarily restrict the license of a practical nurse upon a

finding that the licensed practical nurse presents an immediate, serious danger

to the public health, safety or welfare.

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Case No. 2015-30441

5.

s. Webb's continued unrestricted practice as a licensed practical

nurse constitutes an immediate, serious danger to the health, safety, or welfare

of the citizens of the State of Florida, and this summary procedure is fair under

the circumstances to adequately protect the public.

WHEREFORE, in accordance with Section 120.60(6), Florida Statutes

(2015), it is ORDERED THAT:

1.

The license of Megann E. Webb, L.P.N., to practice as a licensed

practical nurse, license number PN 902331, is immediately restricted to prohibit

Ms. Webb from practicing as a practical nurse until IPN or an IPN-approved

evaluator notifies the Department that Ms. Webb is safe to return to the

practice of nursing.

2.

A proceeding seeking formal discipline of the license of Megann E.

Webb, L.P.N., to practice as a licensed practical nurse in the State of Florida

will be promptly instituted and acted upon in compliance with Sections 120.569

and 120.60(6), Florida Statutes (2015).

[Signature appears on the following page ]

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DONE and ORDERED

this

day of

Aka

2016.

H. Armstrong, M.WF.A.C.S.,

ate Surgeon General &

Secretary of Health




Case No. 2015-30441

COUNSEL FOR THE DEPARTMENT:

Francis A. Carbone, II, Esquire

Assistant General Counsel

Florida Bar Ng 105786

Department of Health, Prosecution Services Unit

4052 Bald Cypress Way, Bin C-65

Tallahassee, Florida 32399-7017

Telephone: 850.245.4444 ext. 8241

Facsimile: 850.245.4662

Email: [email protected]

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Case No. 2015-30441

NOTICE OF RIGHT TO JUDICIAL REVIEW

Pursuant to Sections 120.60(6), and 120.68, Florida Statutes, the

Department's findings of immediate danger, necessity, and procedural fairness

shall be judicially reviewable. Review proceedings are governed by the Florida

Rules of Appellate Procedure. Such proceedings are commenced by filing a

Petition for Review, in accordance with Florida Rule of Appellate Procedure

9.100, and accompanied by a filing fee prescribed by law with the District Court

of Appeal, and providing a copy of that Petition to the Department of Health

within thirty (30) days of the date this Order is filed.

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Documents

State action against Webb