Notices Ohio Nursing Board July 2012

Case #11-003446
July 27, 2012
NOTICE OF OPPORTUNITY FOR HEARING

Robert Joseph Ackerman, R.N. 3710 N McCord RD Toledo, OH 43617 Dear Mr. Ackerman: 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 February 7, 2012, in Toledo Municipal Court Case No. CRB-1113975-0101, you were found guilty of one (1) count of Sexual Imposition Offensive Contact, a third-degree misdemeanor, in violation of Section 2907.06(A)(1), ORC. The events underlying your conviction noted above occurred, on or about August 25, 2011, and consist of you, while working as a nursing supervisor at Northwest Ohio Psychiatric Hospital, grabbing or touching the breast of a co-worker. 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. 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.
Robert Joseph Ackerman, 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, 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 the Notice of Opportunity for Hearing, deny, revoke, permanently revoke, suspend or place restrictions on your license to practice nursing as a registered nurse nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely,
Judith Church, R.N., C.N.P. Supervising Member Certified Mail Receipt No. 7012 1010 0002 4225 1411 cc: Henry G. Appel, Assistant Attorney General
Case #11-002033
July 27, 2012

Gail Lynn Allen, R.N. 1803 Timber Trail Imperial, PA 15126-8900 Dear Ms. Allen: 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: You engaged in the following conduct while working as a nurse at the Cambridge Developmental Center in Cambridge, Ohio (CADC):
1. On or about January 18, 2011, you failed to shake a bottle of liquid Tegretol prior to administering it to Patient #1. A surveyor who was observing your medication pass asked whether you had shaken the Tegretol bottle, and you said, no, and proceeded to administer the medication.
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(C), Ohio Administrative Code (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. 2. On or about March 15, 2011, you failed to administer Patient #2s 8:00 P.M. dose of Lyrica. You falsely documented that Patient #2 received this dose. 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(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. Rule 4723-4-06(G), 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.
Gail Lynn Allen, R.N. Page 2
3. On or about March 15, 2011, you documented the administration of Tylenol to Patient #3 even though Patient #3 spit out the medication. 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), 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. 4. On or about March 24, 2011, you incorrectly prepared Patient #1s dose of crushed Levothyroxine. You crushed the Levothyroxine tablet with a contaminated pestle. You were told that the pestle was contaminated and placed the crushed contaminated tablet in a paper cup. You washed the pestle and crushed a new Levothyroxine tablet and placed it in the same cup that still contained the contaminated dose. You would have prepared a double dose of Levothryoxine for Patient #1 if another nurse had not intervened. 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(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. 5. On or about January 6, 2011 you were observed leaving the medication room to administer oral medications to Patient #4 with unthickened water in a drinking cup. You had to be reminded that Patient #4s liquids must be thickened. 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(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. 6. On or about January 6, 2011 you were preparing to administered eye medication to Patient #4 to the wrong eye until another nurse intervened. 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(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. 7. On or about January 6, 2011, another nurse had to remind you to administer Patient #5s Risperdal dose at 8:00 P.M. 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(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. 8. On or about March 15, 2011 you failed to check Patient #6s blood sugar as ordered. 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(E), OAC, states that a registered nurse shall, in a timely manner: (1) Implement any order for a client unless the registered nurse believes or should have reason to believe the order 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; 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,
Judith A. Church, R.N., C.N.P. Supervising Member
Certified Mail Receipt No. 7012 1010 0002 4225 1558 cc: Henry G. Appel, Assistant Attorney General
Case #11-003444
July 27, 2012

Michele J. Antonio, L.P.N. P.O. Box 44104 Brooklyn, Ohio 44144 Dear Ms. Antonio: 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 7, 2011, while working as a nurse for Parma Care Center in Parma, Ohio (PCC), you submitted a drug screen specimen that was positive for amphetamines. You told a Board Compliance Agent that you ingested a neighbors Adderall the day prior to providing the specimen. 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 September 3, 2011, while working as a nurse for PCC, you signed the Controlled Substance Record indicating withdrawal of two (2) tablets of Patient #1s Oxycodone (Percocet), and failed to account for their administration. In a written statement to PCC, you admit to taking two (2) Oxycodone tablets from Patient #1 and giving them to Patient #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 4723-4-06(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(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.
Michele J. Antonio, 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,
Judith A. Church, R.N., C.N.P. Supervising Member Certified Mail Receipt No. 7012 1010 0002 4225 1480 cc: Henry G. Appel, Assistant Attorney General
Case# 11-004760
July 27, 2012

Kelly Ann Armstrong, R.N. 200 West 9th Street, Apartment 202 Lorain, Ohio 44052 Dear Ms. Armstrong: 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. Your license to practice nursing as a registered nurse is currently suspended for indefinite period of time with conditions for reinstatement pursuant to a Consent Agreement you entered into with the Board, effective May 18, 2007, (May 2007 Consent Agreement), a copy of which is attached hereto and incorporated herein. Attached to incorporated within the May 2007 Consent Agreement is May 19, 2006 Notice of Opportunity for hearing (May 2006 Notice). You submitted a letter to the Board dated March 16, 2012, requesting reinstatement. 2. You failed to meet your conditions for reinstatement as follows: Item 3. of the May 2007 Consent Agreement states, MS. ARMSTRONG shall obey all federal, state, and local laws, and all laws and rules governing the practice of nursing in Ohio, and shall comply with all terms of her sentence in Lorain County Court of Common Pleas Case Number 04CR066478. Despite this provision, on or about March 7, 2008, in Lorain County Municipal, Court Case No. CRB0703383, you pled no contest and were convicted of one (1) amended count of Disorderly Conduct, a first-degree misdemeanor, in violation of Section 2917.11, ORC. You admitted in a statement to the Board that the facts underlying your conviction involve you having an altercation with another women, while intoxicated. Also, on or about October 7, 2008, in Lorain County Municipal Court, Case No. CRB0800848, you pled no contest and were convicted of one (1) count of Telephone Harassment, a first-degree misdemeanor, in violation of Section 2917.21, ORC. You admitted in a statement to the Board that the facts underlying
Kelly Ann Armstrong, R.N. Page 2 your conviction involve you making multiple phone calls to another woman, while in a drunken black out. Furthermore, on or about June 25, 2009, in Vermillion Municipal Court, Case No. TRC 0900472, you pled guilty and were convicted of charges including one (1) count of OMVI, a first-degree misdemeanor, in violation of Vermillion Ordinance 434.01(A)(1)(H). 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 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,
Case # 04-2464
Ohio Board of Nursing

17 South High Srrcet. Suire Sit0
w,w.n~,rsing.ohiogov
(614) 466-3947
Coli~mhus. Ohio 4321.5-7410
CONSENT AGREEMENT BETWEEN KELLY ANN ARMSTRONG, R.N. AND OHIO BOARD OF NURSING
This Consent Agreement is entered into by and between KELLY ANN ARMSTRONG, R.N., A.K.A. KELLEY ARMSTRONG (MS. ARMSTRONG) 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. ARMSTRONG 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 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.
B.
MS. ARMSTRONG is licensed to practice nursing as a registered nurse, RN-255774, in the State of Ohio. MS. ARMSTRONG knowingly and voluntarily admits to the legal and factual allegations set forth in the Notice of Opportunity for Hearing issued by the Board on May 19, 2006, a copy of which is attached hereto and incorporated herein.
C.
Krzlly Ann Armstrong, R.N Page 2
MS. ARMSTRONG admits that in Lorain County Court of Common Pleas Case Number 01CR058133, she was found in violation of her community control sanctions in May 2003 and she completed her sentence in January 2004. MS.ARMSTRONG indicated that she had been consuming alcohol and was intoxicated the day of the October 2004 incident resulting in her Obstructing Official Business conviction. MS. ARMSTRONG further indicated that she has not been employed as a nurse since February 2006, has not consumed alcohol for over a year, has been attending AA meetings on a regular basis and has received support through her church. MS. ARMSTRONG has been functioning as a nurse to fulfill the community service requirement of her sentence in her Obstructing Official Business conviction. 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. ARMSTRONG knowingly and voluntarily agrees with the Board to the following terns, conditions, and limitations:
SUSPENSION OF LICENSE
1.
MS. ARMSTRONG's license to practice nursing as a registered nurse is hereby suspended for an indefinite period of time, but not less than two years retroactive to when MS. ARMSTRONG last employed as a nurse in February 2006. MS. ARMSTRONG may submit a written request for reinstatement anytime after meeting the conditions for reinstatement. MS. ARMSTRONG shall surrender to the Board her Ohio registered nurse license, RN-255774, immediately.
2.
CONDITIONS FOR REINSTATEMENT
3.
MS. ARMSTRONG shaU obey all federal, state, and local laws, and all laws and rules governing the practice of nursing in Ohio, and shall comply with the terns of her sentence in Lorain County Court of Common Pleas Case Number 04CR066478. MS. ARMSTRONG 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. ARMSTRONG agrees that she will submit a request to the Bureau of Criminal Identification and Investigation (BCII) to conduct a criminal records check of MS. ARMSTRONG, including a check of Federal Bureau of Investigation records, and request BCII to submit the MS. ARMSTRONG's criminal records check reports to the Board.
4.
5.
Kelly Ann Armstrong, R.N. Page 3
6.
Prior to reinstatement, MS. ARMSTRONG 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.
Monitoring of Rehabilitation and Treatment
7.
MS. ARMSTRONG 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. ARMSTRONG's history of chemical dependency and recovery status. MS. ARMSTRONG shall self-administer the prescribed drugs only in the manner prescribed. MS. ARMSTRONG shall abstain completely from the use of alcohol
Not less than one (1) year prior to seeking reinstatement by the Board, MS. ARMSTRONG 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. ARMSTRONG shall provide the chemical dependency professional with a copy of this Consent Agreement. Further, MS. ARMSTRONG 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 and recommendations for treatment and monitoring.
8. 9.
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MS. ARMSTRONG 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. ARMSTRONG 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. ARMSTRONG's license and that the terms, conditions, and limitations shall be incorporated in an addendum to this Consent Agreement.
Within three (3) months prior to seeking reinstatement by the Board, MS. ARMSTRONG shall, at her own expense, seek a second 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. ARMSTRONG shall provide the chemical dependency professional with a copy of this Consent Agreement. Further, MS. ARMSTRONG 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 any additional restrictions to be placed on MS. ARMSTRONG7s license to practice, and stating whether MS. ARMSTRONG is capable of practicing nursing according to acceptable and prevailing standards of safe nursing care.
11.
Kelly Ann Armstrong, R.N Page 4 12. For a minimum, continuous period of one (1) year immediately prior to requesting reinstatement, MS. ARMSTRONG shall submit, at her expense and on the day selected, blood or urine specimens for drug andlor alcohol analysis at a collection site specified by the Board at such times as the Board may request. Upon and after MS. ARMSTRONG'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. ARMSTRONG shall be negative, except for substances prescribed, administered, or dispensed to her by another so authorized by law who has full knowledge of MS. ARMSTRONG7s history of chemical dependency and recovery status. a. Within thirty (30) days prior to MS. ARMSTRONG initiating drug screening, MS. ARMSTRONG 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. ARMSTRONG. b. After initiating drug screening, MS. ARMSTRONG 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. ARMSTRONG shall notify the Board of any and all medication(s) or prescription(s) received within twentyfour (24) hours of release from hospitalization or medical treatment. 13. F o r a minimum, continuous period of one (1) year immediately prior to requesting reinstatement, MS. ARMSTRONG 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 prior to reinstatement.
Psychiatric Evaluation and Treatment
14.
Prior to reinstatement, MS. ARMSTRONG shall, at her own expense, seek a psychiatric evaluation from a Board approved psychiatrist and shall provide the Board with complete documentation of such evaluation. Prior to the evaluation, MS. ARMSTRONG 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 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.
Kelly Ann Armstrong, R.N. Page S
ARMSTRONG's license, and a statement as to whether MS. ARMSTRONG is capable of practicing nursing according to acceptable and prevailing standards of safe nursing care.
15.
MS. ARMSTRONG shall provide the Board with satisfactory documentation of compliance with all aspects of the treatment plan developed by the professional until released. Further, MS. ARMSTRONG agrees that the Board may use the professional recommendations and conclusions from the evaluation as a basis for additional terms, conditions, limitations on MS. ARMSTRONG's license and that the terms, conditions, and limitations shall be incorporated in an addendum to this Consent Agreement.
Reporting Requirements of Licensee

16.
MS. ARMSTRONG shall report to the Board in writing, any violation of this Consent Agreement within thirty (30) days of the occurrence of the violation. MS. ARMSTRONG shall sign release of information forms allowing health professionals and other organizations to submit requested documentation or information directly to the Board. MS. ARMSTRONG 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. ARMSTRONG 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. ARMSTRONG 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. ARMSTRONG 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. ARMSTRONG shall verify that the reports and documentation required by this Consent Agreement are received in the Board office. MS. ARMSTRONG shall inform the Board within three (3) business days, in writing, of any change in address andlor telephone number.
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Kelly Ann Amstrong, R.N. Page 6

Refresher Course or Orientation Upon request by the Board or its designee, MS. ARMSTRONG 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 approved in advance by the Board. Temaorary Narcotic Restrictions Upon reinstatement of her license, MS. ARMSTRONG shall not administer, have access to, or possess (except as prescribed for MS. ARMSTRONG's use by another so authorized by law who has full knowledge of MS. ARMSTRONG's history of chemical dependency) any narcotics, other controlled substances, or mood altering drugs for a minimum period of six months in which MS. ARMSTRONG is working in a position that requires a nursing license. At any time after the six-month period previously described, MS. ARMSTRONG may submit a written request to the Board to have this restriction re-evaluated. In addition, MS. ARMSTRONG shall not count narcotics or possess or cany any work keys for locked medication carts, cabinets, drawers, or containers. Permanent Practice Restrictions MS. ARMSTRONG 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. ARMSTRONG 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. ARMSTRONG 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. ARMSTRONG 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, and 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. ARMSTRONG appears to have violated or breached any terms or conditions of this Consent Agreement, the
Kelly Ann Amstrong, R.N Page 7 Board reserves the right to institute fomal 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.
DURATIONlMODIFICATION 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. ARMSTRONG and the Board. The Board may only alter the indefinite suspension imposed if: ( I ) MS. ARMSTRONG submits a written request for reinstatement; (2) the Board determines that MS. ARMSTRONG has complied with all conditions of reinstatement; (3) the Board determines that MS. ARMSTRONG is able to practice according to acceptable and prevailing standards of safe nursing care based upon an interview with MS. ARMSTRONG and review of the documentation specified in this Consent Agreement; and (4) MS. ARMSTRONG 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 years following reinstatement.
ACKNOWLEDGMENTS/LIABILITY RELEASE
MS. ARMSTRONG 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. ARMSTRONG waives all of her rights under Chapter 119, ORC, as they relate to matters that are the subject of this Consent Agreement. MS. ARMSTRONG waives any and all claims or causes of action she may have against the Board, and its members, officers, employees andlor 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.
e l l y Ann Annstrong, R.N. Page 8
EFFECTIVE DATE
MS. ARMSTRONG 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.
3 9 -47 DATE
CYNTHIA A. KRUEGER, President Ohio Board of Nursing
DATE
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, . .
Case # 04-2461
May 19,2006

Kelly Ann Armstrong, R.N A.K.A. Kelley Armstrong 254 Mornington Road Vermillion, OH 44089 Dear Ms. Armstrong: 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 January 9, 2002, in Lorain County Court of Common Pleas Case Number 01CR058133, having entered a plea of guilty, you were found guilty of one (1) count of Driving Under the Influence, a fourth degree felony, in violation of Section 4511.19(A)(1), ORC, and one (1) count of Driving Under the Influence, a fourth degree felony, in violation of Section 451 1.19(A)(3), ORC. The acts underlying your conviction in Case Number 01CR058133 occurred on or about March 22,2001, and involve you operating a vehicle under the influence of alcohol andlor a drug of abuse, having previously been convicted of three or more prior offenses of Driving While Under the Influence within a six year period, to wit: Vermilion Municipal Court on July 13, 1997; Vermilion Municipal Court on June 26, 1995; and Elyria Municipal Court on October 22, 1999. 2. On or about February 10,2006, in Lorain County Court of Common Pleas Case Number 04CR066478, having entered a plea of guilty, you were found guilty of one (1) count of Obstructing Official Business, a fifth degree felony, in violation of Section 2921.31(A), ORC. The acts underlying your conviction in Case Number 04CR066478 occurred on or about October 19,2004, and involve you kicking a security
Kelly Ann Armstrong, R N Page 2 officer in the chest after being transported by ambulance to Community Health Partners, Lorain, Ohio. 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 i n this matter. If you wish to request such hearing, the request must be made in writing and must
b e 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 a t 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,
Bertha Lovelace, R.N., B.A., C.R.N.A. Supervising Board Member
Certified Mail Receipt No. 7006 0810 0003 3208 4275 cc: Katherine Bockbrader, Assistant Attorney General Leah O'Carroll, Assistant Attorney General
Case #11-004838
July 27, 2012

Peggy Lynn Holman Ballinger 6488 Devon Drive Middletown, Ohio 45044 Dear Ms. Ballinger: On or about June 26, 2012, 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 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 17, 2012, in Hamilton County Court of Common Pleas Case Number B 1200002, you pled guilty to Theft of Drugs, felonies of the fourth degree, in violation of Section 2913.02(A)(3), ORC; and Illegal Processing of Drug Documents, felonies of the fourth degree, in violation of Section 2925.23(A), ORC, and were found eligible for Intervention in Lieu of Conviction. The acts underlying this case occurred in or about 2011 and involve you obtaining or exerting control over Oxycodone belonging to The Alois Alzheimer Center by deception. 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), 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 December 29, 2011, you admitted to a Board Compliance Agent that while employed as a nurse at the Alois Alzheimer Center,
Peggy Lynn Holman Ballinger Page 2 Cincinnati, Ohio, for approximately six (6) months you diverted narcotics, including Percocet and Vicodin, for your own personal use. The Disciplinary Notice from the Alois Alzheimer Center, dated November 17, 2011, shows that your employment was terminated after you admitted to facility staff that you had a problem with narcotics, had been under the influence while on duty, and diverted resident medications and taken them yourself. 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)(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 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.ohio.gov.
Peggy Lynn Holman Ballinger 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 licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely,
Judith A. Church, R.N., C.N.P. Supervising Board Member Certified Mail Receipt No. 7012 1010 0002 4225 3866 cc: Henry G. Appel, Assistant Attorney General
Case #11-004838
June 26, 2012
NOTICE OF IMMEDIATE SUSPENSION AND OPPORTUNITY FOR HEARING

Peggy Lynn Holman Ballinger, L.P.N. 6488 Devon Drive Middletown, Ohio 45044 Dear Ms. Ballinger: 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 April 17, 2012, in Hamilton County Court of Common Pleas Case Number B 1200002, you pled guilty to Theft of Drugs, felonies of the fourth degree, in violation of Section 2913.02(A)(3), ORC; and Illegal Processing of Drug Documents, felonies of the fourth degree, 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: 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)(3), ORC; and Illegal Processing of Drug Documents, felonies of the fourth degree, in violation of Section 2925.23(A), 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
Peggy Lynn Holman Ballinger, L.P.N. Page 2 PRACTICAL NURSE, PN-078512, 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 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,
Judith A. Church, R.N., C.N.P. Supervising Board Member
Case #12-002411
July 27, 2012
NOTICE OF AUTOMATIC SUSPENSION AND OPPORTUNITY FOR HEARING

Diana Lynn Von Bauer, L.P.N. 26860 St. Rt. 58 Wellington, Ohio 44090 Dear Ms. Von Bauer: You are hereby notified that, 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 and that such suspension would be stayed subject to probationary terms, conditions, and limitations for a minimum period of at least one (1) year. A. Item 1. of the November 2011 Consent Agreement states, MS. VON BAUER shall obey all federal, state, and local laws, and all laws and rules governing the practice of nursing in Ohio. 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)(1), 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 the board. Item 6. of the November 2011 Consent Agreement states, MS. VON BAUER 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. VON BAUER 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. VON BAUERs 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. VON BAUER 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. VON BAUER. Item 16. of the November 2011 Consent Agreement states, MS. VON BAUER shall not submit or cause to be submitted any
Diana Lynn Von Bauer, L.P.N. Page 2 false, misleading, or deceptive statements, information, or documentation to the Board or to employers or potential employers. Despite these provisions, on May 11, 2012, you provided a urine specimen for analysis to Firstlab, the Boards random drug/alcohol screen program administrator, that tested positive for Ethyl Glucuronide (Alcohol). On or about May 21, 2012, in a telephone interview with your Monitoring Agent, you were specifically asked if you had consumed Alcohol and you stated that you had not consumed Alcohol. You submitted a letter to the Board dated May 22, 2012, stating that you had consumed several beers on the night of May 10, 2012 and had lied to your Monitoring Agent about consuming 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. 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)(1), 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 the board. In accordance with the paragraph under FAILURE TO COMPLY of the November 2011 Consent Agreement, you are hereby notified that it appears to the Board that you have violated Items 1., 6., 7. and 16. of the November 2011 Consent Agreement. YOU ARE FURTHER NOTIFIED THAT YOUR LICENSE TO PRACTICE NURSING AS A LICENSED PRACTICAL NURSE, PN-105650, 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 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 and that such suspension would be stayed subject to probationary terms, conditions, and limitations for a minimum period of at least one (1) year.
Diana Lynn Von Bauer, L.P.N. Page 3 2. Item 1. of the November 2011 Consent Agreement states, MS. VON BAUER shall obey all federal, state, and local laws, and all laws and rules governing the practice of nursing in Ohio. 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)(1), 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 the board. Item 6. of the November 2011 Consent Agreement states, MS. VON BAUER 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. VON BAUER 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. VON BAUERs 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. VON BAUER 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. VON BAUER. Item 16. of the November 2011 Consent Agreement states, MS. VON BAUER 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 these provisions, on May 11, 2012, you provided a urine specimen for analysis to Firstlab, the Boards random drug/alcohol screen program administrator, that tested positive for Ethyl Glucuronide (Alcohol). On or about May 21, 2012, in a telephone interview with your Monitoring Agent, you were specifically asked if you had consumed Alcohol and you stated that you had not consumed Alcohol. You submitted a letter to the Board dated May 22, 2012, stating that you had consumed several beers on the night of May 10, 2012 and had lied to your Monitoring Agent about consuming 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. 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)(1), OAC, states that a
Diana Lynn Von Bauer, L.P.N. Page 4 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 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,
Case #09-1362

17 Souili 1iigl.1Sireet. Srriic 400
~~~ww.~,~~rsi~~g.ohio
(614) 466-3947
C:c.~lr~iiibus. Ohio 43215-7410
CONSENT AGREEMENT BETWEEN DIANA LYNN VON BAUER, L.P.N. AND OHIO BOARD OF NURSING
This Coilsent Agreement is entered into by and between DIANA LYNN VON BAUER, L.P.N., (MS. VON BAUER) 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. VON BAUER 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. B. MS. VON BAUER has been licensed to practice nursing as a licensed practical nurse in the State of Ohio, PN-105650, since October 1999. MS. VON BAUER has an active license as a licensed practical nurse. C. In March 2009 while working as a nurse for Welcome Nursing Home, Oberlin, Ohio, MS. VON BAUER submitted a drug screen that tested positive for Marijuana. MS. VON BAUER's employment with Welcome Nursing Home was subsequently terminated.
Diana Lynn Von Bauer, L.P.N Page 2 D. MS. VON BAUER states that she made an error in judgment and had smoked Marijuana while off work. MS. VON BAUER states that this was an isolated incident.
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. VON BAUER knowingly and voluntarily agrees with the Board to the following terms, conditions, and limitations: MS. VON BAUER'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: 1.
MS. VON BAUER shall obey all federal, state, and local laws, and all laws and rules governing the practice of nursing in Ohio. MS. VON BAUER shall appear in person for iuterviews before the full Board or its designated representative as requested by the Board or its designee. MS. VON BAUER 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 Professionalism and one (1) hour of Ohio Law and Rules. MS. VON BAUER agrees that she will submit a request to the Bureau of Criminal Identification and Investigation (BCII) to conduct a criminal records check of MS. VON BAUER, including a check of Federal Bureau of Investigation (FBI) records, and shall request BCII to submit MS. VON BAUER's criminal records check reports to the Board. MS. VON BAUER'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 probationary terms.
2.
3.
4.
5.
MS. VON BAUER 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. VON BAUER. MS. VON BAUER sball self-administer the prescribed drugs only in the manner prescribed. MS. VON BAUER shall abstain completely from the use of alcohol or products containing alcobol.
6.
Diana Lynn Von Bauer, L.P.N Page 3
7.
Within forty-five (45) days of the effective date of this Consent Agreement and continuing throughout the probationary period MS. VON BAUER shall submit, at her expense and on the day selected, blood, breath, hair, or urine specimens for drug andor alcohol analysis at a collection site specified by the Board at such times as the Board may request. Upon and after MS. VON BAUER'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. VON BAUER 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. VON BAUER.
a. Prior to MS. VON BAUER initiating drug screening, MS. VON BAUER 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. VON BAUER. b. After initiating drug screening, MS. VON BAUER 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. VON BAUER shall notify the Board of any and all medication(s) or prescription(s) received within twentyfour (24) hours of release from hospitalization or medical treatment.
8.
Within thirty (30) days of the effective date of this Consent Agreement and continuing throughout the probationary period, MS. VON BAUER shall attend a minimum of one (1) meeting per week of a support or peer group meeting approved in advance by Lhe Board or its designee, or a Twelve Step program, and MS. VON BAUER shall provide satisfactory documentation of such attendance to Lhe Board beginning within six (6) months of the effective date of this Consent Agreement and every six (6) months thereafter. Upon request of the Board or its designee and within sixty (60) days of that request, MS. VON BAUER shall, at her expense, obtain a che~nical 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. VON BAUER shall provide the chemical dependency professional with a copy of this Consent Agreement. Further, MS. VON BAUER shall execute releases to pe~mitthe chemical
9.
Diana Lynn Von Bauer, L.P.N. Page 4 dependency professional to obtain any infonnation 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. VON BAUER's license to practice, and stating whether MS. VON EAUER is capable of practicing nursing according to acceptable and prevailing standards of safe nursing care.
10.
If a chemical dependency evaluation is requested, MS. VON BAUER 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. VON BAUER 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. VON BAUER's license and that the terms, conditions, and limitations may be incorporated in an addendum to this Consent Agreement.
Employment Conditions
11.
MS. VON BAUER 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 lo accepting employment. MS. VON BAUER, within fifteen (15) day 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. VON BAUER is under a continuing duty lo provide a copy of this Consent Agreement to any new employer prior to accepting nursing employment. MS. VON BAUER 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. VON BAUER shall have her employer(s) send documentatio~l 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.
12.
Reporting Requirements
13.
MS. VON BAUER shall report to the Board, in writing, any violation of this (30) days of the occurrence of the violation. Consent Agreement within thi~ty
14.
MS. VON BAUER shall sign release of infor~nationforms allowing health professionals and other organizations to submit the requested documentation directly to the Board.
Diana Lynn Von Bauer, L.P.N Page 5 15.
MS. VON BAUER 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.
16.
MS. VON BAUER 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.
17.
MS. VON BAUER 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. VON BAUER 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. VON BAUER shall verify that the reports and documentation required by this Consent Agreement are received in the Board office. MS. VON BAUER 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.
18.
19.
20.
Tem~orary Practice Restrictions Unless otherwise approved in advance, in writing, by the Board or its designee, MS. VON BAUER 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 lhe 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. VON BAUER to provide nursing services for fees, compensation, or other consideration or who engage MS. VON BAUER as a volunteer. Unless otherwise approved in advance, in writing, by the Board or its designee, MS. VON BAUER shall not function in a position or employment where the job duties or requirements involve inanage~nentof 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.
Diana Lynn Von Bauer, L.P.N Page 6
FAILURE TO COMPLY MS. VON BAUER agrees that her license to practice nursing as a licensed practical nurse will be automatically suspended if it appears to the Board that MS. VON BAUER has violated or
breached any terms or conditions of the Consent Agreement. Following the automatic suspension, the Board shall notify MS. VON BAUER via certified mail of the specific nature of the cl~argesand automatic suspension of her license. Upon receipt of this notice, MS. VON BAUER 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. VON BAUER 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.
DURATION1 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. VON BAUER and the Board. The Board may only alter the probationary period imposed by this Consent Agreement if: (1) the Board determines that MS. VON BAUER has complied with all aspects of this Consent Agreement; and (2) the Board determines that MS. VON BAUER is able to practice according to acceptable and prevailing standards of safe nursing care without Board monitoring, based upon an interview with MS. VON BAUER and review of the reports as required herein. Any period during which MS. VON BAUER 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.
ACKNOWLEDGMENTSILIABILITYRELEASE MS. VON BAUER 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. VON BAUER waives all of her rights under Chapter 119, ORC, as they relate to matters
that are the subject of this Consent Agreement.
MS. VON BAUER waives any and all claims or causes of action she may have against the
Board, and its members, officers, employees andlor agents arising out of matters, which are the subject of this Consent Agreement.
Diana Lynn Von Bauer, L.P.N. Page 7 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. VON BAUER 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 be!ow .
DATE
s O& &[ (
BERTHA LOVELACE, President Ohio Board of Nursing
DATE
Case #11-001625
July 27, 2012

Nichole Lee Bays, R.N. 3854 Kelly Rd. La Salle, MI 48145 Dear Ms. Bays: 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 April 15, 2011, while working as a nurse at the University of Toledo Medical Center in Toledo, Ohio, you took a page from a physicians prescription pad. You filled out the prescription and presented it to the pharmacy seeking Norco tablets. The pharmacy detected the forgery and refused to fill the prescription. 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, 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
Nichole Lee Bays, 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, 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,
Judith A. Church, R.N., C.N.P. Supervising Member Certified Mail Receipt No. 7012 1010 0002 4225 1336 Attorney Certified Mail Receipt No. 7012 1010 0002 4225 1343 cc: Henry G. Appel, Assistant Attorney General Louis S. Kovacs, Esq.
Case #11-004317
July 27, 2012

Dawn Renee Blagovich, R.N. 1721 Nature Drive Grove City, Ohio 43123 Dear Ms. Blagovich: 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 July 16, 2011, and on or about July 23, 2011, while working as a nurse at Grant Medical Center in Columbus, Ohio, you accessed Patient #1's health care records from an affiliated hospital for personal reasons. You printed the patients records on or about July 23, 2011. Patient #1 is identified on the attached Patient Key to Remain Confidential and Not Subject to Public Disclosure.
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 (H), Ohio Administrative Code, states that a registered nurse shall maintain the confidentiality of client information. The registered nurse shall communicate appropriate client information with other members of the health care team for health care purposes only. 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.
Dawn Renee Blagovich, 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, 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 the 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,
Dawn Renee Blagovich, R.N. Page 3 PATIENT KEY TO REMAIN CONFIDENTIAL AND NOT SUBJECT TO PUBLIC DISCLOSURE 1. Jennifer Campbell
Case #10-3981
July 27, 2012

Robin Annette Brown, L.P.N. 100 Warner Ave Chillicothe, OH 45601 Dear Ms. Brown: 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 21, 2010, the Ohio Department of Job and Family Services (ODJFS) issued Settlement Agreement (2010 Settlement Agreement), in which your Medicaid Provider Agreement (No. 2793722) was cancelled and terminated. A copy of the 2010 Settlement Agreement, along with attachments are attached hereto and incorporated herein.
Section 4723.28(B)(1), 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 432157410, or to the email address, hearing@nursing.ohio.gov.
Robin Annette Brown, L.P.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 licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely,
In the Matter of: Robin Brown, LPN PN. 108628 CERTIFICATION I HEREBY CERTIFY THAT I AM THE KEEPER OF RECORDS AND DOCUMENTS MAINTAINED BY THE BUREAU OF LONG TERM SERVICES & SUPPORT OF THE OHIO DEPARTMENT OF JOB AND FAMILY SERVICES. ATTACHED TO THIS CERTIFICATION ARE COPIES OF THE FOLLOWING:
Proposed Adjudication Order issued to Robin Brown dated Jan. 29,2010 Journal Entry for Docket No: 10HCS18 (Robin Brown) issued on June 26,2010 Adjudication Order issued to Robin Brown dated July 28,2010
THE DOCUMENTS DETAILED ABOVE AND ATTACHED HERETO ARE TRUE AND AUTHENTIC COPIES OF DOCUMENTS KEPT IN THE ORDINARY COURSE OF BUSINESS AND MAINTAINED BY THE OHIO DEPARTMENT OF JOB AND FAMILY SERVICES, BUREAU OF LONG TERM SERVICES AND SUPPORT.
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Date of Signature Bureau of Long Term Services & Support Ohio Department of Job and Family Services
SETTLEMENT AGREEMENT
The Ohio Department of Job and Family Services ("ODJFS") and Robin Brown holder of Medicaid Provider Agreement Number 2793722, as a result of negotiations between them regarding proceedings before ODJFS docketed as 10 HCS 18 (the "Agency Proceeding"), and desiring to resolve the Agency Proceeding without resort to further administrativeor court litigation, do hereby agree as follows:
1.
Robin Brown enters into this Settlement Agreement being fully informed of her rights under R.C. 119, including the right to be represented by counsel and the right to a formal adjudication hearing concerning the issues set forth in the Proposed Adjudication Order dated January 29, 2010. Robin Brown acknowledges and agrees that she was duly notified of her right to a hearing in ODJFS's Proposed Adjudication Order. Robin Brown waives her right to appeal the allegations contained in the January 29,2010 Proposed Adjudication Order. Robin Brown agrees to have her Medicaid Provider Agreement and Provider Agreement Number 2793722 cancelled and terminated by ODJFS and she further agrees to never reapply to become a Non-Agency Provider with ODJFS. It is agreed that Robin Brown's agreement to have her Medicaid Provider Agreement and Provider Agreement Number 2793722 cancelled and terminated by ODJFS and shall not be construed as an admission of the allegations contained in the January 29,2010 Proposed Adjudication Order. This Agreement constitutes a full and complete resolution of the Agency Proceeding named above, as well as any civil disputes between the parties that arise out of, or that is or could be asserted regarding the Agency Proceeding or the facts upon which the Agency Proceeding was or is based.
2.
3.
4.
'ibis Agreement is based upon unique facts and circumstances, and is intended to apply only to Robin Brown and only to the circumstances that relate to the abovenamed Agency Proceeding.
The parties agree that all or part of this Agreement may be released as a public record pursuant to R.C. Chapter 149, and that any information in the Agreement may be reported to appropriate organizations, data banks, and governmental bodies. The individual terms and conditions of this Agreement shall be severable and individually enforceable should any term or condition be determined not to be enforceable for any reason.
By signing this Agreement, ODJFS and Robin Brown agree that they, either directly or acting through their respective representatives, have read this Agreement. understand all of its terms, expressly represent that each has the authority to enter in this Agreement on behalf of their respective organizations, and have executed this Agreement voluntarily.
5.
6.
7.
8.
The terms of this Agreement constitute the entire agreement, acknowledgment and understanding between ODJFS and Robin Brown as to the claims, allegations and arguments that were or that could have been made or raised in the Agency Proceeding. No modification or waiver of this Agreement shall be valid unless in writing and signed by all parties. The effective date of this Agreement is the latest signature date below.
9.
Date
Robin Brown Medicaid Provider No. 2793722
A c mo Date
Counsel for Robin Brown
Date
Sara Coleman Abbott, Chief Bureau of Long Term Services and Support Ohio Department of Job and Family Services
Date ~ s s h t a n~ n o r n e y t ~eneral. Counsel for Ohio Department of Job and Family Services
THEOHIO DEPARTMENT JOBAM) FAMILY OF SERVICES 30 EAST BROADSTREET a g

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Appearances: For the Department of Job and Family Services: Richard Cordray, Attorney General, b ~ S a l l y Ann Steuk, Assistant Attorney General, Health and Human Services Section, 26 Floor, 30 East Broad Street, Columbus, Ohio 43215. Phone: (614) 466-8600; Fax: (614) 466-6090. For the Providen Jonathan D. Schmidt, Benson & Schmidt, LLP, 36 South Paint Street, Chiliicothe, Ohio 45601-3238. Phone: (740) 773-3600; Fax: (740) 773-3610. The parties notified the Hearing Examiner that they had reached a settlement in this matter and that a hearing on the proposed termination of Respondent's Provider Agreement was unnecessary. Therefon, the hearing scheduled to commence June 15, 2010 was continued pendig finaliition of the settlement agreement. Subsequently, the parties submitted a W e n sWIement agreement, the terms of which are ready to be implemented. Accordingly, these administrative proceedings are terminated, upon the recommendation that the Director of the Ohio Department of Job and Family Services issue an Adjudication Order adopting the terms and conditions of the parties' agreement, which are incorporated by reference in this entry.
6 . 2 ~toDate Hearing Examiner P.O. Box 14366 Columbus, Ohio 43214 (614) 2844678 Facsimile: (6 14) 267-2060
CERTIFICATE OF SERVICE
I certify that the original of this document was hand delivered to the Ohio Department of Job and Family Services, 3 1'' Floor, State Oftics Tower, 30 East Bmad Street, Coiumbus, Ohio 43215-3414, on June 28,2010, with instructions to serve copies of the same upon the parties.
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Ted Strickland, G o v e r n o r DouglasE. Lumpkin, D i r e c t o r
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PROPOSED ADJUDICATION ORDER For Termination of Provider Agreement

Robin Brown 100 Warner Avenue Chillicothe, OH 45601
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Notice of Opportunity for a Hearing regarding ODJFS' Proposed Action to Terminate Provider Agreement No. 2793722
Dear Robin Brown: The Ohio Department of Job and Family Services (ODJFS), pursuant to its authority under the Ohio Revised Code ("ORC") Chapter 119 and ORC 5 111.034 and 5 111.06, proposes to terminate your Provider Agreement (No. 2793722). The proposed termination is based on the following: VIOLATION(S) On or about March 31, 1997, in the Municipal Court of Chillicothe, Ohio, in Case Number 96CRB3235, you were convicted of assault in violation of ORC 2903.13. This is one of the enumerated disqualifying offenses listed in Ohio Revise Code 51 11.034 (D)(l) and lor (2) and in Ohio Administrative Code 5101:3-45-08(B)(4). ODJFS has obtained a certified copy of the Judgment Entry showing the disposition of the conviction. On or about April 3, 1997, in the Municipal Court of Chillicothe, Ohio, in Case Number 97CRB511-1, you were convicted of theft in violation of section 545.05 of the Revised Ordinances of the City of Chillicothe, Ohio. This is substantially equivalent to a violation of ORC 2913.02, which is one of the enumerated disqualifying offenses listed in Ohio Revise Code 511 1.034 (D)(l) and lor (2) and in Ohio Administrative Code 5101:3-45-08(B)(4). ODJFS has obtained a certified copy of the Judgment Entry showing the disposition of the conviction. On or about August 24, 1999, in the Municipal Court of Chillicothe, Ohio in Case Number CRB9902893 you were convicted of disorderly conduct in violation of section 509.03 of the Revised Ordinances of the City of Chillicothe, Ohio. This is substantially equivalent to a violation of ORC 2917.1 1, which is one of the enumerated disqualifying offenses listed in Ohio Revise Code 5111.034 (D)(l) and lor (2) and in Ohio Administrative Code 5101:3-4508(B)(4). ODJFS has obtained a certified copy of the Judgment Entry showing the disposition of the conviction. On or about July 26, 2004, in the Municipal Court of Chillicothe, Ohio in Case Number CRB0402371 you were convicted of disorderly conduct in violation of section 509.03 of the Revised Ordinances of the City of Chillicothe, Ohio. This is substantially equivalent to a violation of ORC 2917.1 1, which is one of the enumerated disqualifying offenses listed in Ohio Revise Code 51 11.034 (D)(l) and lor (2) and in Ohio Administrative Code 5101:3-4508(B)(4). ODJFS has obtained a certified copy of the Judgment Entry showing the disposition of the conviction. Based upon the preceding information, ODJFS proposes to terminate your Provider Agreement in accordance with the following provisions of the ORC or OAC: 1. ORC 5111.034(D) States in relevant part: "...the department shall not issue a new provider agreement to, and shall terminate an existing provider agreement of an independent provider if the person has been convicted of, has pleaded
guilty to, or has been found eligible for intervention in lieu of conviction for any of and (D)(2) of this Revised Code.
..." the violations listed in (D)(l)
2 OAC 5101:3-1-17.6(D) States in relevant part "ODJFS may propose termination or denial of a provider agreement at . any time it is determined that continuation or assumption of provider status is not in the best interest of consumers or the state of Ohio. The phrase "not in the best interest" shall include, but not be limited to, the following circumstances or occurrences:. ..(2) The provider, or any person having an ownership or controlling interest in the provider, or who is an agent or employee of the provider, has been indicted or granted immunity from prosecution for, or has pled guilty to, or has been convicted of, any criminal offense against the state of Ohio or any other state or territory."
3. OAC 5101:3-1-17.6m States: "ODJFS shall terminate or deny a provider agreement when any of the following apply: ...(9) The provider fails to timely submit a required background check or when the background check reveals that the provider has been convicted of, or pled guilty to a disqualifying offense unless the provider meets specific circums&ces provided in division 5 101:3 of the Administrative Code" 4. OAC 5101:3-45-08(C)(6) States: "Except as provided by paragraph (D) of this rule, the department shall not issue a new provider agreement to, and shall terminate an existing provider agreement of a non-agency provider if he or she has been convicted of, pleaded guilty to, or has been found eligible for intervention in lieu of conviction for any of the disqualifying offenses set forth in paragraph (B)(4) of this mle." Under Ohio Revised Code Chapter 119, you are entitled to a hearing on this matter if you request a hearing within 30 days of the date of mailing of this Notice. An expianation of how to compute the 30-day deadline is provided in Ohio Administrative Code 5 101:6-50-03(B), which is attached. At the hearing, you may appear in person, be represented by your attorney, or by such other representative as is permitted to practice before this agency. You may also present your position, arguments, or contentions entirely in writing and, at the hearing you may present evidence and examine witnesses appearing for and against you. The rules governing Chapter 119 hearings can be found in OAC 5101:6-50. A request for hearing must be made in writing and be submitted to: The Ohio Department of Job and Family Services Office of Legal Services Attention: Scheduling Coordinator 30 East Broad Street, 31" Floor Columbus, Ohio 43215 If you do not request a hearing within 30 days of the date of the mailing of this notice, ODJFS will issue a final and binding order of adjudication terminating your Provider Agreement, No. 2793722. If you have any questions regarding this notice, piease contact Wayne Morgan at (614) 466-6742. Sincerely,
~ a r Abbott, Chief a Bureau of Community Services Enclosure: OAC 5 101:6-50-03@) Certified mail, return receipt request number 700q 2ESn 0000 8822 57b7
C: T. Lehr, BPO
Carestar
30 East Broad Street Columbus, Ohio 43215 jfs.ohio.gov
An Equal Opportunity Employer and Service Provider
Ohio
Department of J O and Farnify Services ~

Ted Se&&lond. Governor Dou@la#&Lumpkln, Director
IN THE MAllER OF:
DOCKET NO. 10HCS18

ROBIN BROWN
ADJUDICATION ORDER
Pursuant to Chapters 119. and 5111. of the Ohio Revised Code, Douglas E. Lumpkin, Director of the Ohio Department of Job and Family Services ("ODJFS" or "Department"). issues this Adjudication Order regarding the above-captioned Medicaid provider. The Director finds that on January 29, 2010 the Department issued a Proposed Adjudication Order seeking to teninate the provider agreement for Robin Brown. The Provider timely requested an adjudication hearing and the case was assigned to a hearing examiner. In the course of Chapter 119 litigation, the Attorney General's Office, on behalf of the Department, and the Provider entered into a Settlement Agreement. The Settlement ~ ~ r e e m ehas been remanded by the hearing examiner to the Director for review. (See nt Journal Entry filed on June 28,2010 attached). Pursuant to this Settlement Agreement the provideragrees to have her Medicaid Provider Agreement and Provider ~greement Number cancelled. The specific t e n s agreed upon are set forth in the attached Settlement Agreement, which is incorporated in its entirety herein. (See Attached Settlement Agreement). After a review of this matter, the Director hereto affixes his signature and enters this Adjudication Order, as of the date specified below directing the implementation of the attached Settlement Agreement, which is incorporated in its entirety herein. Hereby be advised that you may be entitled to appeal this Adjudication Order to the Court to of Common Pleas of Franklin Countv ~ursuant Sections 119.12 and 5111.06 of the Ohio Revised Code and Ohio ~dministraiive Code Section 5201:6-50-09(D). Any adverselyaffected party desiring to appeal this Order must file an original notice of appeal with the Ohio Department of Job and Family Services ("ODJFS"), Hearing Coordinator, 30 East Broad Street, 31" Floor, Columbus, Ohio 43215-3414, setting forth the order appealedfrom and the grounds of the party's appeal. In order to be determined filed with ODJFS, the original notice of appeal must be received by ODJFS, as evidenced by an ODJFS date and time stamp, no later than fifteen (15) days after the mailing to the affected party of the order to be appealed from. The affected party shall also file a copyof the notice of appeal with
In the matter of Robin Brown Adjudication Order
Page 2
the court of common pleas no later than fifteen days after the mailingto the affected party of the order to be appealed from.
July 28, 2010
Date of Joumalization and Effective Date of Order
1 hereby certify this to be a true and exact reproduction of the original Adjudication Order of the hio Department of Job and Family Services,
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Appeals Coordinator Date of certification
7-2& 6 7
Case #12-003083
July 27, 2012

Jennifer Ann Burgess, L.P.N. 17488 Mallard Court LaGrange, Ohio 44050 And 42785 Albrecht Road Elyria, Ohio 44035 Dear Ms. Burgess: 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 April 18, 2012, in Lorain County Court of Common Pleas Case No. 12 CR 084275, 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 one (1) count of Illegal Processing of Drug Documents, a felony of the fourth degree, in violation of 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: 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 of 2925.23(A), ORC, constitute felony drug abuse offenses as defined in Section 2925.01, ORC.
Jennifer Ann Burgess, 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, PN-124265, 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 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 April 18, 2012, in Lorain County Court of Common Pleas Case No. 12 CR 084275, 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 one (1) count of Illegal Processing of Drug Documents, a felony of the fourth degree, in violation of 2925.23(A), ORC, and were found eligible for Intervention in Lieu of Conviction. The acts underlying this case occurred on or about December 20, 2011 through December 21, 2011, and involve you obtaining a dangerous drug without the consent of the owner or person authorized to give consent. Further acts underlying this case occurred on or about December 20, 2011 through December 21, 2011 and involve you making a false statement in any prescription, order, report, or record involving Percocet. 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 December 22, 2011, you admitted to a Board Compliance Agent that, while working as a licensed practical nurse at Kendal at Oberlin (Kendal) in Oberlin, Ohio, you consumed beverages containing alcohol before and during your shift on December 20, 2011 through December 21, 2011. During this shift, Kendal staff observed that you returned from a break crying, with unsteady gait and speech that was difficult to understand. You had difficulty remembering to which patient you had administered a narcotic prior to break.
Jennifer Ann Burgess, L.P.N. Page 3 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 December 22, 2011, you admitted to a Board Compliance Agent that, while working as a licensed practical nurse at Kendal on or about December 20 through 21, 2011, you stole narcotics from the facility for self-administration.
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)(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. 4. On or about December 22, 2011, you admitted to a Board Compliance Agent that, while working as a licensed practical nurse at Wesleyan Village in Elyria, Ohio, you stole medication from the facility.
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 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.
Jennifer Ann Burgess, L.P.N. Page 4 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,
Judith A. Church, R.N., C.N.P. Supervising Board Member Certified Mail Receipt No. 7012 1010 0002 4225 4757 Second Address Certified Mail Receipt No. 7012 1010 0002 4225 4764 cc: Henry G. Appel, Assistant Attorney General
Case# 12-001643
July 27, 2012

Joseph R. Burkey, R.N. 134 Wilber Avenue Columbus, Ohio 43215 Dear Mr. Burkey: 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. Your license to practice nursing as a registered nurse is currently suspended for indefinite period of time with conditions for reinstatement pursuant to a Consent Agreement you entered into with the Board, effective January 21, 2011, (January 2011 Consent Agreement), a copy of which is attached hereto and incorporated herein. 2. You sent a letter to the Board dated October 26, 2011, requesting to activate your monitoring status. 3. While subject to the January 2011 Consent Agreement, you violated the terms as follows: a) Item 2. of the January 2011 Consent Agreement states, MR. BURKEY shall obey all federal, state, and local laws, and all laws and rules governing the practice of nursing in Ohio. Item 12. of the January 2011 Consent Agreement states, MR. BURKEY shall report to the Board in writing any violation of this Consent Agreement within thirty (30) days of the occurrence of the violation. Despite these provisions, on or about August 25, 2011, in Franklin County Court of Common Pleas, Case No. 11CR-04-2002, you pled guilty to and were convicted of one (1) count of Attempted Possession of Cocaine, a first-degree misdemeanor, in violation of Section 2923.02, ORC as it relates to Section 2925.11, ORC. You failed to notify the Board of your conviction until December 2, 2011.
Joseph R. Burkey Page 2 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)(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 7. of the January 2011 Consent Agreement states, MR. BURKEY shall abstain completely from the use of alcohol.
Despite this provision, you admitted in a telephone interview on December 2, 2011, with your Board Monitoring Agent that you continue to drink alcohol, have not sought treatment, do not attend 12-Step meetings and have had no sober time from 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 432157410, or to the e-mail address, hearing@nursing.ohio.gov.
Joseph R. Burkey 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 ($500.00) per violation. Sincerely,
Judith A. Church, R.N., C.N.P. Supervising Member Certified Mail Receipt No.: 7012 1010 0002 4225 1756 cc: Henry G. Appel, Assistant Attorney General
Case # 10-4928
Ohio Board of Nursing 17 South High Street, S~iite 400

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Coluillbun, Ohio 43215-7410
(614) 466-3947
CONSENT AGREEMENT BETWEEN JOSEPH R. BURKEY, R.N. AND OHIO BOARD OF NURSING
This Consent Agreement is entered into by and between JOSEPH R. BURKEY, R.N. (MR. BURKEY) 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. MR. BURKEY voluntarily enters into this Consent Agreement being fully informed of his 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)(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 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)(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, states that a licensed nurse shall not falsify any client record or any other document
Joseph R. Burkey, R.N Page 2 prepared or utilized in the course of, or in conjunction with, nursing practice. B.
MR. BURKEY is licensed to practice nursing as a registered nurse, RN250953, in the State of Ohio, since 1994. MR. BURKEY knowingly and voluntarily admits to the following:
While employed as a case nurse for Specialty Select Hospitals at The Ohio State University East in Columbus, Ohio, in September 2005, MR. BURKEY was confronted by supervisors regarding narcotic discrepancies. MR. BURKEY admitted that he had been stealing injectable Dilaudid from work for approximately 18 months and that he was self-administering the stolen Dilaudid. MR. BURKEY was terminated from his employment.
C.
MR. BURKEY was charged with Possession of a Controlled Substance (Ecstasy) in May 2005 in Orange County, Florida. MR. BURKEY pled no contest to the charges and adjudication was withheld by the court while MR. BURKEY completed probation. MR. BURKEY underwent a chemical dependency assessment and treatment at The Ohio State University Medical Center Talbot Hall where he was diagnosed with Opioid, Cannabis, and Alcohol Dependence. MR. BURKEY reports that he completed inpatient and aftercare treatment at Talbot Hall in 2006. MR. BURKEY further reports that although he drinks occasionally, he has abstained from drugs since entering treatment. MR. BURKEY voluntarily made his nursing license inactive in September 2005. MR. BURKEY indicated that since making his license inactive, he has worked for the American Red Cross. MR. BURKEY feels that he is now ready to return to the practice of nursing, and is willing to cooperate with the Board. 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. BURKEY knowingly and voluntarily agrees with the Board to the following terms, conditions, and limitations:
1.
MR. BURKEY's license to practice nursing as a registered nurse is hereby suspended for an indefinite period of time, but not less than six (6) months. MR. BURKEY may submit a written request for reinstatement anytime after the conditions for reinstatement have been met.
Joseph R. Burkey, R.N. Page 3
2.
3.
MR. BURKEY shall obey all federal, state, and Local laws, and all laws and rules
governing the practice of nursing in Ohio.
MR. BURKEY shall appear in person for interviews before the full Board or its
designated representative as requested by the Board.
4.
Within three (3) months prior to requesting reinstatement, MR. BURKEY agrees
that he will submit a request to the Bureau of Criminal Identification and Investigation (BCII) to conduct a criminal records check of MR. BURKEY, including a check of FederaI Bureau of Investigation (FBI) records, and shall cause BCII to submit MR. BURKEY's criminal records check reports to the Board. MR. BURKEY 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.
Prior to reinstatement, MR. BURKEY 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.

6.
MR. BURKEY 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 who has full knowledge of MR. BURKEY's history of chemical dependency and recovery status. MR. BURKEY shall self-administer the prescribed drugs only in the manner prescribed.
7.
8.
MR. BURKEY shall abstain completely from the use of alcohol Within lhree (3) months prior to requesting reinstatement, MR. BURKEY 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. BURKEY shall provide the chemical dependency professional with a copy of this Consent Agreement. Further, MR. BURKEY shall execute releases to permit the chemical dependency professional to obtain any information deemed appropriate and necessar; 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 MR. BURKEY's license to practice, and stating whether MR. BURKEY is capable of practicing nursing according to acceptable and prevailing standards of safe nursing care. MR. BURKEY 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. BURKEY
9.
Joseph R. Burkey, R.N. Page 4 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 MR. BURKEY's license and that the terms, conditions, and limitations shall be incorporated in an addendum to this Consent Agreement. 10.
For a minimum, continuous period of six (6) months immediately prior to requesting reinstatement, MR. BURKEY shall submit, at his expense and on the
day selected, blood or urine specimens for drug andlor alcohol analysis at a collection site specified by the Board at such times as the Board may request. Upon and after MR. BURKEY'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. BURKEY shall be negative, except for substances prescribed, administered, or dispensed to him by another so authorized by law who has full knowledge of MR. BURKEY's history of chemical dependency and recovery status. a. Within thirty (30) days prior to MR. BURKEY initiating drug screening, MR. BURKEY 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 MR.
BURKEY.
b. After initiating drug screening, MR. BURKEY 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, MR. BURKEY 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. 11.
For a minimum, continuous period of six (6) months immediately prior to requesting reinstatement, MR. BURKEY 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 prior to reinstatement.

12.
MR. BURKEY shall report to the Board in writing, any violation of this Consent
Agreement within thirty (30) days of the occurrence of the violation.
Joseph R. Burkey, R.N. Page 5 13.
MR. BURKEY shall sign release of information forms allowing health professionals andother organizations to submit requested documentation or information directly to the Board. MR. BURKEY shall submit any and all information that the Board may request regarding his ability to practice according to acceptable and prevailing standards of safe nursing practice. MR. BURKEY 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. BURKEY 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. MR. BURKEY 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. MR. BURKEY shall verify that the reports and documentation required by this Consent Agreement are received in the Board office. MR. BURKEY shall inform the Board within five (5) business days, in writing, of any change in address and/or telephone number.
14.
15.
16.
17.
18.
19.
Nursing Refresher Course MR. BURKEY 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 approved in advance by the Board or its designee. Tem~orarv Narcotic Restrictions MR. BURKEY shall not administer, have access to, or possess (except as prescribed for MR. BURKEY's use by another so authorized by law who has full knowledge of MR. BURKEY's history of chemical dependency) any narcotics, other controlled substances, or mood altering drugs for a minimum period of six (6) months in which MR. BURKEY is working in a position that requires a nursing license. At any time after the six-month period previously described, MR. BURKEY may submit a written request to the Board to have this restriction re-evaluated. In addition, MR. BURKEY shall not count narcotics or possess or carry any work keys for loclted medication carts, cabinets, drawers, or containers.
Permanent Practice Restrictions MR. BURKEY 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, MR. BURKEY 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 MR. BURKEY 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, MR. BURKEY 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 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, MR. BURKEY 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 MR. BURKEY and the Board. The Board may only alter the indefinite suspension imposed if: (1) MR. BURKEY submits a written request for reinstatement; (2) the Board determines that MR. BURKEY has complied with all conditions of reinstatement; (3) the Board determines that MR. BURKEY is able to practice according to acceptable and prevailing standards of safe nursing care based upon an interview with MR. BURKEY and review of the documentation specified in this Consent Agreement; and (4) MR. BURKEY 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.
ACKNOWLEDGMENTSILIABILITY RELEASE
MR. BURKEY 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. BURKEY waives all of his rights under Chapter 119, ORC, as they relate to matters that are the subject of this Consent Agreement. MR. BURKEY waives any and all claims or causes of action he 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.
EFFECTIVE DATE MR. BURKEY 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.
EERTWA LOVELACE, President

1,
DATE
Case #12-000938
July 27, 2012

Lea Dawn Bush, R.N. 103 Columbia Street Newark, Ohio 43055 and Oriana House 941 Sherman Street Akron, Ohio 44311 Dear Ms. Bush: 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 8, 2012, in Licking County Court of Common Pleas Case Number 11 CR 034, you were found guilty of one (1) count of Aggravated Possession of Drugs (Methamphetamine), a fifth-degree felony, in violation of Section 2925.11(A)(C)(1)(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. Aggravated Possession of Drugs (Methamphetamine), a fifth-degree felony, in violation of Section 2925.11(A)(C)(1)(a), ORC, constitutes a felony drug abuse offense as defined in Section 2925.01, ORC.
Lea Dawn Bush, R.N. Page 2 WHEREFORE, PURSUANT TO SECTION 3719.121(C), ORC, YOU ARE HEREBY NOTIFIED THAT YOUR LICENSE TO PRACTICE NURSING AS A REGISTERED NURSE, RN-354912, 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 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 8 2012, in Licking County Court of Common Pleas Case Number 11 CR 034, you were found guilty of one (1) count of Aggravated Possession of Drugs (Methamphetamine), a fifth-degree felony, in violation of Section 2925.11(A)(C)(1)(a), ORC. The acts underlying the above criminal case occurred on or about November 5, 2010, and involve you obtaining, possessing or using Methamphetamine. On April 28, 2011, you pled guilty to one count of Aggravated Possession of Drugs and were found eligible for Intervention in Lieu of Conviction. On March 8, 2012, the Licking County Common Pleas Court found that you violated the terms and conditions of Intervention in Lieu of Conviction, found you guilty of Aggravated Possession of Drugs and sentenced you to community control. 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 April 2, 2012, you admitted to a Board Compliance Agent that you used Methamphetamine from the streets. In a written statement, dated April 7, 2012, you admitted that on November 5, 2010, you had a positive urine test for Methamphetamine.
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.
Lea Dawn Bush, R.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 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,
Case #11-003579
July 27, 2012

Laura Elizabeth Campbell, R.N. 996 Cheery Hill Dr. Johnstown, Ohio 43031 Dear Ms. Campbell: 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 September 20, 2011, you told a Board Compliance Agent that, while working as a nurse at Riverside Methodist Hospital in Columbus, Ohio, you diverted Percocet and Oxycodone tablets and ingested them. 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)(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 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
Laura Elizabeth Campbell, R.N. Page 2 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,
Case #11-001447
July 27, 2012
Cary R. Camron, L.P.N. 4615 Dartford Road Englewood, Ohio 45322 Dear Mr. Camron: 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 May 3, 2011, in Montgomery County Court of Common Pleas Case Number 2011 CR 01346, 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. 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 LICENSED PRACTICAL NURSE, PN-072341, IS HEREBY SUSPENDED. Continued practice after
Cary R. Camron, 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 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 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 3, 2011, in Montgomery County Court of Common Pleas Case Number 2011 CR 01346, you pled guilty to and were found guilty of, one (1) count of Burglary, a felony of the fourth degree, in violation of Section 2911.12(A)(4), ORC; and one (1) count of Theft of Drugs, a felony of the fourth degree, in violation of Section 2913.02(A)(1), ORC. The acts underlying this case occurred on or about April 3, 2011, and involve you trespassing in a permanent or temporary habitation of a person, when a person other than an accomplice was present or likely to be present. Further acts underlying this case involve you obtaining or exerting control over a dangerous drug without the consent of the owner or person authorized to give consent. 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 28, 2010, you submitted an on-line application to the Board for renewal of your licensed practical nurse license (Application). Under the Compliance section of the Application, you were asked: [H]ave you been convicted of, found guilty of, pled guilty to, pled no contest to, entered an Alford plea, received treatment or intervention in lieu of conviction or received diversion for a misdemeanor in Ohio, another state, commonwealth, territory, province, or country. This does not include non-DUI/OVI traffic violations. You answered, No to this question. However, on or about February 23, 2010, in Miami County Municipal Court Case Number 2010 CR A
Cary R. Camron, L.P.N. Page 3 00500, you were convicted of one (1) count of Criminal Trespass, a misdemeanor of the fourth degree, in violation of Section 2911.21, 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, Rule 4723-4-06(P)(1), Ohio Administrative Code, 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 the board or any representative of the board. 3. On or about April 14, 2011, you admitted to a Board Compliance Agent that you deceived physicians by not disclosing your history of addiction or currently prescribed medications in order to obtain narcotics. You stated that you received treatment by dentists and physicians at four (4) or five (5) urgent care centers. You stated that your drug usage escalated in the prior six (6) to eight (8) months. You stated that you consumed eight (8) to twelve (12) Hydrocodone per day.
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 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. 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.
Cary R. Camron, L.P.N. Page 4 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,
Case# 12-002733
July 27, 2012

Julia Marie Chapman, L.P.N. 801 Ridgelawn Avenue Hamilton, Ohio 45013 Dear Ms. Chapman: 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 probation three (3) years. Attached to and incorporated within the January 2012 Consent Agreement is a July 2011 Notice of Opportunity for Hearing (July 2011 Notice). A. Item 6. of the January 2012 Consent Agreement states, Within forty-five (45) days of the effective date of this Consent Agreement and continuing throughout the probationary period, MS. CHAPMAN 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. CHAPMANs 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. CHAPMAN 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. CHAPMAN. Despite this provision, on the following dates, you failed to call Firstlab, the Boards random drug/alcohol screen program administrator, to determine if you had been selected to provide a urine specimen: April 26, 2012; May 11, 2012; May 21-23, 2012; June 11-12, 2012; June 16, 2012; June 19-20, 2012; and June 22-23, 2012. Furthermore, on the following dates, you were selected to provide a urine specimen for analysis and failed to do so: May 11, 2012; May 23, 2012; June 11, 2012; and June 21, 2012.
Julia Marie Chapman, L.P.N. Page 2 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 January 2012 Consent Agreement, you are hereby notified that it appears to the Board that you have violated Item 6. of the January 2012 Consent Agreement. YOU ARE FURTHER NOTIFIED THAT YOUR LICENSE TO PRACTICE NURSING AS A LICENSED PRACTICAL NURSE, PN-104279, 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 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 probation three (3) years. Attached to and incorporated within the January 2012 Consent Agreement is a July 2011 Notice of Opportunity for Hearing (July 2011 Notice). 2. Item 6. of the January 2012 Consent Agreement states, Within forty-five (45) days of the effective date of this Consent Agreement and continuing throughout the probationary period, MS. CHAPMAN 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. CHAPMANs 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. CHAPMAN 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. CHAPMAN.
Julia Marie Chapman, L.P.N. Page 3 Despite this provision, on the following dates, you failed to call Firstlab, the Boards random drug/alcohol screen program administrator, to determine if you had been selected to provide a urine specimen: April 26, 2012; May 11, 2012; May 21-23, 2012; June 11-12, 2012; June 16, 2012; June 19-20, 2012; and June 22-23, 2012. Furthermore, on the following dates, you were selected to provide a urine specimen for analysis and failed to do so: May 11, 2012; May 23, 2012; June 11, 2012; and June 21, 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,
Julia Marie Chapman, L.P.N. Page 4 Certified Mail Receipt No. 7012 1010 0002 4225 1916 cc: Henry G. Appel, Assistant Attorney General
Case #lo-3277
I 7 South H ~ s h Street, Suite 400
Colu~nbus.Ohio 43215-7410 * (014) 466-3947
CONSENT AGREEMENT BETWEEN JULIA MARIE CHAPMAN, L.P.N. AND OHIO BOARD OF NURSING
This Consent Agreement is entered into by and between JULIA MARIE CHAPMAN, L.P.N. (MS. CHAPMAN) 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 to include the following document that is attached hereto and incorporated herein: July 29,201 1 Notice of Opportunity for Hearing. 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)(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), Ohio Administration 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 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 docu~nentsor reports or time records, reports, and other documnents related to billing for nursing services. Rule 4723-4-
Julia Marie Chapman, L.P.N. Page 2
06(H), OAC, states that a licensed nurse shall implement measures to promote a safe environment for each client. B.
MS. CHAPMAN was initially licensed to practice nursing as a licensed practical nurse in the State of Ohio, PN-104279, in March 1999. MS. CHAPMAN'S license to practice as a licensed practical nurse is currently active. MS. CHAPMAN knowingly and voluntarily admits to the factual and legal allegations set forth in the July 201 1 Notice. MS. CHAPMAN states, with respect to paragraphs 1 and 2 of the July 2011 Notice that she does not specifically recall Patient #l's Controlled Drug Records (CDR). However, MS. CHAPMAN states that CDRs are prepared by the pharmacy and transferred to the nurse at the facility with the medications, and, if MS. CHAPMAN is the acting floor nurse, then she signs the CDR indicating the facility's receipt of the mediations. MS. CHAPMAN states that the pharmacy affixes the label to the CDR and sometimes marks on the label with modifications regarding the transfer or circles the amount of tablets transferred. MS. CHAPMAN does not dispute that she may have signed the CDR's and inadvertently indicated the incorrect number of tablets delivered. MS. CHAPMAN states, with respect to paragraph 3 of the July 2011 Notice that MS. CHAPMAN did not documel~ton the nurse's notes whether the treatment given was effective. MS. CHAPMAN states, with respect to paragraph 4 , of the July 2011 Notice, that she misplaced the CDR. MS. CHAPMAN denies chemical dependency. MS. CHAPMAN last worked as a nurse in August 2010. AGREED CONDITIONS
C.
D.
E.
F.
G.
H.
Wherefore, in consideration of the foregoing and mutual promises hereinafter set forth, and in lieu of any formal proceedings at this time, MS. CHAPMAN knowingly and voluntarily agrees with the Board to the following terms, conditions, and limitations: MS. CHAPMAN'S license to practice nursing as a licensed practical nurse shall he suspended indefinitely. Such suspension shall he stayed, subject to the following PROBATIONARY terms, conditions, and limitations for a minimum period of probation three (3) years: 1.
MS. CHAPMAN shall obey all federal, state, and local laws, and all laws and rules governing the practice of nursing in Ohio.
Julia Marie Chapman, L.P.N Page 3
2.
MS. CHAPMAN shall appear in person for interviews before the full Board or its designated representative as requested by the Board or its designee. MS. CHAPMAN agrees that she will submit a request to the Bureau of Criminal Identification and Investigation (BCII) to conduct a criminal records check of MS. CHAPMAN, including a check of Federal Bureau of Investigation (FBI) records, and shall request BCII to submit MS. CHAPMAN'S criminal records check reports to the Board. MS. CHAPMAN'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.
3.
Educational Requirement
4.
Within six (6) months of the effective date of this Consent Agreement, MS. CHAPMAN 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, taken subsequent to the effective date of this Consent Agreement: ten (10) hours of Documentation; ten (10) hours of Medication Administration; and five (5) hours of Professionalism.
Monitoring
5.
MS. CHAPMAN 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. CHAPMAN. MS. CHAPMAN 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. CHAPMAN shall submit, at her expense and on the day selected, blood, breath, hair, or urine specimens for drug andlor alcohol analysis at a collection site specified by the Board at such times as the Board may request. Upon and after MS. CHAPMAN'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. CHAPMAN 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. CHAPMAN.
6.
a. Prior to MS. CHAPMAN initiating drug screening, MS. CHAPMAN 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. CHAPMAN. b. After initiating drug screening, MS. CHAPMAN 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. CHAPMAN 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.
Upon the request of the Board or its designee and beginning within thirty (30) days of that request and continuing throughout the probationary period, MS. CHAPMAN 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. CHAPMAN 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. Upon the request of the Board or its designee and within sixty (60) days of that reauest, MS. CHAPMAN shall. at her exuense. obtain a chemical dependekcy 'evaluation by a ~ o a r d approve; chkmical dependency professional and shall provide the Board with complete documentation of this &aluation. Prior to the evaluation, MS. CHAPMAN shall provide the chemical dependency professional with a copy of this Consent Agreement. Further, MS. CHAPMAN 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. CHAPMAN'S license to practice, and stating whether MS. CHAPMAN is capable of practicing nursing according to acceptable and prevailing standards of safe nursing care.
8.
9.
If a chemical dependency evaluation is requested, MS. CHAPMAN 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. CHAPMAN 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. CHAPMAN'S license and that the terms, conditions, and limitations may be incorporated in an addendum to this Consent Agreement.
10.
MS. CHAPMAN 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 nursing
employment.
11.
MS. CHAPMAN, within fifteen (15) day 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. CHAPMAN is under a continuing duty to provide a copy of this Consent Agreement to any new employer prior to accepting nursing employment. MS. CHAPMAN 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. CHAPMAN 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.
12.
MS. CHAPMAN shall report to the Board, in writing, any violation of this
Consent Agreement within thirty (30) days of the occurrence of the violation.
13.
MS. CHAPMAN shall sign release of information forms allowing health

professionals and other organizations to submit the requested documentation directly to the Board.
14.
MS. CHAPMAN 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.
MS. CHAPMAN shall not submit or cause to be submitted any false,

16.
MS. CHAPMAN 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. CHAPMAN 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. CHAPMAN shall verify that the reports and documentation required by this Consent Agreement are received in the Board office. MS. CHAPMAN 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.
JVursin~ Refresher Course Upon the request of the Board or its designee, MS. CHAPMAN shall complete and submit satisfactory documentation of completion of nurse refresher courses or an extensive orientation to be approved in advance by the Board, or its designee. Temporarv Narcotic Restriction MS. CHAPMAN shall not administer, have access to, or possess (except as prescribed for MS. CHAPMAN'S use by another so authorized by law who has received a complete copy of this Consent Agreement prior to prescribing for MS. CHAPMAN) any narcotics, other controlled substances, or mood altering drugs for a minimum of three (3) months in which MS. CHAPMAN is working in a position that requires a nursing license. At any time after the three (3) month period previously described, MS. CHAPMAN may submit a written request to the Board to have this restriction re-evaluated. In addition, MS. CHAPMAN shall not possess or carry any work keys for locked medication carts, cabinets, drawers, or containers. MS. CHAPMAN shall not count narcotics. MS. CHAPMAN shall not call in or order prescriptions or prescription refills for narcotics, other controlled substances, or mood altering drugs. Permanent Practice Restrictions MS. CHAPMAN further knowingly and voluntarily agrees with the Board to the following PERMANENT LICENSURE RESTRICTIONS: Unless otherwise approved in advance, in writing, by the Board or its designea, MS. CHAPMAN 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. CHAPMAN to provide nursing services for fees, compensation, or other consideration or who engage MS. CHAPMAN as a volunteer.
Unless otherwise approved in advance, in writing, by the Board or its designee, MS. CHAPMAN 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. CHAPMAN agrees that her license to practice nursing as a licensed practical nurse will be automatically suspended if it appears to the Board that MS. CHAPMAN has violated or breached any terms or conditions of the Consent Agreement. Following the automatic suspension, the Board shall notify MS. CHAPMAN via certified mail of the specific nature of the charges and automatic suspension of her license. MS. CHAPMAN 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. CHAPMAN 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.

The terms, limitations, and conditions, of this Consent Agreement may, other than permanent licensure restrictions, be modified or terminated, in writing, at any time upon the agreement of both MS. CHAPMAN and the Board. The Board may only alter the probationary period imposed by this Consent Agreement if: (1) the Board determines that MS. CHAPMAN has complied with all aspects of this Consent Agreement; and (2) the Board determines that MS. CHAPMAN is able to practice according to acceptable and prevailing standards of safe nursing care without Board monitoring, based upon an interview with MS. CHAPMAN and review of the reports as required herein. Any period during which MS. CHAPMAN 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.
2012 J N 13 PH 2: 57 A
MS. CHAPMAN acknowledges that she has had an oo~ortunltv ask auestions conce!%!@the to . terms of this Consent Agreement and that all questions asked have been answered in a satisfactory manner MS. CHAPMAN waives all of her rights under Chapter 119, ORC, as they relate to matters that are the subject of this Consent Agreement. MS. CHAPMAN 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.
BOAED U f WRSING
EFFECTIVE DATE MS. CHAPMAN 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.
I-t 0-12
DATE
DATE
Case #lo-3277
Ohio Board s f Nursing

17 South High Street, Suite 400
,,,i.nursillg.ohio.gov
(614) 466-3947
Columbus, Ohio 4.32 15-7410
July 29,201 1

Julia Marie Chapman, L.P.N. 801 Ridgelawn Ave. Hamilton. Ohio 45013 Dear Ms. Chapman: 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 May 2,2010, while working as a nurse at The Home At Taylor's Pointe in Cincinnati, Ohio (Taylor's Pointe), Patient #1 received a delivery of 60 Oxycodone (Percocet) tablets from the pharmacy. You falsely indicated on Patient # l ' s Controlled Drug Record that only thirty (30) Oxycodone tablets had been received and initiated the Oxycodone tablet count at thirty (30) tablets.
2. On or about June 4, 2010, while working as a nurse at Taylor's Pointe, you accepted a pharmacy delivery of 60 Oxycodone (Percocet) tablets intended for Patient # l . You falsely indicated on Patient #l's Controlled Drug Record that only thirty (30) Oxycodone tablets had been received and initiated the Oxycodone tablet count at thirty (30) tablets. 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 prepared or utilized in the course of, or in conjunction with, ilursing practice. other docu~nent 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. On July 14, 15, 17,20,25,26,28, and 30, 2010, while working as a nurse at Taylor's Pointe, you documented administering Oxycodone (Percocet) to Patient #1 but failed to documelit in the Nurse's Notes or Pain Flow Sheets the administration andlor needs assessment for these doses.
Julia Marie Chapman, L.P.N. Page 2 Section 4723.28(B)(16), ORC, authorizes the Board to discipline a licensee for violation of adopted under it. Specifically, Rule 4723-4-06(E), OAC, states Chapter 4723, ORC, or any ~ u l e s that a licensed nurse shall, in a comnplete, 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. 4. On or about August 6, 2010, while working as a nurse at Taylor's Pointe, you admitted to losing the Controlled Drug Record for the July 30, 2010 delivery of Patient #l's Oxycodone (Percocet), thereby failing to account for Patient #l's pharmacologic inventory. 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 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.: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 fille of not more than five hundred dollars ($500.00) per violation. Sincerely,
Julia Marie Chapman, L.P.N. Page 3 Judith A . Church, R.N., C.N.P Supervising Member Certified Mail Receipt No. 701 1 1150 0000 9243 8879 cc: Michelle Sutter, Assistant Attorney General
Case #12-001080
July 27, 2012

Sarah Rose Coble, R.N. 170 W. Carriage Drive Chagrin Falls, OH 44022 and 170 W. Carriage Drive, Apt. 203 Chagrin Falls, OH 44022 Dear Ms. Coble: In accordance with Chapter 119, Ohio Revised Code (ORC), you are 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 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. Your license to practice as a registered nurse in the State of Ohio has been suspended since on or about February 7, 2006. On or about March 8, 2012, in Cuyahoga County Court of Common Pleas Case Number CR-12-558537-A, you pled guilty to one (1) count of Drug Possession, a felony of the fifth degree, in violation of Section 2925.11(A), ORC. The acts underlying this case occurred on or about January 15, 2012, and involve you obtaining, possessing, or using Heroin.
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. 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
Sarah Rose Coble Page 2 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.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 registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely,
Case 11-003954
July 27, 2012

Billie Marie Colley, R.N. 837 Centerpoint Road Oak Hill, Ohio 45656 Dear Ms. Colley: 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 September 16, 2011, while working as a nurse at Arbors at Gallipolis in Gallipolis, Ohio, you submitted a drug screen specimen that tested positive for Morphine. You did not have a current, valid prescription for Morphine. 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. 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.
Billie Marie Colley, 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, 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,
Case# 12-001952
July 27, 2012

Alicia M. Conant, L.P.N. 100 Highland Avenue Williamstown, WV 26187 Dear Ms. Conant: 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 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 for a minimum period of at least two (2) years. A. You were issued a license to practice nursing as a licensed practical nurse in the State of Ohio on January 31, 2012. B. Item 4. of the January 2012 Consent Agreement states, Within ninety (90) days from the effective date of this Consent Agreement, MS. CONANT 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 other comparable courses approved in advance by the Board, taken subsequent to the effective date of this Consent Agreement: fifteen (15) hours of chemical dependency. Despite this provision, as of July 2, 2012, you have failed to submit to the Board satisfactory documentation of successful completion of fifteen (15) hours of chemical dependency. C. Item 7. of the January 2012 Consent Agreement states, Within sixty (60) days of the effective date of this Consent Agreement and continuing throughout the probationary period, MS. CONANT shall begin submitting, at her expense and on the day selected, 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. 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
Alicia M. Conant, L.P.N. Page 2 MS. CONANT shall be negative, except for substances prescribed, administered, or dispensed to her by another so authorized by law who has full knowledge of MS. CONANTs history of chemical use. Despite this provision, on the following dates, you failed to call Firstlab, the Boards random drug/alcohol screen program administrator, to determine if you had been selected to provide a urine specimen: April 16, 2012; April 19-20, 2012; April 22, 2012; April 24-26, 2012; April 28-30, 2012; May 3-4, 2012; May 6, 2012; May 8-10, 2012; May 12-13, 2012; May 15-31, 2012; and June 1-11, 2012. Furthermore, on the following dates, you were selected to provide a urine specimen for analysis and failed to do so: March 26, 2012; April 5, 2012; April 25, 2012; May 9, 2012; May 24, 2012; and June 4, 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 January 2012 Consent Agreement, you are hereby notified that it appears to the Board that you have violated Items 4. and 7. of the January 2012 Consent Agreement. YOU ARE FURTHER NOTIFIED THAT YOUR LICENSE TO PRACTICE NURSING AS A LICENSED PRACTICAL NURSE, PN-147874, 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 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 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 for a minimum period of at least two (2) years. 2. You were issued a license to practice nursing as a licensed practical nurse in the State of Ohio on January 31, 2012.
Alicia M. Conant, L.P.N. Page 3 3. Item 4. of the January 2012 Consent Agreement states, Within ninety (90) days from the effective date of this Consent Agreement, MS. CONANT 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 other comparable courses approved in advance by the Board, taken subsequent to the effective date of this Consent Agreement: fifteen (15) hours of chemical dependency. Despite this provision, as of July 2, 2012, you have failed to submit to the Board satisfactory documentation of successful completion of fifteen (15) hours of chemical dependency. 4. Item 7. of the January 2012 Consent Agreement states, Within sixty (60) days of the effective date of this Consent Agreement and continuing throughout the probationary period, MS. CONANT shall begin submitting, at her expense and on the day selected, 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. 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. CONANT shall be negative, except for substances prescribed, administered, or dispensed to her by another so authorized by law who has full knowledge of MS. CONANTs history of chemical use. Despite this provision, on the following dates, you failed to call Firstlab, the Boards random drug/alcohol screen program administrator, to determine if you had been selected to provide a urine specimen: April 16, 2012; April 19-20, 2012; April 22, 2012; April 24-26, 2012; April 28-30, 2012; May 3-4, 2012; May 6, 2012; May 8-10, 2012; May 12-13, 2012; May 15-31, 2012; and June 1-11, 2012. Furthermore, on the following dates, you were selected to provide a urine specimen for analysis and failed to do so: March 26, 2012; April 5, 2012; April 25, 2012; May 9, 2012; May 24, 2012; and June 4, 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.
Alicia M. Conant, L.P.N. Page 4 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,
Case #11-002906

17 South IIigh Strcet, Suite 400
a
www.n~~rsi~~phio.gov
(614) 466-1947
Colmnbus, Ohio 43215-7410
CONSENT AGREEMENT BETWEEN ALICIA M. CONANT, L.P.N. APPLICANT AND OHIO BOARD OF NURSING
This Consent Agreement is entered into by and between ALICIA M. CONANT, L.P.N. APPLICANT (MS. CONANT) 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.
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)(5), ORC, authorizes the Board to deny a license or otherwise 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, violating any municipal, state, county, or federal drug law. On or about May 21,201 1, MS. CONANT submitted to the Board an Application for Licensure by Examination to Practice in Ohio as a Licensed Practical Nurse.
B.
Alicia M. Conant, L.P.N. Applicant Page 2
C.
MS. CONANT knowingly and voluntarily admits that in Washington County, Ohio, she has two misdemeanor convictions. MS. CONANT was convicted of an alcohol-related OVI offense in 2009. Further, MS. CONANT was convicted of one (1) amended misdemeanor count of Menacing in 2008 that stemmed from a verbal dispute with another female adult.
In Preston County, West Virginia, MS. CONANT was convicted of one (1) misdemeanor count of Possession of Marijuana in 2009.
D.
In her statement to the Board, MS. CONANT expressed remorse for her earlier actions and reported that she is now more mature and on a better path.
E.
MS. CONANT was permitted to take the NCLEX-PN, and on or about November 17,2011, MS. CONANT passed the exam. 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. CONANT knowingly and voluntarily agrees with the Board to the following terms, conditions, and limitations: Upon meeting the requirements for licensure, MS. CONANT shall be granted a license to practice nursing as a licensed practical nurse in the State of Ohio. MS. CONANT'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 at least two (2)years:
1.
2.
MS. CONANT shall obey all federal, state, and local laws, and all laws and rules governing the practice of nursing in Ohio. MS. CONANT shall appear in person for interviews before the full Board or its designated representative as requested by the Board or its designee.
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, MS. CONANT agrees that she will submit a request to the Bureau of Criminal Identification and Investigation (BCII) to conduct a criminal records check of MS. CONANT, including a check of Federal Bureau of Investigation (FBI) records, and shall cause BCII to submit MS. CONANT's criminal records check reports to the Board. MS. CONANT agrees that a request for release
Alicia M. Conant, L.P.N. Applicant Page 3 from the probationary 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 Hours

4.
Within ninety (90) days from the effective date of this Consent Agreement, MS. CONANT 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 other comparable courses approved in advance by the Board, taken subsequent to the effective date of this Consent Agreement: fifteen (15) hours of chemical dependency.
Monitoring
5.
MS. CONANT 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. CONANT's history of chemical use. MS. CONANT shall self-administer prescribed drugs only in the manner prescribed. MS. CONANT shall abstain completely from the use of alcohol, if recommended by a chemical dependency professional, as referenced in Paragraph 8. below. Within sixty (60) days of the effective date of this Consent Agreement and continuing throughout the probationary period, MS. CONANT shall begin submitting, at her expense and on the day selected, breathe, hair, blood or urine specimens for drug andlor 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. CONANT shall be negative, except for substances prescribed, administered, or dispensed to her by another so authorized by law who has full knowledge of MS. CONANT's history of chemical use. Prior to working as a nurse, MS. CONANT shall, at her own expense, obtain a chemical dependency evaluation by a Board approved chemical dependency professional and shall provide the
Alicia M. Conant, L.P.N. Applicant Page 4 Board with complete docu~nentationof this evaluation. Prior to the evaluation, MS. CONANT shall provide the chemical dependency professional with a copy of this Consent Agreement. Further, MS. CONANT 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. CONANT's license to practice, and a statement as to whether MS. CONANT is capable of practicing nursing according to acceptable and prevailing standards of safe nursing care.
MS. CONANT 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. CONANT 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. CONANT's license 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, MS. CONANT 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. CONANT 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. CONANT 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. CONANT throughout the duration of this Consent Agreement.
Within twenty-four (24) hours of release from hospitalization or medical treatment, MS. CONANT shall notify the Board of any and all medication(s) or prescription(s) received.
11.
12.
13.
Prior to accepting employment as a nurse, each time with every employer, MS. CONANT shall notify the Board of the name and address of the employer in writing.
14.
MS. CONANT 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. CONANT 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 1,2012 or within thirty (30) days of accepting nursing employment. MS. CONANT 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.
MS. CONANT shall report to the Board, in writing, any violation of this Consent Agreement within thirty (30) days of the occurrence of the violation. MS. CONANT shall sign release of information forms allowing health professionals and other organizations to submit the requested documentation directly to the Board. MS. CONANT 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. CONANT 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. CONANT 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. CONANT 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.
16.
17.
18.
19.
20.
21.
MS. CONANT shall verify that the reports and documentation required by this Consent Agreement are received in the Board office. MS. CONANT 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.
Temporarv Practice Restrictions MS. CONANT shall not practice nursing as 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. CONANT to provide nursing services for fees, compensation, or other consideration or as a volunteer. MS. CONANT 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. CONANT agrees that her license to practice nursing as a licensed practical nurse will be automatically suspended if it appears to the Board that MS. CONANT has violated or breached any terms or conditions of the Consent Agreement. Following the automatic suspension, the Board shall notify MS. CONANT via certified mail of the specific nature of the charges and automatic suspension of her license. Upon receipt of this notice, MS. CONANT 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. CONANT 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.

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. CONANT and the Board.
WASH ST COMM C O L L
Alicia M. Conant, L.P.N. Applicant Page 7 The Board may only alter the probationary period imposed by this Consent Agreement if: (1) the Board determines that MS. CONANT has complied with all aspects of this Consent Agreement: and ( 2 ) the Board determines that MS. CONANT is able to practice according to acceptable and prevailing standards of safe nursing care without Board monitoring, based upon an interview with MS. CONANT and review of the reports as required herein. Any period during which MS. CONANT 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/LIABnXTY RELEASE
MS. CONANT 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. CONANT waives all of her rights under Chapter 119, ORC, as they relatc to matters that are the subject of this Consent Agreement. MS. CONANT 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 Adminiskative Procedures Act, Chapter 119, ORC.
EFFECTIVE DATE MS. CONANT understands that this Consent Agreement is subject to ratification by the Board prior to signature by the Board President and shall become effective upon ihe last date of signature below.
[ \ - P B . APPLICANT ALICIA M. CONAI?IT,L

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Case #12-002665
July 27, 2012

Tracy Ann Conley, R.N. 4355 Wayne-Madison Road Trenton, Ohio 45067 and 5018 Trenton Franklin Road Middletown, Ohio 45044 Dear Ms. Conley: 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 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 22, 2011, in Butler County Court of Common Pleas Case Number CR2011-01-0042, you pled guilty to one (1) count of Failure to Provide Notice of Change of Address or Place of Employment, a felony of the fourth degree, in violation of Section 2950.05(A), ORC. The acts underlying this case occurred on or about October 31, 2010, through December 9, 2010, and involve you failing to provide notice of change of address of your residence, school or institution of higher learning, or place of employment as required due to your conviction for Attempted Unlawful Sexual Conduct. 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. 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
Tracy Ann Conley, R.N. Page 2 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.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 registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely,
Judith A. Church, R.N., C.N.P. Supervising Board Member Certified Mail Receipt No. 7012 1010 0002 4225 1787 Second Certified Mail Receipt No. 7012 1010 0002 4225 1794 cc: Henry G. Appel, Assistant Attorney General
Case #12-000890
July 27, 2012

Christina Faye Cornelia, R.N. 143 Village LN Wheeling, WV 26003 Dear Ms. Cornelia: 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 application to reactivate or reinstate your license to practice, in Ohio, as a registered nurse; 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. You license to practice nursing as a registered nurse in the State of Ohio has been inactive since on or about September 2, 2009. In February 2012 you submitted an application to the Board to reactivate your license. On or about June 23, 2011, the State of West Virginia Board of Examiners for Registered Professional Nurses (West Virginia Board) issued a letter and informed you that your license to practice as a registered professional nurse in West Virginia was suspended (West Virginia 2011 Letter). A copy of the West Virginia Board 2011 Letter, along with the attachment are attached hereto and incorporated herein.
Section 4723.28(B)(1), ORC, authorizes the Board to deny a license or otherwise 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.
Christina Faye Cornelia, 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, 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 allegations set forth in this Notice of Opportunity for Hearing, deny or permanently deny your application to reactivate or reinstate your license to practice in Ohio as a registered nurse; 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,
Laura S. Rhodes, M.S.N., R.N Executive Director
TELEPHONE
(304) 558-3596
email: rnboard@wv.gov web address: www.wvrnboard.com
FAX (304) 558-3666
STATE OF WEST VIRGINIA
BOARD OF EXAMlNERS FOR REGISTERED PROFESSIONAL NURSES 101 Dee Drive, Suite 102 Charleston. WV 25311-1620
April 23, 2012 Ohio Buard of Nursing Compliance Unit Attention: Rose Ferguson 17 South High Street, Suite 400 Columbus. OH 43215
1, ALICE R FAUCETT, JD, 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 Christina Cornelia, registered professional nurse, license number 67633 are true and correct copies of said documents as they appear among the files and records of this office. Witness my hand and seal of the Board of Nursing this 23rdday of April, 2012.
General counsel and Director of Discipline
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STATE OF WEST VIRGINIA BOARD OF EXAMINERS FOR REGISTERED PROFESSiONAL NURSES 101 Dee Drive, Suite 102 Charleston, WV 2531 I;? 620
June 23,201 1 CHRISTINA FAYE CORNELIA 251 CLEARVIEW AVENUE WHEELING WV 26003Re: Suspension License No. 67633
Dear Ms. CORNELIA: This letter is to inform you.your license to practice registered professional nursing is SUSPENDED. Return the license presently in your possession to this office immediately in the envelope enclosed. Records contained at the Board office indicate you are noncompliantwith the lmpaired Nurse Treatment Program contract signed into effect on December 6, 2010. Specifically, you failed to call the Board's drug screening program daily and you failed to submit evidence of attending monthly counseling as required in the contract. Therefore you have violated your contract. Your license is SUSPENDED and will be reported as such upon inquiry to this office. You may not practice as a registered professional nurse in the State of West Virginia without a valid active license to do so. Refer to the section Violation of Terms found on page six (6) of the Impaired Nurse Program Contract for information regarding the reinstatement of your license. Should you have any questions or require further information please contact me at this office. Should you have any questions or desire further information please contact this office and speak with me. For the Board,
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~au& Skidmore Rhodes, RN, MSN Executive Director xc: file
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WEST VIRGINIA STATE BOARD OF EXAMINERS FOR REGISTERED PROFESSIONAL NURSES IMPAIRED NURSE PROGRAM CONTRACT
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In the Matter of CHRISTINA FAYE CORNELIA

License No. 67633
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Comes now Christina Fave Cornelia ("Licensee"), and the West Virginia Board of Examiners for Registered Professional Nurses ("Board"), through its lmpaired Nurse Program Committee (INPC), for the purpose of allowing Licensee the opportunity of participating in the lmpaired Nurse Treatment Program (Program) through this contract in lieu of disciplinary action being taken against Licensee's registered nursing license pursuant to the authority of W. Va. Code $30-7-1 1 and specifically defined in 19 CSR 9 section 6. As reflected in this document, Licensee has admitted to the stipulations set forth herein. In offering this proposal for settlement of the complaint against the above stated license, Licensee acknowledges that there has been a violation of one or more of the provisions contained in W. Va. Code $ 30-7-11, which permits the Board to take disciplinary action against the license. Licensee also acknowledges that if this Contract is violated, the license will be automatically suspended and other appropriate disciplinary action taken by the Board to allow for the reinstatement of Licensee's license. STIPULATIONS
1. West Virginia.
11.
Licensee is licensed as a registered professional nurse in the state of Licensee admits to the abuse of the following drug(s) Alcohol.
Licensee acknowledges engaging in conduct in violation of West Ill. Virginia Code $ 30-7-11 (d) and (0,which state that the licensee may be disciplined if he or she "(d) [i]s habitually intemperate or is addicted to the use of habit-forming drugs; or . . . (f) [i]s guilty of conduct derogatory to the morals or standing of the profession of registered nursing". CONCLUSIONS OF CAW The West Virginia Board of Examiners for Registered Professional Nurses concludes that the stipulations support the sanction of disciplinary action pursuant to West pertaining to the practice of registered professional nursing. Virginia Code $ 30-7-1
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Impaired Nurse Program Contract
Specifically, the stipulations support sanctions under the following sections of the West Virginia Code: West Virginia Code 5 30-7-11(d), which states that a licensee a. maybe disciplined upon proof that he or she "[ils habitually intemperate or is addicted to the use of habit-forming drugs", and West Virainia Code 6 30-7-11(fl, which states that a licensee may be b.' oo il ~ disciplined ~ ~ o n " ~ rthatfheor she " [ i j ~ ' ~ u oftconduct derogatory to the mbra~s or standing of the profession of registered nursing".
CONSENT
Licensee, by signing this document, agrees to the following: 1. Licensee acknowledges awareness of the option to retain legal counsel and to be represented by legal counsel at a formal hearing before the Board. Licensee intelligently and voluntarily waives the right to a formal hearing 2. before the Board in this matter, and accepts the terms and conditions set forth herein in lieu of disciplinary action being taken against their license. Licensee acknowledges full awareness that without licensee's consent, no 3. legal action can be taken against the license by this Board, except pursuant to West and relevant rules. Virginia Code $ 30-7-1
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Licensee enters this contract freely and voluntarily and not under duress, 4. restraint or compulsion. Licensee agrees that the Board may investigatelicensee's background at any 5. time during the term of this contract.
ORDER
On the basis of the foregoing, the Board hereby ORDERS that license number , issued to Licensee, be under the following terms and 67633 year(s) from the date of execution of this contract. The conditions for a period of 3 computation of such period is to begin on the date on which notice is received in the office of the Board that Licensee is employed as a registered professional nurse and shall run only during such time that Licensee 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. Licensee shall also pay administrative costs in the amount of three thousand dollars ($3000.00) To be accepted in and remain in the impaired nurse program, regardless of employment status, Licensee shall meet the following conditions:
Terms:
1.
2.
Notwork at Nursing Registry, Temporary Nursing Agency, Home Health Care Agency, Private Duty Nurse Not work in an autonomous or supervisory nursing position. Shall work only under the direct supervision of a registered professional nurse in a structured setting throughout the term of this contract. Such supervising registered professional nurse must, at the time of said supervision, hold an active, unencumbered West Virginia license. Shall inform the Board in writing within ten (10) days of the date they assume the practice of registered professional nursing, or any employment in the health care field, in the State of West Virginia and shall includethe name, address, and telephone number of her employer. They shall provide in writing the name of her immediate registered professional nurse supervisor. They shall inform the Board of any interruption in nursing practice or change in employment within ten (10) days of such interruption or change.
,
Shall immediatelyinformtheir nursingemployer, any prospective nursing employer, and the director of any nursing education program in which they enroll orteach, that they are under contract with the Board and shall provide a complete copy of this contract to their employer(s). The Board may provide their employer(s) with a copy of this contract and may communicate with their empioyer(s). Shall, within ten (10) days of employment or continuation of practice, cause their employer or immediate registered professional nurse supervisor to notify the Board, in writing, of the employer's or supervisor's receipt of a copy of this contract. Shall further cause their employer or supervisor to submit monthly reports to the Boarddescribing their job performance, attendance, attitude, and other work behaviors during the first year of the contract and if their progress is satisfactory to the Board, quarterly thereafter.
6.
Shall submit documentation of fifteen (15) contact hours of continuing education in depression each year during the length of this contract in addition to those already required by law. Shall report in person for appointment with the Board staff upon request. Shall not handle nor administer narcoticor psychotropicmedications, nor have access to locked or other storage areas in which such medications are kept. Six (6) months before the end of this contract Cornelia may petition for this requirement to be lifted, providedthe Work Performance Reports from Cornelia's supervisor have been satisfactory. Shall submit to unannounced, witnessed drug-screening tests. Said tests shall be on demand and to the specifications of the Board and at licensee's expense. Licensee shall call the Board's drug screening company DAILY between the hours of 5:00 a.m. through 2:30 p.m. to see if helshe is selected to test. Receipt of a positive drug screen andlor not calling the drug screening program daily within the specified time frame is deemed to be a violation of this agreement, and shall result in immediate suspension of licensee's license. Eating products containing poppy seeds will not constitute as an accepted reason for having a positive screen for opioids. Licensee shall not consume tonic water, quinine water, hemp tea or other products containing substances that trigger a positive drug screen. Shall abstain from the use of alcohol and limit their use of drugs to those prescribed for a legitimate purpose by a physician, dentist or nurse practitioner duly licensed in the State of West Virginia. Shall provide a copy of this contract to any prescribing physician, dentist or nurse practitioner. Shall cause their physician, dentist or nurse practitioner to notify the Board in writing of any medicationsldrugs prescribed and the condition for which said drug(s) has been prescribed. Agrees that, if helshe accepts a prescription for narcotic or psychotropic drugs, the Board may impose additional terms. Shall coordinate any health care services they requirewith one physician or registered nurse practitioner, who shall be informed of any services or prescriptions sought or obtained by any physician, dentist or nurse practitioner. Shall provide this individual, who serves as her point of contact for health care needs, with a copy of this contract.
12.
Shall execute a release to permit the Board to obtain medical or other health care records, which may be requested at any time while their license is under this contract, regarding their physical or mental health and any treatment rendered. Shall annually submit to the Board a written personal statement regarding their progress. The statement shall be due at the end of the first year and in each subsequent year during the month in which this contract is accepted by the Board. Shall participate in a structured aftercare program, with a certified addictions counselor approved by the Board and have a report of completion of this program submitted to the Board within fifteen (15) days of signing this contract or after completion of the program whichever comes first. Shall meet with a certified addictions counselor at least monthly and shall require the certified addictions counselor to make a monthly report to the Board about their progress. Shall visit their approved treatment time(s) per month during the term of this contract. provider at least 1 This requirement may be modified upon request to the Board by the certified addictions counselor. Shall meet with a psychiatristfor medication management and follow up with her Primary Care Provider for any medical issues. Shall submit or have submitted to the Board evidence of participation in 12-Step meetings. Shall attend at least three (3) 12-Step meetings per week where at least one of those meetings is for the purpose of working on the 12-Steps. Written evidence of participation in meetings shall be submitted to the Board on or before the fifth day of each month. This requirement may be modified upon request to the Board by the certified addictions counselor. Shall maintain a current and active license in the State of West Virginia. Shall not allow license to lapse or be placed on an inactive status. Shall cause monthly reports to be submitted to the Board by any treating physician andlor psychiatrist relating to medication management, dosage adjustments and medication response.

Please list any other applicable conditions:
Shall provide to the Board copies of all prescription(s) filled throuahout the term of this aareement within 24 hours of havina said prescription(s) filled.
Violation of Terms:
1. Any deviation from these requirements without priorwritten consent of the Board shall constitute a violation of this Contract, and result in immediate suspension of licensee's license. 2. The Board shall immediately notify Licensee via certified mail of the specific nature of the charges, and the suspension of their license. a. Licensee may request to be reinstated to a probationary license through a contract, which is disciplinary action. The Board is not bound to comply with this request. b. If Licensee's license is not reinstated to a probationary license, which is disciplinary action, Licensee shall be notified in writing. Licensee may request a hearing to seek reinstatement. If Licensee requests a hearing following suspension for violation of this contract and does not prevail, the cost incurred in holding such hearing shall be borne by Licensee. If Licensee 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 Licensee in bringing the matter to hearing. c. The Board may schedule a hearing on its own initiative for the purpose of allowing the Board opportunity for considering further suspension or revocation of Licensee's license. Said hearing shall be scheduled in accordance with the provisions of West Virginia Code $30-1-8 and 30-7-1 et. sea. The Board shall bear the cost if it should seek a hearing following suspension of Licensee's probationary license for violation of this contract. 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 Licensee in bringing the matter to hearing.
Petition for Termination of Contract: 3. Following the term of this contract, Licensee may petition to appear before the INPC and submit satisfactory evidence of present ability to safely engage in the practice
Impaired Nurse Program Contract of registered professional nursing and have the provisions of this contract lifted. Evidence in support of this request shall include: Letter of reference from a physician andlor therapist involved in a. Licensee's aftercare; b. c. d. Letter of reference from Licensee's employer, if employed; Letter from Licensee outlining future plans; and Payment of all administrative costs.
However, the terms of this contract shall remain in effect and subject to yearly review and appropriate revision by the tNPC until such time as Licensee license is fully reinstated by the INPC. .
Licensee
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Impaired Nurse Program Committee
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Case #11-003762
July 27, 2012

Daphne Counts, L.P.N., R.N. 3089 Karl Rd Columbus, OH 43224 Dear Ms. Counts: 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 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 November 30, 2011, in the United States District Court for the Southern District of Ohio, Eastern Division, Case No. CR2-11-183, you pled guilty to one (1) count of Health Care False Statement, in violation of 18 United States Code 1035 and 2. The events underlying your conviction noted above occurred on or about October 5, 2010, in the Southern District of Ohio, and consist of you submitting false billing information regarding the hours of nursing services provided. 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. 2. On or about October 14, 2010, met with a special agent from the Federal Bureau of Investigation and a special agent from the Ohio Attorney Generals Office, Medicaid Fraud Control Unit and admitted that in 2010, while working as a home health care nurse through or with Damal Home Care Services, Inc., you had submitted false nursing visit forms for nursing services/visits that you didnt provide that resulted in fraudulent billings. You further indicated that you paid patients or their family members $70 to $300 per week to sign fraudulent nursing forms.
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
Daphne Counts, L.P.N., R.N. Page 2 discipline a licensee for violation of Chapter 4723, ORC, or any rules adopted under it. Specifically, Rule 4723-4-06(G), Ohio Administrative Code, 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 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@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 the Notice of Opportunity for Hearing, deny, revoke, permanently revoke, suspend or place restrictions on your licenses to practice nursing as a 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,
Case #12-000201
July 27, 2012

Cathy Jo Cummins (fka Cathy Jo Thomas), L.P.N. 813 Vienna Rd Niles, Ohio 44446 Dear Ms. Cummins: 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 May 14, 2012, in Warren Municipal Court Case No. 2012CRA00531, you pled no contest to and were found guilty of one (1) amended count of Theft, a first-degree misdemeanor, in violation of Section 545.05, Warren (Ohio) Municipal Code. The acts underlying this conviction involve you stealing from St. Joseph Hospital, on or about December 19, 2011, where you were employed as a licensed practical nurse.
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. 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.
Cathy Jo Cummins (fka Cathy Jo Thomas), 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, 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 the 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,
Case #12-002588
July 27, 2012

David P. Daigle 356 Durling Drive Wadsworth, Ohio 44281 Dear Mr. Daigle: On or about June 26, 2012, 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 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 29, 2010, in Medina County Court of Common Pleas Case Number 10CR0414, you pled guilty to and were subsequently found guilty of one (1) count of Trafficking in Drugs (Oxycodone, Sch. II, in Vicinity of a School), a felony of the third degree, in violation of Section 2925.03(A)(1)(C)(1)(b), ORC; and one (1) count of Trafficking in Drugs (Methadone, Sch. II), a felony of the fourth degree, in violation of 2925.03(A)(1)(C)(1)(a), ORC. The acts underlying this case occurred on or about March 19, 2009, and March 12, 2009, and involve you selling or offering to sell Oxycodone, in the vicinity of a school, and Methadone. 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. Accordingly, the Board is authorized to impose one or more of the sanctions as cited in Section 4723.28, ORC.
David P. Daigle 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@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,
Case #12-002588
June 26, 2012

David P. Daigle, L.P.N. 356 Durling Drive Wadsworth, Ohio 44281 Dear Mr. Daigle: 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 November 29, 2010, in Medina County Court of Common Pleas Case Number 10CR0414, you pled guilty to and were subsequently found guilty of one (1) count of Trafficking in Drugs (Oxycodone, Sch. II, in Vicinity of a School), a felony of the third degree, in violation of Section 2925.03(A)(1)(C)(1)(b), ORC; and one (1) count of Trafficking in Drugs (Methadone, Sch. II), a felony of the fourth degree, in violation of 2925.03(A)(1)(C)(1)(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. Trafficking in Drugs (Oxycodone, Sch. II, in Vicinity of a School), a felony of the third degree, in violation of Section 2925.03(A)(1)(C)(1)(b), ORC; and of Trafficking in Drugs (Methadone, Sch. II), a felony of the fourth degree, in violation of 2925.03(A)(1)(C)(1)(a), ORC, constitute felony drug abuse offenses as defined in Section 2925.01, ORC.
David P. Daigle, 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, PN-142565, 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 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,
Cases #10-4727; 10-4653
July 27, 2012

Casey Leigh Dennis, L.P.N. 580 Franklin Circle Chillicothe, Ohio 45601 Dear Ms. Dennis: 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 November 20, 2010, you were interviewed by law enforcement regarding discrepancies in your withdrawal and documentation of drugs, in 2010, while working as a licensed practical nurse for the Adena Health System (Greenfield Medical Center, Greenfield and Adena Regional Medical Center, Chillicothe) (Adena). You stated the following: (a) You have an addiction issue related to Oxycodone (Percocet) dating back approximately two (2) years, and you obtained the Percocet in amounts up to 5-10 tablets per day, from a friend; (b) You diverted Percocet from Adena for selfadministration; (c) At times you did not divert Percocet but failed to document the administration of the drug to patients in their medical record.
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)(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)(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(E), 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. Accordingly, the Board is authorized to impose one or more of the sanctions cited in Section 4723.28, ORC.
Casey Leigh Dennis, 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, OH 432157410 or, 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,
Case# 12-002732
July 27, 2012

Angela L. Doepke, R.N. 7516 US Hwy 42 Apt. 6 Florence, KY 41042 Dear Ms. Doepke: You are hereby notified that 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. Under the September 2011 Consent Agreement, your license to practice as a registered nurse was suspended with the suspension stayed subject to probationary terms, conditions, and limitations for a minimum period of at least one (1) year. A. Item 4. of the September 2011 Consent Agreement states, Within ninety (90) days from the effective date of this Consent Agreement, MS. DOEPKE shall, in addition to the requirements of licensure renewal, successfully complete and submit satisfactory documentation of successful completion of the following continuing education, or other comparable courses approved in advance by the Board, taken subsequent to the effective date of this Consent Agreement: 5.4 hours of Professional Accountability and Legal Liability for Nurses and 30 hours of Critical Thinking in Nursing. Despite this provision, as of July 2, 2012, you have not submitted documentation to the Board of completing 5.4 hours of Professional Accountability and Legal Liability for Nurses and 30 hours of Critical Thinking in Nursing. Your Monitoring Agent mailed a letter to you on or about January 30, 2012 warning you that the documentation was not received. 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 16. of the September 2011 Consent Agreement states, MS. DOEPKE 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. Despite this provision, your Monitoring Agent mailed a letter to you on or about January 30, 2012 warning you that she had been unable to reach you by telephone.
Angela L. Doepke, R.N. Page 2 You did not respond to this letter, nor did you provide any information regarding a change in your telephone number, until you sent an email on or about June 7, 2012 to the Board stating you did not have a telephone number for several weeks and had a new telephone number. 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 2011 Consent Agreement, you are hereby notified that it appears to the Board that you have violated Items 4. and 16. of the September 2011 Consent Agreement. YOU ARE FURTHER NOTIFIED THAT YOUR LICENSE TO PRACTICE NURSING AS A REGISTERED NURSE, RN #375152 IS HEREBY 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 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 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. Under the September 2011 Consent Agreement, your license to practice as a registered nurse was suspended with the suspension stayed subject to probationary terms, conditions, and limitations for a minimum period of at least one (1) year. 2. Item 4. of the September 2011 Consent Agreement states, Within ninety (90) days from the effective date of this Consent Agreement, MS. DOEPKE shall, in addition to the requirements of licensure renewal, successfully complete and submit satisfactory documentation of successful completion of the following continuing education, or other comparable courses approved in advance by the Board, taken subsequent to the effective date of this Consent Agreement: 5.4 hours of Professional Accountability and Legal Liability for Nurses and 30 hours of Critical Thinking in Nursing. Despite this provision, as of July 2, 2012, you have not submitted documentation to the Board of completing 5.4 hours of Professional Accountability and Legal Liability for Nurses and 30 hours of Critical Thinking in Nursing. Your Monitoring Agent mailed a letter to you on or about January 30, 2012 warning you that the documentation was not received.
Angela L. Doepke, R.N. Page 3 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 16. of the September 2011 Consent Agreement states, MS. DOEPKE 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. Despite this provision, your Monitoring Agent mailed a letter to you on or about January 30, 2012 warning you that she had been unable to reach you by telephone. You did not respond to this letter, nor did you provide any information regarding a change in your telephone number, until you sent an email on or about June 7, 2012 to the Board stating you did not have a telephone number for several weeks and had a new telephone number. 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 email address, hearing@nursing.ohio.gov.
Angela L. Doepke, R.N. Page 4 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,
Case #2011-001093

17 South Hlgh St~ect, Sultc 400
www.nursing.ohio.gov Columbus, Ohio 43215-7410 * (614)466-3947
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CONSENT AGREEMENT BETWEEN ANGELA L. DOEPKE, R.N. APPLICANT AND OHIO BOARD OF NURSING
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This Consent Agreement is entered into by and between ANGELA L . DOEPKE, R.N. APPLICANT (MS. DOEPKE) 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. DOEPKE 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.
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. On or about March 7,201 1, MS. DOEPKE submitted to the Board an Application for Licensure by Examination to Practice in Ohio as a Registered Nurse.
B.
Angela L. Doepke, R.N. Applicant Page 2 C.
MS. DOEPKE knowingly and voluntarily admits that, in April 2009, in Hamilton County Municipal Court (Ohio), she was convicted of misdemeanor Theft resulting from a retail-shoplifting incident involving designer merchandise and high-end skin care products.
In her statement to the Board, MS. DOEPKE reported that she is extremely remorseful and accepts full responsibility for her prior actions. MS. DOEPKE further reported that she has learned a valuable lesson and has since made positive changes in her life.
D.
E.
MS. DOEPKE was permitted to take the NCLEX-RN, and on or about July 25,201 I , MS. DOEPKE passed the exam.
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. DOEPKE knowingly and voluntarily agrees with the Board to the following terms, conditions, and limitations: Upon meeting the requirements for licensure, MS. DOEPKE shall be granted a license to practice nursing as a registered nurse in the State of Ohio. MS. DOEPKE'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 limitationsfor a minimum period of at least one ( I ) year:
1.
MS. DOEPKE shall obey all federal, state, and local laws, and all laws and rules governing the practice of nursing in Ohio. MS. DOEPKE shall appear in person for interviews before the full Board or its designated representative as requested by the Board or its designee.
2.

3.
Within ninety (90) days prior to submitting a request for release from the probationary terms, conditions and limitations of this Consent Agreement, MS. DOEPKE agrees that she will submit a request to the Bureau of Criminal Identification and Investigation (BCII) to conduct a criminal records check of MS. DOEPKE, including a check of Federal Bureau of Investigation (FBI) records, and shall cause BCII to submit MS. DOEPKE's criminal records check reports to the Board. MS. DOEPKE agrees that a request for release from the probationary 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.
Angela L. Doepke, R.N. Applicant Page 3
Continuing Education I-Tours

4.
Within ninety (90) days from the effective date of this Consent Agreement, MS. DOEPKE 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 other comparable courses approved in advance by the Board, taken subsequent to the effective date of this Consent Agreement: 5.4 hours of Professional Accountability and Legal Liability for Nurses and 30 hours of Critical Thinking in Nursing.
Psychiatric Evaluation & Treatment

5.
If the Board or its designee requests a psychiatric evaluation and within ninety (90) days of such a request, MS. DOEPKE shall, at her
own expense, obtain a psychiatric evaluation from a Board approved psychiatrist and shall provide the Board with complete documentation of this evaluaLion. Prior to the evaluation, MS. DOEPKE shall provide the evaluating psychiatrist with a copy of this Consent Agreement. Further, MS. DOEPKE 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. DOEPKE's license, and a statement as to whether MS. DOEPKE is capable of practicing nursing according to acceptable and prevailing standards of safe nursing care.
6.
If a psychiatric evaluation is requested, MS. DOEPKE shall provide the Board with satisfactory documentation of compliance with all aspects of the treatment plan developed by the psychiatrist until released. Further, MS. DOEPKE 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. DOEPKE's license and that the terms, conditions, and limitations may be incorporated in an addendum to this Consent Agreement.
7.
8.
Prior to accepting employment as a nurse, each time with every employer, MS. DOEPKE shall notify the Board.
MS. DOEPKE 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.
DOEPKE 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 November 1, 2011 or within thirty (30) days of accepting nursing employment. MS. DOEPKE 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.
9.
MS. DOEPKE shall report to the Board, in writing, any violation of this Consent Agreement within thirty (30) days of the occurrence of the violation. MS. DOEPKE shall sign release of information forms allowing health professionals and other organizations to submit the requested documentation directly to the Board. MS. DOEPKE 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. DOEPKE 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. DOEPKE 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. DOEPKE 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. DOEPKE shall verify that the reports and documentation required by this Consent Agreement are received in the Board office. MS. DOEPKE 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.
10.
11.
12.
13.
14.
15. 16.
Temaorarv Practice Restrictions MS. DOEPKE 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. DOEPKE to provide nursing services for fees, compensation, or other consideration or as a volunteer. MS. DOEPKE 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. DOEPKE agrees that her license to practice nursing as a registered nurse will be automatically suspended if it appears to the Board that MS. DOEPKE has violated or breached any terms or conditions of the Consent Agreement. Following the automatic suspension, the Board shall notify MS. DOEPKE via certified mail of the specific nature of the charges and automatic suspension of her license. Upon receipt of this notice, MS. DOEPKE 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. DOEPKE 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, hut not limited to, alleged violations of the laws of Ohio occurring before the effective date of this Consent Agreement.

The terms, limitations, and conditions, of this Consent Agreement, may he modified or terminated, in writing, at any time upon the agreement of both MS. DOEPKE and the Board. The Board may only alter the probationary period imposed by this Consent Agreement if: (1) the Board determines that MS. DOEPKE has complied with all aspects of this Consent Agreement; and (2) the Board determines that MS. DOEPKE is able to practice according to acceptable and prevailing standards of safe nursing care without Board monitoring, based upon an interview with MS. DOEPKE and review of the reports as required herein. Any period during which MS. DOEPKE does not work in a position for
Angela L. Doepke, R.N. Applicant Page 6 which a nursing license is required shall not count toward fulfilling the probationary period imposed by this Consent Agreement.
MS. DOEPKE 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. DOEPKE waives all of her rights under Chapter 119, ORC, as they relate to matters that are the subject of this Consent Agreement. MS. DOEPKE 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.
EFFECTIVE DATE MS. DOEPKE 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.
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Case #11-003679
July 27, 2012

Andrew Leroy Eade, R.N. 584 Colonial Drive Painesville, Ohio 44077 Dear Mr. Eade: 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 June 4, 2012, in Lake County Court of Common Pleas Case Number 11-CR-000559, you pled guilty to one (1) count of Illegal Processing of Drug Documents, a felony of the fourth degree, in violation of Section 2925.23(B)(1), ORC; one (1) count of Deception to Obtain a Dangerous Drug, a felony of the fourth degree, in violation of Section 2925.22 (A), ORC; three (3) counts of Deception to Obtain a Dangerous Drug, felonies of the fifth degree, in violation of Section 2925.22(A), ORC; and one (1) count of Illegal Processing of Drug Documents, a felony of the fifth degree, in violation of Section 2925.23(B)(2), 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. Illegal Processing of Drug Documents, a felony of the fourth degree, in violation of Section 2925.23(B)(1), ORC; Deception to Obtain a Dangerous Drug, a felony of the fourth degree, in violation of Section 2925.22 (A), ORC; Deception to Obtain a Dangerous Drug, a felony of the fifth degree, in violation of Section 2925.22(A), ORC; and Illegal Processing of Drug
Andrew Leroy Eade, R.N. Page 2 Documents, a felony of the fifth degree, in violation of Section 2925.23(B)(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 REGISTERED NURSE, RN-272575, 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 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 4, 2012, in Lake County Court of Common Pleas Case Number 11-CR-000559, you pled guilty to one (1) count of Illegal Processing of Drug Documents, a felony of the fourth degree, in violation of Section 2925.23(B)(1), ORC; one (1) count of Deception to Obtain a Dangerous Drug, a felony of the fourth degree, in violation of Section 2925.22 (A), ORC; three (3) counts of Deception to Obtain a Dangerous Drug, felonies of the fifth degree, in violation of Section 2925.22(A), ORC; and one (1) count of Illegal Processing of Drug Documents, a felony of the fifth degree, in violation of Section 2925.23(B)(2), ORC, and were found eligible for Intervention in Lieu of Conviction. The acts underlying this case occurred on or about September 20, 2011, and involve you making, uttering, selling, or possessing a false or forged prescription for Percocet. Further acts underlying this case occurred in or between February through May 2011 and August through September 2011 and involve you using deception to procure the administration of a prescription for, or the dispensing of, dangerous drugs, to wit: Adderall, Albuterol, Provigil and Azithromycin. Further acts underlying this case occurred on or about September 20, 2011, and involve you making, uttering, selling, or possessing a false or forged uncompleted preprinted prescription blank used for writing a prescription. 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.
Andrew Leroy Eade, R.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 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,
Judith A. Church, R.N., C.N.P. Supervising Board Member Certified Mail Receipt No. 7012 1010 0002 4225 4733 Attorney Certified Mail Receipt 7012 1010 0002 4225 4740 cc: Henry G. Appel, Assistant Attorney General Brian R. Good, Esq.
Case# 12-001957
July 27, 2012

Leslie C. Eakle, L.P.N. 2020 Culver Avenue Kettering, Ohio 45420 Dear Ms. Eakle: You are hereby notified that, 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 upon meeting the requirements for renewal, your license to practice nursing as a licensed practical 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 at least three (3) years. Attached to and incorporated within the November 2011 Consent Agreement is a May 15, 2009 Consent Agreement (May 2009 Consent Agreement) and a September 19, 2008 Notice of Opportunity for Hearing (September 2008 Notice). A. Item 1. of the November 2011 Consent Agreement states, MS. EAKLE 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. 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)(1), 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 the board. Item 4. of the November 2011 Consent Agreement states, MS. EAKLE 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. EAKLEs history of chemical dependency and recovery status. MS. EAKLE shall self-administer prescribed drugs only in the manner prescribed. Item 6. of the November 2011 Consent Agreement states, Within sixty (60) days of the effective date of this Consent Agreement and continuing throughout the probationary period, MS. EAKLE shall continue to submit, at her expense and on the day selected, breathe, 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.
Leslie C. Eakle, R.N. Page 2 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. EAKLE shall be negative, except for substances prescribed, administered, or dispensed to her by another so authorized by law who has full knowledge of MS. EAKLEs history of chemical dependency and recovery status. Item 18. of the November 2011 Consent Agreement states, MS. EAKLE 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 these provisions, on the following dates, you provided urine specimens for analysis to Firstlab, the Boards random drug/alcohol screen program administrator, that tested positive for Codeine and Morphine, without legal, valid prescriptions: April 23, 2012; May 7, 2012; May 17, 2012; June 1, 2012; and June 13, 2012. In addition, on or about April 24, 2012, you reported during a telephone interview with your Board Monitoring Agent that on April 17, 2012, you called 911 due to falling through a glass table and cutting your wrist. You stated that were transported to the Kettering Medical Center Emergency Room (ER) and your treatment included a prescription for Vicodin. You subsequently submitted a prescription medication report to the Board dated April 26, 2012, signed with the name Balonier on the form and the following medications listed on the form: Morphine in ER; Percocet in ER; Vicodin; Keflex; and Bactrim. The Board verified with Kettering Police that they never received a 911 call from you on April 17, 2012. The Board also verified with Kettering Medical Center that you were not a patient on April 17, 2012. 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)(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(P)(1), 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 the board. 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. You failed to call Firstlab to determine if you had been selected to provide a urine specimen: March 2, 2012; April 8, 2012; June 2-3, 2012; June 8, 2012; and June 14-15, 2012.
Leslie C. Eakle, R.N. Page 3 C. On April 6, 2012, you were selected to provide a urine specimen for analysis and failed to do so. 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 1. of the November 2011 Consent Agreement states, MS. EAKLE shall obey all federal, state, and local laws, and all laws and rules governing the practice of nursing in Ohio. 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)(1), 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 the board. Item 10. of the November 2011 Consent Agreement states, Within sixty (60) days of the effective date of this Consent Agreement, MS. EAKLE shall provide a copy of this Consent Agreement, the attached May 2009 Consent Agreement, and the attached September 2008 Notice to all treating practitioners and shall provide to the Board a list of all treating practitioners, including addresses and telephone numbers. Further, MS. EAKLE shall be under a continuing duty to provide a copy of this Consent Agreement and the 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. Item 11. of the November 2011 Consent Agreement states, MS. EAKLE 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. EAKLE throughout the duration of this Consent Agreement. Item 18. of the November 2011 Consent Agreement states, MS. EAKLE 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 March 2, 2012, you reported in a telephone interview with your Board Monitoring Agent that Dr. Ronald Suprenant, an addiction specialist, was no longer one of your treating physicians and that you had not been prescribed Suboxone for some time. On June 13, 2012, the Board received documentation that you continue to attend appointments and continue to receive prescriptions for Suboxone from Dr. Suprenant. You have failed to submit to the Board an updated treating practitioner list to include Dr. Suprenant and you have failed to provide a copy of your November 2011 Consent Agreement to Dr. Suprenant. Furthermore, you have failed to have Dr. Suprenant submit a prescription medication report to the Board.
Leslie C. Eakle, R.N. Page 4 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)(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(P)(1), 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 the board. 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 7. of the November 2011 Consent Agreement states, MS. EAKLE shall continue to participate in psychotherapy and pharmacotherapy at intervals deemed appropriate by Dr. Patwa, or another psychiatrist approved in advance by the Board or its designee until released. MS. EAKLE shall have the psychiatrist submit written reports regarding MS. EAKLEs progress, status, and compliance with her treatment plan to the Board on a quarterly basis beginning January 1, 2012. MS. EAKLE shall provide the chemical dependency professional with a copy of this Consent Agreement, the attached May 2009 Consent Agreement, and the attached September 2008 Notice prior to December 23, 2011. MS. EAKLE shall inform the Board, in writing, within five (5) business days of discontinuing participation in psychotherapy, and prior to said discontinuation, shall inform the Board, in writing, of the name(s) of another psychiatrist(s) and intervals of treatment for approval by the Board or its designee. Despite this provision, you have failed to have Dr. Patwa or another psychiatrist approved in advanced by the Board submit a progress report to the Board since Dr. Patwas initial report dated February 28, 2012, was submitted. F. Item 12. of the November 2011 Consent Agreement states, Within twentyfour (24) hours of release from hospitalization or medical treatment, MS. EAKLE shall notify the Board of any and all medication(s) or prescription(s) received. Despite this provision, you were admitted to Southview Medical Center on or about May 14, 2012 and received treatment and medications including, but limited to Oxycontin. As of July 9, 2012, you have not notified the Board of medication and/or prescriptions received during that hospitalization. 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 November 2011 Consent Agreement, you are hereby notified that it appears to the Board that you have violated Items 1., 4., 6., 7., 10, 11., 12. and 18. of the November 2011 Consent Agreement.
Leslie C. Eakle, R.N. Page 5 YOU ARE FURTHER NOTIFIED THAT YOUR LICENSE TO PRACTICE NURSING AS A LICENSED PRACTICAL NURSE, PN-105799, 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 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 upon meeting the requirements for renewal, your license to practice nursing as a licensed practical 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 at least three (3) years. Attached to and incorporated within the November 2011 Consent Agreement is a May 15, 2009 Consent Agreement (May 2009 Consent Agreement) and a September 19, 2008 Notice of Opportunity for Hearing (September 2008 Notice. 2. Item 1. of the November 2011 Consent Agreement states, MS. EAKLE 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. 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)(1), 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 the board. Item 4. of the November 2011 Consent Agreement states, MS. EAKLE 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. EAKLEs history of chemical dependency and recovery status. MS. EAKLE shall self-administer prescribed drugs only in the manner prescribed. Item 6. of the November 2011 Consent Agreement states, Within sixty (60) days of the effective date of this Consent Agreement and continuing throughout the probationary period, MS. EAKLE shall continue to submit, at her expense and on the day selected,
Leslie C. Eakle, R.N. Page 6 breathe, 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. 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. EAKLE shall be negative, except for substances prescribed, administered, or dispensed to her by another so authorized by law who has full knowledge of MS. EAKLEs history of chemical dependency and recovery status. Item 18. of the November 2011 Consent Agreement states, MS. EAKLE 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 these provisions, on the following dates, you provided urine specimens for analysis to Firstlab, the Boards random drug/alcohol screen program administrator, that tested positive for Codeine and Morphine, without legal, valid prescriptions: April 23, 2012; May 7, 2012; May 17, 2012; June 1, 2012; and June 13, 2012. In addition, on or about April 24, 2012, you reported during a telephone interview with your Board Monitoring Agent that on April 17, 2012, you called 911 due to falling through a glass table and cutting your wrist. You stated that were transported to the Kettering Medical Center Emergency Room (ER) and your treatment included a prescription for Vicodin. You subsequently submitted a prescription medication report to the Board dated April 26, 2012, signed with the name Balonier on the form and the following medications listed on the form: Morphine in ER; Percocet in ER; Vicodin; Keflex; and Bactrim. The Board verified with Kettering Police that they never received a 911 call from you on April 17, 2012. The Board also verified with Kettering Medical Center that you were not a patient on April 17, 2012. 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)(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(P)(1), 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 the board. 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. You failed to call Firstlab to determine if you had been selected to provide a urine specimen: March 2, 2012; April 8, 2012; June 2-3, 2012; June 8, 2012; and June 14-15, 2012.
Leslie C. Eakle, R.N. Page 7 4. On April 6, 2012, you were selected to provide a urine specimen for analysis and failed to do so. 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 1. of the November 2011 Consent Agreement states, MS. EAKLE shall obey all federal, state, and local laws, and all laws and rules governing the practice of nursing in Ohio. 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)(1), 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 the board. Item 10. of the November 2011 Consent Agreement states, Within sixty (60) days of the effective date of this Consent Agreement, MS. EAKLE shall provide a copy of this Consent Agreement, the attached May 2009 Consent Agreement, and the attached September 2008 Notice to all treating practitioners and shall provide to the Board a list of all treating practitioners, including addresses and telephone numbers. Further, MS. EAKLE shall be under a continuing duty to provide a copy of this Consent Agreement and the 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. Item 11. of the November 2011 Consent Agreement states, MS. EAKLE 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. EAKLE throughout the duration of this Consent Agreement. Item 18. of the November 2011 Consent Agreement states, MS. EAKLE 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 March 2, 2012, you reported in a telephone interview with your Board Monitoring Agent that Dr. Ronald Suprenant, an addiction specialist, was no longer one of your treating physicians and that you had not been prescribed Suboxone for some time. On June 13, 2012, the Board received documentation that you continue to attend appointments and continue to receive prescriptions for Suboxone from Dr. Suprenant. You have failed to submit to the Board an updated treating practitioner list to include Dr. Suprenant and you have failed to provide a copy of your November 2011 Consent Agreement to Dr. Suprenant.
Leslie C. Eakle, R.N. Page 8 Furthermore, you have failed to have Dr. Suprenant submit a prescription medication report to the Board. 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)(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(P)(1), 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 the board. 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 7. of the November 2011 Consent Agreement states, MS. EAKLE shall continue to participate in psychotherapy and pharmacotherapy at intervals deemed appropriate by Dr. Patwa, or another psychiatrist approved in advance by the Board or its designee until released. MS. EAKLE shall have the psychiatrist submit written reports regarding MS. EAKLEs progress, status, and compliance with her treatment plan to the Board on a quarterly basis beginning January 1, 2012. MS. EAKLE shall provide the chemical dependency professional with a copy of this Consent Agreement, the attached May 2009 Consent Agreement, and the attached September 2008 Notice prior to December 23, 2011. MS. EAKLE shall inform the Board, in writing, within five (5) business days of discontinuing participation in psychotherapy, and prior to said discontinuation, shall inform the Board, in writing, of the name(s) of another psychiatrist(s) and intervals of treatment for approval by the Board or its designee. Despite this provision, you have failed to have Dr. Patwa or another psychiatrist approved in advanced by the Board submit a progress report to the Board since Dr. Patwas initial report dated February 28, 2012, was submitted. 7. Item 12. of the November 2011 Consent Agreement states, Within twentyfour (24) hours of release from hospitalization or medical treatment, MS. EAKLE shall notify the Board of any and all medication(s) or prescription(s) received. Despite this provision, you were admitted to Southview Medical Center on or about May 14, 2012 and received treatment and medications including, but limited to Oxycontin. As of July 9, 2012, you have not notified the Board of medication and/or prescriptions received during that hospitalization. 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.
Leslie C. Eakle, R.N. Page 9 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,
Case #11-3485

L7 Soutli High Slieel, Suite 400
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(614) 466-3947
REINSTATEMENT CONSENT AGREEMENT BETWEEN LESLIE C. EAKLE, L.P.N. AND OHIO BOARD OF NURSING
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This Consent Agreement is entered into by and between LESLIE C. EAKLE, L.P.N. (MS. EAKLE) 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. MS. EAKLE admits to violating Section 4723.28, ORC, as set forth in her May 15, 2009 Consent Agreement (May 2009 Consent Agreement) and in her September 19, 2008 Notice of Opportunity for Hearing (September 2008 Notice). In 1999, MS. EAKLE was issued a license to practice nursing in Ohio as a licensed practical nurse, PN-105799. MS. EAKLE's nursing license was indefinitely suspended by her May 2009 Consent Agreement. Copies of the May 2009 Consent Agreement and the September 2008 Notice are attached hereto and incorporated herein.
B.
C.
MS. EAKLE submitted a written request to the Board to reinstate her license and provided the Board with supporting documentation.
1)
MS. EAKLE's treating psychiatrist, Vinod K. Patwa, M.D. performed her psychiatric evaluation in June 2011. MS.
Leslie C . Eakle, L.P.N Page 2
EAKLE was diagnosed with Bipolar Affective Disorder, Panic Disorder, Poly Substance Abuse in Remission and with a Personality Disorder. Dr. Patwa reported that MS. EAKLE is prescribed antidepressants and antipsychotic medications. Dr. Patwa further reported that MS. EAKLE has remained compliant with treatment and recommended that she should continue with therapy, take her medication and undergo the Board's random drug screening process. Dr. Patwa opined that MS. EAKLE's nursing license should be reinstated if MS. EAKLE continues to comply the abovenoted treatment recommendations.
2) An April 18,2011 statement from Andrew Bixler, Psy.D. and Kathleen Malloy, Ph.D., ABPP, indicates that MS. EAKLE is in counseling and that her prognosis is good. Evidence of successful completion of a nursing refresher course at Upper Valley Medical Center has been submitted to the Board.
3)
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. EAKLE knowingly and voluntarily agrees with the Board to the following terms, conditions, and limitations: Upon meeting the requirements for renewal, MS. EAKLE's license to practice nursing as a licensed practical nurse shall be reinstated and suspended indefinitely. Such suspension shall be stayed, subject to the following PROBATIONARY terms, conditions, and limitations for a minimum period of at least three (3)years: 1.
MS. EAKLE shall obey all federal, state, and local laws, and all laws and rules governing the practice of nursing in Ohio. MS. EAKLE shall appear in person for interviews before the full Board or its designated representative as requested by the Board or its designee.
2.

3.
Within ninety (90) days prior to submitting a request for release from the probationary terms, conditions and limitations of this Consent Agreement, MS. EAKLE agrees that she will submit a request to the Bureau of Criminal Identification and Investigation (BCII) to conduct a criminal records check of MS. EAKLE, including a check of Federal Bureau of Investigation (FBI) records, and shall
Leslie C. Eakie, L.P.N. Page 3 cause BCII to submit MS. EAKLE's criminal records check reports to the Board. MS. EAKLE agrees that a request for release from the probationary 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

4.
MS. EAKLE 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. EAKLE's history of chemical dependency and recovery status. MS. EAKLE shall self-administer prescribed drugs only in the manner prescribed. MS. EAKLE shall abstain completely from the use of alcohol andlor substances containing alcohol. Within sixty (60) days of the effective date of this Consent Agreement and continuing throughout the probationary period, MS. EAKLE shall continue to submit, at her expense and on the day selected, breathe, hair, blood or urine specimens for drug andlor 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 oil 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. EAKLE shall be negative, except for substances prescribed, administered, or dispensed to her by another so authorized by law who has full knowledge of MS. EAKLE's history of chemical dependency and recovery status. MS. EAKLE shall continue to participate in psychotherapy and pharmacotherapy at intervals deemed appropriate by Dr. Patwa, or another psychiatrist approved in advance by the Board or its designee until released. MS. EAKLE shall have the psychiatrist submit written reports regarding MS. EAKLE's progress, status, and compliance with her treatment plan to the Board on a quarterly basis beginning January 1, 2012. MS. EAKLE shall provide the chemical dependency professional with a copy of this Consent Agreement, the attached May 2009 Consent Agreement, and the attached September 2008 Notice prior to December 23,2011. MS. EAKLE shall inform the Board, in writing, within five (5) business days of discontinuing participation in psychotherapy, and prior to said discontinuation, shall
Leslie C. Eakle, L.P.N. Page 4
inform the Board, in writing, of the name(s) of another psychiatrist(s) and intervals of treatment for approval by the Board or its designee.
Addiction Psychiatric Evaluation

8.
Upon request by the Board or its designee and within ninety (90) days of such a request, MS. EAKLE shall, at her expense, obtain a comprehensive evaluation by a psychiatrist who is certified by the American Board of Medical Specialties (ABMS) in Addiction Psychiatry and who is approved in advance by the Board. Prior to the evaluation, MS. EAKLE shall provide the evaluating psychiatrist with a copy of this Consent Agreement, the attached May 2009 Consent Agreement, and the attached September 2008 Notice and with summaries from her treating physicians for the past five years, including the types and frequency of drugs she has been prescribed in that period. Further, MS. EAKLE 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, any additional restrictions that should be placed on MS. EAKLE's license, and a statement as to whether MS. EAKLE is capable of practicing nursing according to acceptable and prevailing standards of safe nursing care. If an addiction psychiatric evaluation is requested, MS. EAKLE shall provide the Board with satisfactory documentation of compliance with 911 aspects of the treatment plan.developed by the psychiatrist described above until released. Further, MS. EAKLE 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. EAKLE's license 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, MS. EAKLE shall provide a copy of this Consent Agreement, the attached May 2009 Consent Agreement, and the attached September 2008 Notice to all treating practitioners and shall provide to the Board a list of all treating practitioners, including addresses and telephone numbers. Further, MS. EAKLE shall be under a continuing duty to provide a copy of this Consent Agreement and the attachments, prior to initiating treatment, to additional treating practitioners, and to update the list of treating practitioners with the
Leslie C. Eakle, L.P.N. Page 5 Board within forty-eight (48) hours of being treated by another practitioner. 11. MS. EAKLE 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. EAKLE throughout the duration of this Consent Agreement. Within twenty-four (24) hours of release from hospitalization or medical treatment, MS. EAKLE shall notify the Board of any and all medication(s) or prescription(s) received.
12.
13.
Prior to accepting employment as a nurse, each time with every employer, MS. EAKLE shall notify the Board in writing.
MS. EAKLE is under a continuing duty to provide a copy of this Consent Agreement, the attached May 2009 Consent Agreement, and the attached September 2008 Notice to any new employer prior to accepting employment as a nurse. MS. EAKLE shall have her employer(s) submit written reports regarding job performance on a quarterly basis beginning within thirty (30) days of accepting Further, MS. EAKLE shall have her nursing employment. employer(s) send documentation to the Board, along with the first employer report, of receipt of a copy of this Consent Agreement and the attachments, including the date they were received.
14.

15. MS. EAKLE shall report to the Board, in writing, any violation of this Consent Agreement within thirty (30) days of the occurrence of the violation. MS. EAKLE shall sign release of information forms allowing health professionals and other organizations to submit the requested documentation directly to the Board. MS. EAKLE 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.
16.
17.
Leslie C. Eakie, L.P.N. Page 6 18.
MS. EAKLE 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. EAKLE 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. EAKLE 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, Colunlbus, OH 43215-7410. MS. EAKLE shall verify that the reports and documentation required by this Consent Agreement are received in the Board office. MS. EAKLE 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.
19.
20.
21.
22.
Temporarv Narcotic Restriction MS. EAKLE shall not administer, have access to, or possess (except as prescribed for MS. EAKLE's use by another so authorized by law who has full knowledge of MS. EAKLE'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. EAKLE is working in a position that requires a i~ursing license. At any time after the six (6) month period previously described, MS. EAKLE may submit a written request to the Board to have this restriction re-evaluated. In addition, MS. EAKLE shall not count narcotics or possess or carry any work keys for locked medication carts, cabinets, drawers, or containers. MS. EAKLE shall not call in or order prescriptions or prescription refills for narcotics, other controlled substances, or mood altering drugs. Permanent Practice Restrictions MS. EAKLE further knowingly and voluntarily agrees with the Board to the following PERMANENT LICENSURE RESTRICTIONS: MS. EAKLE 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. EAKLE to provide nursing services for fees, compensation, or other consideration or as a volunteer.
MS. EAKLE 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, VicePresident of Nursing. FAILURE TO COMPLY MS. EAKLE agrees that her license to practice nursing as a licensed practical nurse will be autoinatically suspended if it appears to the Board that MS. EAKLE has violated or breached any terms or conditions of the Consent Agreement. Following the automatic suspension, the Board shall notify MS. EAKLE via certified mail of the specific nature of the charges and automatic suspension of her license. Upon receipt of this notice, MS. EAKLE 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. EAKLE 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.

The terms, limitations, and conditions, of this Consent Agreement, other than the permanent practice restrictions, may be modified or terminated, in writing, at any time upon the agreement of both MS. EAKLE and the Board. The Board may only alter the probationary period iinposed by this Consent Agreement if: (1) the Board determines that MS. EAKLE has complied with all aspects of this Consent Agreement; and (2) the Board determines that MS. EAKLE is able to practice according to acceptable and prevailing standards of safe nursing care without Board monitoring, based upon an interview with MS. EAKLE and review of the reports as required herein. Any period during which MS. EAKLE 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/LIABILITYRELEASE
MS. EAKLE 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. EAKLE waives all of her rights under Chapter 119, ORC, as they relate to matters that are the subject of this Consent Agreement. MS. EAKLE waives any and all claims or causes of action she may have against the Board, and its members, officers, employees andlor agents arising out of matters, which are the subject of this Consent Agreement.
MS. EAKLE 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.
@ b 6 d 8fi.t?,40fi,u~ ~
BERTHA LOVELACE, President Ohio Board of Nursing DATE
Case #08-1909

17 Soukh High Street, Suile 400
,vww.,~ursi~~~ohio.gw
Col~unbus, Ohio 43215-7410
(614) 466-5917
CONSENT AGREEMENT BETWEEN LESLIE C. EAKLE, L.P.N. AND OHIO BOARD OF NURSING
This Consent Agreement is entered into by and between LESLIE C. EAKLE, L.P.N. (MS. EAKLE) 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. EAKLE 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 ad,judicative hearing on the issues considered herein. This Consent Agreement contains the entire a,geement 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)(4), ORC, authorizes the Board to discipline a licensee for conviction of, a plea of guilty to, or a judicial finding of guilt of any felony or of any crime involving gross immorality or moral turpitude. Section (B)(5), 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; or conviction or, 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.
MS. EAKLE has been licensed to practice nursing as a licensed practical

nurse in the State of Ohio, PN105799, since November 1999. EAKLE's license lapsed September 1,2008.
MS.
Leslie C. Eakle, L.P.N. Page 2 C.
MS. EAKLE knowingly and voluntarily admits to the factual and legal
allegations set forth in the Notice of Opportunity for Hearing issued to her by the Board on or about September 19, 2008 (September 2008 Notice), a copy of which is attached hereto and incorporated herein.
MS. EAKLE admits that on April 17,2007, she was granted Intervention in
Lieu of Conviction in Montgomery County Court of Common Pleas Case Number 2006 CR 05505 for Illegally Processing of a Drug Document. MS. EAKLE states she successful completed her treatment and the case was dismissed on September 7, 2007 The acts underlying the criminal conviction involved MS. EAKLE, on or about March 19, 2006, forging prescription for Vicodin.
MS. EAKLE further explains that, during the events described in the September 2008 Notice, she had been the victim of domestic violence from her former boyfriend. MS. EAKLE states she was fearful for her physical welf being if she did not comply with her former boyfriend's requests. MS. EAKLE states that while he was admitted to Twin Valley Behavioral Health Center, Dayton, Ohio, her former boyfriend requested that she bring him Valium. MS. EAKLE states that she was afraid not to comply with his request MS. EAKLE states that her former boyfriend is currently "on the run from the law," and that she does not know where he is. MS. EAKLE reports that she has been compliant with her probation in
Montgomery County Court of Common Pleas Case Number 2007 CR 04870.
MS. EAKLE reports that she last worked as a nurse in January 2008.
MS. EAKLE admits and acknowledges her mistake in following her former
boyfriend's directions and asks this Board for another chance.
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. EAKLE knowingly and voluntarily agrees with the Board to the following terms, conditions, and limitations:
1 .
MS. EAKLE's license to practice nursing as a licensed practical nurse is hereby

suspended for an indefinite period of time, but not less two (2) years from the date of the September 2008 Notice. MS. EAKLE may submit a written request for
Leslie C. Eakle, L.P.N. Page 3 reinstatement after September 2010 if the conditions for reinstatement have been satisfied. CONDITIONS FOR REINSTATEMENT 2.
MS. EAKLE shall obey all federal, state, and local laws, and all laws and rules
governing the practice of nursing in Ohio. MS. E A a E shall comply with all terms and conditions imposed by the Court in Montgomery County Court of Common Pleas Case Number 2007 CR 04870.
3.
MS. EAKLE shall appear in person for interviews before the full Board or its designated representative as requested by the Board or its designee. Prior to requesting reinstatement, in addition to requirements for ticensure renewal, MS. EAKLE shall complete and submit satisfactory documentation of her successfully completing ten (10) hours of continuing education on Ethics and one (1) hour continuing education on Ohio Nursing Law and Rules, all taken subsequent to the effective date of this Consent Agreement. Prior to requesting reinstatement, MS. EAKLE 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.
Psychiatric Evaluation
6.
Within three (3) months prior to requesting reinstatement from the Board o r its designee, MS. EAKLE shall, at her own 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. EAKLE shall provide the psychiatrist with a copy of this Consent Agreement and the attached September 2008 Notice. MS. E A m E 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. EAKLE's license, and a statement as to whether MS. EAKLE is capable of practicing nursing according to acceptable and prevailing standards of safe nursing care.
7.
MS. EAKLE shall provide the Board with satisfactory documentation of compliance
with all aspects of the treatment plan developed by the professional until released. Further, MS. E A a E agrees that the Board may use the professional recommendations and conclusions from the evaluation as a basis for additional terms, conditions, and limitations on MS. EAKLE's license and that the terms, conditions, and limitations may be incorporated in an addendum to this Consent Agreement.
Leslie C. Eakle, L.P.N Page 4 Monitoring of Rehabilitation and Treatment 8. MS. EAlKLE 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. EAKLE's history. MS. EAKLE shall selfadminister the prescribed drugs only in the manner prescribed. Upon the request of the Board or its designee, and within thirty (30) days of that request, MS. EAKLE 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. EAKLE shall provide the chemical dependency professional with a copy of this Consent Agreement and the September 2008 Notice. Further, MS. EAKLE 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 shall submit a written opinion to the Board that includes any additional restrictions to be placed on MS. EAKLE's license to practice, and stating whether MS. EAKLE is capable of practicing nursing according to acceptable and prevailing standards of safe nursing care. If requested by the Board or its designee, MS. EAKLE 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. EAKLE agrees that the Board may utilize the professional's recommendations and conclusions from the evaluation as a basis for additional terns, conditions, and limitations on MS. EAKLE's license and that the terns, conditions, and limitations may be incorporated in an addendum to this Consent Agreement Upon request of the Board o r its designee, and within forty-five (45) days of that request, MS. EAKLE shall submit, at her expense and on the day selected, blood or urine specimens for drug andlor alcohol analysis at a collection site specified by the Board at such times as the Board may request. Upon and after MS. EAKLE'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. EAKLE shall be negative, except for substances prescribed, administered, or dispensed to her by another so authorized by law who has full knowledge of MS. EAKLE's a. Within thirty (30) days prior to MS. EAKLE initiating drug screening, MS. EAKLE shall provide a copy of this Consent Agreement and the attached September 2008 Notice to all treating practitioners and shall provide to the
9.
10.
11.
L ~ s l i e Eakle, L.P.N. C. Page 5 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. EAKLE. b. After initiating drug screening, MS. EAKLE shall be under a continuing duty to provide a copy of this Consent Agreement and the attached September 2008 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. EAKLE 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. Reporting Requirements
12.
MS. EAKLE shall report to the Board, in writing, any violation of this Consent
13.
MS. EAKLE shall sign release of infomation forms allowing health professionals
and other organizations to submit requested documentation or infomation directly to the Board.
14.
MS. EAKLE 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.
MS. EAKLE 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.
16.
MS. EAKLE 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.
MS. EAKLE 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. EAKLE shall verify that the reports and documentation required by this Consent
Agreement are received in the Board office.
18.
19.
MS. EAKLE shall inform the Board within five (5) business days, in writing, of any change in address andlor telephone number.
Leslie C. Eakle, L.P.N. Page G Nursing Refresher Course o r Orientation Upon request of the Board o r its designee, MS. EAKLE 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. T e m p o r a y Narcotic Restriction MS. EAKLE shall not administer, have access to, or possess (except as prescribed for MS. EAKLE's use by another so authorized by law who has full knowledge of MS. EAKLE's history) any narcotics, other controlled substances, or mood altering dmgs for a minimum of six (6) months in which MS. EAKLE is working in a position that requires a nursing license. At any time after the six (6) month period previously described, MS. EAKLE may submit a written request to the Board to have this restriction re-evaluated. In addition, MS. EAKLE shall not possess or carry any work keys for locked medication carts, cabinets, drawers, or containers. MS. EAKLE shall not count narcotics. MS. EAKLE shall not caI1 in or order prescriptions or prescription refills for narcotics, other controlled substances, or mood altering drugs. Permanent Practice Restrictions MS. EAKLE further knowingly and voluntarily agrees with the Board to the following PERMANENT LICENSURE RESTRICTIONS: MS. EAKLE 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 staff~ng 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. EAKLE to provide nursing services for fees, compensation, or other consideration or as a volunteer. MS. EAKLE 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 T O COMPLY The above described terns and conditions shall constitute "restrictions placed on a Iicense" for purposes of Section 4723,28(B), ORC. If, in the discretion of the Board, MS. EAKLE appears to have violated or breached any terns or conditions of this Consent Agreement, the Board
Leslie C. Eakle, L.P.N Page 7 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 1 MODIFICATION OF TERMS

The terms, limitations, and conditions of this Consent Agreement, other than the permanent liceosure restriction(s), may be modified or terminated, in writing, at any time upon the agreement of both MS. EAKLE and the Board. The Board may only alter the indefinite suspension imposed if: (1) MS. EAKLE submits a written request for reinstatement; (2) the Board determines that MS. EAKLE has complied with all conditions of reinstatement; (3) the Board determines that MS. EAKLE is able to practice according to acceptable and prevailing standards of safe nursing care based upon an interview with MS. EAKLE and review of the documentation specified in this Consent Agreement; and (4) MS. EAKLE 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.
&CKNOWLEDGMENTSLIABILITY RELEASE
MS. EAKLE 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. EAKLE waives all of her rights under Chapter 119, ORC, as they relate to matters that are the subject of this Consent Agreement. MS. EAKLE waives any and all claims or causes of action she may have against the Board, and
its members, officers, employees andlor 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 Adminisbative 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.
Leslie C. Eakle, L.P..N Page 8
EFFECTIVE DATE MS. EAKLE understands that this Consent Agreement is subject to ratification by tile Board
prior to signature by the Board President and shall become effective upon the last date of signature below.
?&.)!l&
--- -.
LESLIE C. EAKLE, L.P.N.
LISA KLFNKE, President Ohio Board of Nursing
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...- ..DATE
Case # 08-1909
September 19,2008

Leslie C. Eakle, L.P.N. 2640 Hayward Avenue Dawn, Ohio 45414 Deal' Ms. Eakle: 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 Montgomery County Cou~t Common Pleas Case Number 2007 CR 4870, on of

or about May 22, 2008, you pled guilty to, and you were subsequently convicted of, one (1) count of Illegal Conveyance of Drugs of Abuse Onto the Grounds of a Detention Facility, a third-degree felony, in violation of Section 2921.36(A)(2), ORC, and were sentenced to five (5) years community conk01 sanctions. The acts underlying the criminal conviction referenced above involve you, on or about October 3,2007, knowingly conveying, or attempting to convey, Diazepam onto the grounds of a state facility or institution. On or about July 25, 2008, you stated to a Board investigator that you had given Diazepam to an ex-boyfriend after he had been admitted to Twin Valley Behavioral Health Center, Dayton, Ohio, and had been observed providing the drug to him by a nurse aide. The court in the above referenced criminal case ordered you to complete a ten-page essay on the dangers of prescription medications especially when given to patients in a psychiabic hospital. Section 4723,.28(B)(4), ORC, authorizes the Board to discipline a licensee for conviction of, a plea of guilty to, or a judicial finding of guilt of any felony or of any crime involving gross immorality or moral turpitude. 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 h e of mailing of this notice.
Leslie C. Eakle, L.P.N. Page 2 You are hereby further iuformed that, if you timely request a hearing, you are entitled to appear at such hearing in persan, 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. If the Board fails to receive a request for a heating 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, revokk, suspend or place resb5ctions on your license to practice nursing as a licensed practical nurse; reprimand or athewise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely,
Debra A. Broadnax, RN, MNS, CNS Supervising Member Certified Mail Receipt No. 7008 1140 0002 1620 7748 cc: Leah O'Ca~rollAssistant Attorney General
Cases # 09-0690 & 12-001615
July 27, 2012
NOTICE OF TEMPORARY SUSPENSION AND OPPORTUNITY FOR HEARING

Alicia Renee Eaton, L.P.N. 17723 State Route 247 Seaman, Ohio 45679 Dear Ms. Eaton: In accordance with Section 4723.35(D)(2) of the Ohio Revised Code (ORC), it has been determined that you were significantly out of compliance with the terms and conditions for participation in the Alternative Program for Chemical Dependency (Program) of the Ohio Board of Nursing (Board) based on the information set forth below in Item 2. Further, Section 4723.35(D)(2), ORC, states as follows: If the program coordinator determines that a participant is significantly out of compliance with the terms and conditions for participation, the coordinator shall notify the Boards supervising member for disciplinary matters and the supervising member shall temporarily suspend the participants license or certificate. The program coordinator shall notify the participant of the suspension by certified mail sent to the participants last known address and shall refer the matter to the Board for formal action under section 4723.28 or 4723.86 of the Revised Code. WHEREFORE, PURSUANT TO SECTION 4723.35(D)(2), ORC, YOU ARE HEREBY NOTIFIED THAT YOUR LICENSE TO PRACTICE NURSING AS A LICENSED PRACTICAL NURSE, PN-100003, IS HEREBY TEMPORARILY 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 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 December 30, 2008, you were terminated from employment as a licensed practical nurse at Healthsource of Ohio in Seaman, Ohio, after several prescriptions for controlled substances written to you, while you were a patient of
Alicia Renee Eaton, L.P.N. Page 2 Healthsource, could not be authenticated in your medical record. In a written statement to the Board dated March 19, 2009, you admitted that you were chemically dependent on pain medication due to neck and back injuries. Section 4723.28(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 extent that impairs ability to practice. 2. On or about January 7, 2010, you entered into an Alternative Program Participant Agreement (Agreement) with the Boards Alternative Program for Chemical Dependency (Program). a. Item 21. of your Agreement states, Participant shall abstain form the use of alcohol, drugs of abuse, and controlled substances, excepting Participants time limited use of alcohol, drugs of abuse and controlled substances in accordance with this Agreement, and the treatment plan established for the Participant by a legally authorized prescriber. Despite this provision, on or about February 17, 2011, you provided a urine specimen for analysis to Firstlab, the Boards random drug/alcohol screen program administrator, that tested positive for Ethyl Glucuronide (Alcohol). b. Item 27. of your Agreement states, Participant shall comply with drug testing in such a manner as the Program may request, including but not limited to submission of an unadulterated urine, hair, blood, or breath specimen, expressed or extracted directly from Participants body to the drug testing company designated by the Board. Item 30. of your Agreement states, Within four weeks (4) following the effective date of this Agreement, Participant shall begin daily calling to the Boards designated drug testing company and submit to drug testing within the designated timeframe required by the drug testing company, on the date the Participant is selected for drug testing. Despite these provisions, on the following dates, you failed to call FirstLab to determine if you had been selected to provide a specimen for analysis: May 26, 2010, September 18, 2010; January 20, 2011; June 26, 2011; March 20-31, 2012; and April 1-24, 2012. Furthermore, on the following dates, you were selected to provide a urine specimen for analysis and failed to do so: May 26, 2010; June 23, 2011; March 19, 2012; and April 11, 2012. c. Item 33. of your Agreement states, Participant shall appear in person for an interview with a Program representative in accordance with a schedule established by the Program (Meeting Schedule). The Participant is
Alicia Renee Eaton, L.P.N. Page 3 responsible for scheduling the interviews. In addition, Participant shall in appear in person for an interview at any time upon the Programs request. You were sent a letter from the Board dated March 27, 2012 notifying you of an in-person interview on April 11, 2012. Despite this provision, you failed to appear at the Board for the scheduled in-person interview on April 11, 2012. d. Item 34. of your Agreement states, Participant shall complete and submit the Personal Report Form provided by the Program in accordance with a schedule (Report Schedule) established by the Program. You were required to submit a Personal Report Form to the Board every month beginning on February 1, 2010. Despite this provision, you have failed to submit a Personal Report Form since March 2, 2012. e. On or about April 24, 2012, you were terminated from the Program based on your failure to comply with the terms and conditions of your Agreement.
Section 4723.28(B)(25), ORC, authorizes the Board to discipline a licensee for failure to comply with the terms and conditions of participation in the chemical dependency monitoring program established under Section 4723.35, 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, Rule 4723-6-03(A), Ohio Administrative Code, requires a participant in the Alternative Program for Chemical Dependency to comply with all of the terms and conditions of the participants agreement with the Alternative Program for Chemical Dependency for the time period specified in the agreement. 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 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.
Alicia Renee Eaton, L.P.N. Page 4 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 Temporary 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,
Case #12-002064
July 27, 2012

Erika Sue Eubanks 9150 Lithopolis Road Canal Winchester, Ohio 43110 Dear Ms. Eubanks: On or about May 23, 2012, 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; 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 9, 2012, in Fairfield County Court of Common Pleas Case Number 2011-CR-0460, you pled guilty to one (1) count of Theft of Drugs by Deception, a felony of the fourth degree, in violation of Section 2913.02(A)(3) and (B)(6), ORC, and were found eligible for Intervention in Lieu of Conviction. The acts underlying this case occurred on or between May 5, 2011, and August 2, 2011, and involve you obtaining Oxycodone from Fairfield Medical Center by deception. 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. 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
Erika Sue Eubanks Page 2 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.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 registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely,
Case #12-002064
May 23, 2012

Erika Sue Eubanks, R.N. 9150 Lithopolis Road Canal Winchester, OH 43110 Dear Ms. Eubanks: 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 9, 2012, in Fairfield County Court of Common Pleas Case Number 2011-CR-0460, you pled guilty to one (1) count of Theft of Drugs by Deception, a felony of the fourth degree, in violation of Section 2913.02(A)(3) and (B)(6), 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 by Deception, a felony of the fourth degree, in violation of Section 2913.02(A)(3) and (B)(6), 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-308455, IS HEREBY SUSPENDED. Continued practice after receipt of this
Erika Sue Eubanks, R.N. Page 2 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. 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 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 registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely,
Case #12-002491
July 27, 2012

Ashley Marie Fitzsimmons, R.N. 7510 Spring Garden Road Parma, Ohio 44129 and 1362 West Blvd, Apt. 2 Cleveland, Ohio 44102 Dear Ms. Fitzsimmons: 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 15, 2012, in Cuyahoga County Court of Common Pleas Case Number CR-11-557771-A, you pled guilty to one (1) count of Drug Possession, a felony of the fifth degree, in violation of Section 2925.11(A), 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. Drug Possession, 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 REGISTERED
Ashley Marie Fitzsimmons, R.N. Page 2 NURSE, RN-333862, 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 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 15, 2012, in Cuyahoga County Court of Common Pleas Case Number CR-11-557771-A, you pled guilty to one (1) count of Drug Possession, a felony of the fifth degree, in violation of Section 2925.11(A), ORC; and one (1) count of Possessing Criminal Tools, a felony of the fifth degree, in violation of Section 2923.24(A), ORC, and were found eligible for Intervention in Lieu of Conviction. The acts underlying this case occurred on or about May 19, 2011, and involve you obtaining, possessing, or using Heroin. Further acts underlying this case involve you possessing or having under your control drug paraphernalia items. 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. 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.
Ashley Marie Fitzsimmons, R.N. Page 3 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 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,
Judith A. Church, R.N., C.N.P. Supervising Board Member Certified Mail Receipt No. 7012 1010 0002 4225 4696 Second Address Certified Mail Receipt No.7012 1010 0002 4225 4702 cc: Henry G. Appel, Assistant Attorney General
Case 11-001943
July 27, 2012

Tina Marie Fitzwater, R.N. 418 Park Dr. Apt C Trenton, OH 45067 Dear Ms. Fitzwater: 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 May 9, 2011, as part of the pre-employment process for a nursing position with Butler County (Ohio) Care Center, you submitted a specimen for drug screening that was positive for Cocaine. 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. 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.
Tina Marie Fitzwater, 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, 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,
Case #12-001946
July 27, 2012

Heather L. Flynn, L.P.N. 1328 Camphill Way #8 West Carrollton, Ohio 45449 Dear Ms. Flynn: You are hereby notified that, 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 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 for a minimum period of at least one (1) year. A. You were issued a license to practice nursing as a licensed practical nurse in the State of Ohio on December 8, 2011. B. Item 7. of the November 2011 Consent Agreement states, Within sixty (60) days of the effective date of this Consent Agreement and continuing throughout the probationary period, MS. FLYNN shall begin submitting, at her expense and on the day selected, 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. 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. FLYNN shall be negative, except for substances prescribed, administered, or dispensed to her by another so authorized by law. Despite this provision, on the following dates, you failed to call Firstlab, the Boards random drug/alcohol screen program administrator, to determine if you had been selected to provide a urine specimen: February 1-24, 2012; February 26, 2012; March 1-6, 2012; March 10-11, 2012; April 8, 2012; April 24, 2012; April 27, 2012; April 29, 2012; May 1, 2012; May 16, 2012; May 18, 2012; May 26, 2012; June 2, 2012; and June 9, 2012.
Heather L. Flynn, L.P.N. Page 2 Furthermore, on the following dates, you were selected to provide a urine specimen for analysis and failed to do so: February 23, 2012; March 21, 2012; and April 27, 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 November 2011 Consent Agreement, you are hereby notified that it appears to the Board that you have violated Item 7. of the November 2011 Consent Agreement. YOU ARE FURTHER NOTIFIED THAT YOUR LICENSE TO PRACTICE NURSING AS A LICENSED PRACTICAL NURSE, PN-147385, 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 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 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 for a minimum period of at least one (1) year. 2. You were issued a license to practice nursing as a licensed practical nurse in the State of Ohio on December 8, 2011. 3. Item 7. of the November 2011 Consent Agreement states, Within sixty (60) days of the effective date of this Consent Agreement and continuing throughout the probationary period, MS. FLYNN shall begin submitting, at her expense and on the day selected, 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. 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. FLYNN
Heather L. Flynn, L.P.N. Page 3 shall be negative, except for substances prescribed, administered, or dispensed to her by another so authorized by law. Despite this provision, on the following dates, you failed to call Firstlab, the Boards random drug/alcohol screen program administrator, to determine if you had been selected to provide a urine specimen: February 1-24, 2012; February 26, 2012; March 1-6, 2012; March 10-11, 2012; April 8, 2012; April 24, 2012; April 27, 2012; April 29, 2012; May 1, 2012; May 16, 2012; May 18, 2012; May 26, 2012; June 2, 2012; and June 9, 2012. Furthermore, on the following dates, you were selected to provide a urine specimen for analysis and failed to do so: February 23, 2012; March 21, 2012; and April 27, 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.
Heather L. Flynn, L.P.N. Page 4 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,
Case #11-2925
Board of Nursing
L7 South 1Iigh Sireet, Sulie 400
a
wwwwrsing.ohio,gov
0
Colwrtbus, Ohio 43215-7410
(614) 466-3047
CONSENT AGREEMENT BETWEEN HEATHER L. FLYNN, L.P.N. APPLICANT AND OHIO BOARD OF NURSING
This Consent Agreement is entered into by and between HEATHER L. FLYNN, L.P.N. APPLICANT (MS. FLYNN) 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 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. On or about May 26,201 1, MS. FLYNN submitted to the Board an Application for Licensure by Examination to Practice in Ohio as a Licensed Practical Nurse. MS. FLYNN knowingly and voluntarily admits that in Montgomery County, Ohio, she was convicted of a drunk-driving charge in 2008 and a Public Intoxication charge in 2007. Additionally, in 2007, MS. FLYNN was convicted of an amended misdemeanor charge of Disorderly Conduct that stemmed from a
B.
C.
Heather L. Flynn, L.P.N. Applicant Page 2 2006 verbal dispute with a former boyfriend. At that time, MS. FLYNN was very emotional and refused to comply with law enforcement officers' repeated requests that she remain quiet.
D. E.
In her statement to the Board, MS. FLYNN reported that she regrets her earlier mistakes.
MS. FLYNN was permitted to take the NCLEX-PN, and on or about October 24,201 1,MS. FLYNN passed the exam. 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. FLYNN knowingly and voluntarily agrees with the Board to the following terms, conditions, and limitations: Upon meeting the requirements for licensure, MS. FLYNN shall be granted a license to practice nursing as a licensed practical nurse in the State of Ohio. MS. FLYNN7slicense 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 at least one (1)year: 1.
MS. FLYNN shall obey all federal, state, and local laws, and all laws and rules governing the practice of nursing in Ohio. MS. FLYNN shall appear in person for interviews before the full Board or its designated representative as requested by the Board or its designee.
2.

3.
Within ninety (90) days prior to submitting a request for release from the probationary terms, conditions and limitations of this Consent Agreement, MS. FLYNN agrees that she will submit a request to the Bureau of Criminal Identification and investigation (BCII) to conduct a criminal records check of MS. FLYNN, including a check of Federal Bureau of Investigation (FBI) records, and shall cause BCII to submit MS. FLYNN's criminal records check reports to the Board. MS. FLYNN agrees that a request ,for release from the probationary 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.
Heather L. Flynn, L.P.N. Applicant Page 3

4.
Within ninety (90) days from the effective date of this Consent Agreement, MS. FLYNN 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 other comparable courses approved in advance by the Board, taken subsequent to the effective date of this Consent Agreement: six (6) hours of professionalism/ethics; and, twelve (12) hours of angeristress management.
Monitoring
5.
MS. FLYNN shall abstain completely from the persotla1 use or possession of drugs, except those prescribed, administered, or dispensed to her by another so authorized by law. MS. FLYNN shall self-administer prescribed drugs only in the manuer prescribed. MS. FLYNN shall abstain completely from the use of alcohol, if recommended by a chemical dependency professional, as referenced in Paragraph 8. below. Within sixty (60) days of the effective date of this Consent Agreement and continuing throughout the probationary period, MS. FLYNN shall begin submitting, at her expense and on the day selected, breathe, 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. 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. FLYNN shall be negative, except for substances prescribed, administered, or dispensed to her by another so authorized by law. Within sixty (60) days following the effective date of this Consent Agreement, MS. FLYNN 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. FLYNN shall provide the chemical dependency professional with a copy of this Consent Agreement. Further, MS. FLYNN shall execute releases to permit the chemical dependency professional to obtain any information deemed appropriate and necessary for the evaluation. The evaluating
6.
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. FLYNN's license to practice, and a statement as to whether MS. FLYNN is capable of practicing nursing according to acceptable and prevailing standards of safe nursing care.
MS. FLYNN 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. FLYNN 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. FLYNN's license and that the terms, conditions, and limitations may be incorporated in an addendum to this Consent Agreement.
10.
Within sixty (60) days of the effective date of this Consent Agreement, MS. FLYNN 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. FLYNN 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.
11.
MS. FLYNN 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. FLYNN throughout the duration of this Consent Agreement.
Within twenty-four (24) hours of release from hospitalization or medical treatment, MS. FLYNN shall notify the Board of any and all medication(s) or prescription(s) received.
12.
13.
Prior to accepting employment as a nurse, each time with every employer, MS. FLYNN shall notify the Board of the name and address of the employer in writing.
MS. FLYNN 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. FLYNN 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 January 1, 2012 or within thirty (30) days of accepting nursing employment. MS. FLYNN 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.
Repc~rting Requirements of Licensee
15.
MS. FLYNN shall report to the Board, in writing, any violation of this Consent Agreement within thirty (30) days of the occurrence of the violation. MS. FLYNN shall sign release of information forms allowing health professionals and other organizations to submit the requested documentation directly to the Board. MS. FLYNN 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. FLYNN 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. FLYNN 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. FLYNN 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. FLYNN shall verify that the reports and documentation required by this Consent Agreement are received in the Board office. MS. FLYNN 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.
Temporarv Practice Restrictions MS. FLYNN 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. FLYNN to provide nursing services for fees, compensation, or other consideration or as a volunteer. MS. FLYNN 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. FLYNN agrees that her license to practice nursing as a licensed practical nurse will be automatically suspended if it appears to the Board that MS. FLYNN has violated or breached any terms or conditions of the Consent Agreement. Following the automatic suspension, the Board shall notify MS. FLYNN via certified mail of the specific nature of the charges and automatic suspension of her license. Upon receipt of this notice, MS. FLYNN 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. FLYNN 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.

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. FLYNN and the Board. The Board may only alter the probationary period imposed by this Consent Agreement if: (1) the Board determines that MS. FLYNN has complied with ail aspects of this Consent Agreement; and (2) the Board determines that MS. FLYNN is able to practice according to acceptable and prevailing standards of safe nursing care without Board monitoring, based upon an interview with MS. FLYNN and review of the reports as required herein. Any period during which MS. FLYNN does not work in a position for which a nursing
Heather L. Flynm, L.P.N. Applicant Pkge 7 license is required shall not count toward fulfilling the probariorlnry period imposed by this Consent Agreement.
MS. FLYNN ncknowledges chat she has had an opporttinity to ask questions concerning
[he brms of this Consent Agreement and that all quesrions asked have been answered in a satisfacrory manner.
MS. FLYNN waives all of her rights under Chapter 110, OKC, as they relate to matters
that are the subject of this Co~isent Agreemenr.
MS. FLYNN waives any and ail clainls or causes of action she may have against rhe
Board, and its members, officers. en~ployeesnndlor agents arising out of matters, which are the subject of this Consent Agreement.
This Consent Agreement shdll be considered a public record as chat term is used in Section 149.43, ORC. The information contained hereill may be reported ro appropriate organizations, data banks and governmental bodies.
This Consent Agreement is not an adjudication order as discussed in Chapter 119, OKC. Any action initiated by the Board based on ullegcd violations c i l this Consent Agreement
shall comply with the Administrative Procedures Act, Chapter 119. OKC.
MS. FLYNN understands rhttt this Consent Agreement is si~bjectto ratification by the
Board prior to signarure by the Board President and shall become effective upon the last date of signature below.
LYNN, L.P.N. APPLICANT
Y &;fi-rn 1
L / o 11
DATE
L
BERTHA LOVELACE. President Ohio Board of Nursing
DATE
Case #12-003094
July 27, 2012
Megan Dawn French, R.N. 8272 Alpine Aster Ct Liberty Twp, Ohio 45044 and Talbert House 1617 Reading Road Cincinnati, Ohio 45202 Dear Ms. French: 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 April 17, 2012, in Hamilton County Court of Common Pleas Case Number B-1108234, you pled guilty to one (1) count of Illegal Processing of Drug Documents, a felony of the fifth degree, in violation of Section 2925.23(A), ORC; two (2) counts of Illegal Processing of Drug Documents, felonies of the fourth degree, in violation of Section 2925.23(A), ORC; and three (3) counts of 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. On or about June 11, 2012, you were found guilty of the above-noted offenses and sentenced to confinement. 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
Megan Dawn French, R.N. Page 2 person's eligibility for treatment or intervention in lieu of conviction in another jurisdiction. Illegal Processing of Drug Documents, a felony of the fifth degree, in violation of Section 2925.23(A), ORC; Illegal Processing of Drug Documents, felonies of the fourth degree, in violation of Section 2925.23(A), ORC; and 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 REGISTERED NURSE, RN-348755, 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 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 17, 2012, in Hamilton County Court of Common Pleas Case Number B-1108234, you pled guilty to one (1) count of Illegal Processing of Drug Documents, a felony of the fifth degree, in violation of Section 2925.23(A), ORC; two (2) counts of Illegal Processing of Drug Documents, felonies of the fourth degree, in violation of Section 2925.23(A), ORC; and three (3) counts of 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. On or about June 11, 2012, you were found guilty of the above-noted offenses and sentenced to confinement. The acts underlying this case occurred on or in August and September 2011, and involve you making a false statement in a prescription, order, report, or record involving Lorazepam and Morphine. Further acts underlying this case involve you obtaining or exerting control over Lorazepam and Morphine without the consent of the owner, to wit: Childrens Hospital, or person authorized to give consent. 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.
Megan Dawn French, R.N. Page 3 2. On or about September 24, 2011, you submitted a specimen for drug testing. The specimen that you submitted tested positive for Phenobarbital and Morphine without a legal, valid prescription.
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 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,
Judith A. Church, R.N., C.N.P. Supervising Board Member Certified Mail Receipt No. 7012 1010 0002 4225 4801 Second Certified Mail Receipt No. 7012 1010 0002 4225 4818 Attorney Certified Mail Receipt No. 7012 1010 0002 4225 4825 cc: Henry G. Appel, Assistant Attorney General LaTonia Denise Wright, Esq.
Case #10-5020
July 27, 2012

Gail Marie Gardner, R.N. 7881 Neil Dr. Parma, Ohio 44130 Dear Ms. Gardner: 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. In or about March 2010, you asked Patient #1, a person for whom you were providing nursing services, for a loan and received $750 from Patient #1. On or about June 2010, while still providing nursing to care to Patient #1, you asked Patient #1 for another loan and received $3,000 from Patient #1. As of May 31, 2012, you have not paid Patient #1 back any of the $3,750 you received from Patient #1. 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, Rule 4723-4-06(I), Ohio Administrative Code (OAC), states that a licensed nurse shall delineate, establish, and maintain professional boundaries with each client. Rule 4723-4-06(L), OAC, states 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; 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. 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
Gail Marie Gardner, 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 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,
Case# 12-002241
July 27, 2012

Jodi Lynn Gordon, R.N. 1020 Rowland Avenue Columbus, Ohio 43228 Dear Ms. Gordon: You are hereby notified that, 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 upon meeting the requirements for renewal, 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 at least three (3) years. Attached to and incorporated within the September 2011 Consent Agreement is a November 19, 2010 Consent Agreement (November 2010 Consent Agreement) and a July 30, 2010 Notice of Opportunity for Hearing (July 2010 Notice). A. Item 1. of the September 2011 Consent Agreement states, MS. GORDON 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. 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)(1), 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 the board. Item 4. of the September 2011 Consent Agreement states, MS. GORDON 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. GORDONs history of chemical dependency, relapse, and recovery status. MS. GORDON shall self-administer prescribed drugs only in the manner prescribed. Item 6. of the September 2011 Consent Agreement states, MS. GORDON shall continue 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
Jodi Lynn Gordon, R.N. Page 2 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. GORDON shall be negative, except for substances prescribed, administered, or dispensed to her by another so authorized by law who has full knowledge of MS. GORDONs history of chemical dependency, relapse and recovery status. Item 21. of the September 2011 Consent Agreement states, MS. GORDON 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 these provisions, on February 16, 2012, you provided a urine specimen for analysis to Firstlab, the Boards random drug/alcohol screen program administrator, that tested positive for Lorazepam and Clonazepam, without legal, valid prescriptions. You subsequently had two (2) prescription medication reports dated February 14, 2012 and February 16, 2012, submitted to the Board in an envelope bearing the return address of Urgent Care Premium Medical Care, LLC (Premium Medical), Columbus, Ohio. Both prescription medication reports bear the signature of Dr. Gaines and list one (1) dose of Clonazepam and one (1) dose of Lorazepam, with no refills and no start or end dates. You submitted a statement to the Board dated March 15, 2012, indicating that you had met with Lisa Gaines, M.D. and she was aware of your past medical history. You further stated that while Dr. Gaines did not write you a prescription, she did direct you to take one Clonazepam and one Ativan (Lorazepam), which were medications previously prescribed to you by another physician. On or about April 22, 2012, the Board received a statement from Lisa Gaines, D.O. denying that she recommended you take any medication. Dr. Gaines also denied making any treatment recommendations or signing any papers for you. Records obtained from Premium Medical indicate that Dr. Gaines did not work there, and that on February 16, a woman came in an[d] asked if I would fax paper to phone # she gave me . . . said person has not been seen or treated at this location since 10/20/11. On May 9, 2012, during an interview with Board staff, you admitted that the prescription medication reports submitted to the Board for Klonopin (Clonazepam) and Ativan (Lorazepam), bearing the signature of Dr. Gaines, were actually signed at your request by someone at a meeting. 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. 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)(1), OAC,
Jodi Lynn Gordon, R.N. Page 3 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 the board. C. Item 25. of the September 2011 states, MS. GORDON shall inform the Board within (5) business days, in writing, of any change in employment status of any change in residential or home address or telephone number. Despite this provision, you failed to notify the Board that on or about March 16, 2012, you were released from employment as a registered nurse from Northwest Pediatrics in Dublin, Ohio. In accordance with the paragraph under FAILURE TO COMPLY of the September 2011 Consent Agreement, you are hereby notified that it appears to the Board that you have violated Items 1., 4., 6., 21. and 25. of the September 2011 Consent Agreement. YOU ARE FURTHER NOTIFIED THAT YOUR LICENSE TO PRACTICE NURSING AS A REGISTERED NURSE, RN-311931, 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 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 upon meeting the requirements for renewal, 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 at least three (3) years. Attached to and incorporated within the September 2011 Consent Agreement is a November 19, 2010 Consent Agreement (November 2010 Consent Agreement) and a July 30, 2010 Notice of Opportunity for Hearing (July 2010 Notice). 2. Item 1. of the September 2011 Consent Agreement states, MS. GORDON 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
Jodi Lynn Gordon, R.N. Page 4 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(P)(1), 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 the board. Item 4. of the September 2011 Consent Agreement states, MS. GORDON 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. GORDONs history of chemical dependency, relapse, and recovery status. MS. GORDON shall self-administer prescribed drugs only in the manner prescribed. Item 6. of the September 2011 Consent Agreement states, MS. GORDON shall continue 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. GORDON shall be negative, except for substances prescribed, administered, or dispensed to her by another so authorized by law who has full knowledge of MS. GORDONs history of chemical dependency, relapse and recovery status. Item 21. of the September 2011 Consent Agreement states, MS. GORDON 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 these provisions, on February 16, 2012, you provided a urine specimen for analysis to Firstlab, the Boards random drug/alcohol screen program administrator, that tested positive for Lorazepam and Clonazepam, without legal, valid prescriptions. You subsequently had two (2) prescription medication reports dated February 14, 2012 and February 16, 2012, submitted to the Board in an envelope bearing the return address of Urgent Care Premium Medical Care, LLC (Premium Medical), Columbus, Ohio. Both prescription medication reports bear the signature of Dr. Gaines and list one (1) dose of Clonazepam and one (1) dose of Lorazepam, with no refills and no start or end dates. You submitted a statement to the Board dated March 15, 2012, indicating that you had met with Lisa Gaines, M.D. and she was aware of your past medical history. You further stated that while Dr. Gaines did not write you a prescription, she did direct you to take one Clonazepam and one Ativan (Lorazepam), which were medications previously prescribed to you by another physician. On or about April 22, 2012, the Board received a statement from Lisa Gaines, D.O. denying that she recommended you take any medication. Dr. Gaines also denied making any treatment recommendations or signing any papers for you.
Jodi Lynn Gordon, R.N. Page 5 Records obtained from Premium Medical indicate that Dr. Gaines did not work there, and that on February 16, a woman came in an[d] asked if I would fax paper to phone # she gave me . . . said person has not been seen or treated at this location since 10/20/11. On May 9, 2012, during an interview with Board staff, you admitted that the prescription medication reports submitted to the Board for Klonopin (Clonazepam) and Ativan (Lorazepam), bearing the signature of Dr. Gaines, were actually signed at your request by someone at a meeting. 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. 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)(1), 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 the board. 3. Item 25. of the September 2011 states, MS. GORDON shall inform the Board within (5) business days, in writing, of any change in employment status of any change in residential or home address or telephone number. Despite this provision, you failed to notify the Board that on or about March 16, 2012, you were released from employment as a registered nurse from Northwest Pediatrics in Dublin, Ohio. 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.
Jodi Lynn Gordon, R.N. Page 6 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 ($500.00) per violation. Sincerely,
Judith A. Church, R.N., C.N.P. Supervising Member Certified Mail Receipt No. 7012 1010 0002 4225 2043 Attorney Certified Mail Receipt No. 7012 1010 0002 4225 2050 cc: Elizabeth Y. Collis, Esq. Henry G. Appel, Assistant Attorney General
Case #11-3384
Columbus, Ohio 41215-7410
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7 '
(611) 466-3947
REINSTATEMENT CONSENT AGREEMENT BETWEEN JODI LYNN GORDON, R.N. AND OHIO BOARD OF NURSING
This Consent Agreement is entered into by and between JODI LYNN GORDON, R.N. (MS. GORDON) 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. MS. GORDON admits to violating Section 4723.28, ORC, as set forth in her November 19, 2010 Consent Agreement (November 2010 Consent Agreement) and in her July 30,2010 Notice of Opportunity for Hearing (July 2010 Notice). MS. GORDON was initially issued a license to practice nursing in Ohio as a registered nurse, RN-311931 in 2004. MS. GORDON placed her license on inactive status in Febmary 2010. MS. GORDON'S November 2010 Consent Agreement resolved by her July 2010 Notice in which her license was indefinitely suspended. A copy of the November 2010 Consent Agreement and the July 2010 Notice are attached hereto and incorporated herein. MS. GORDON was a prior participant in the Board's Alternative Program (AP Program) and was successfully released early from the AP Program in August 2009.
B.
C.
Jodi Lynn Gordon, R.N, Page 2 Pursuant to the terms of her November 2010 Consent Agreement, MS. GORDON is now eligible to request reinstatement of her license. MS. GORDON has submitted such a request in writing and the following supporting documentation to the Board:
D.
E.
MS. GORDON is currently in counseling with Barbara C. Tudas, MS, PCC. In her May 2011 statement to the Board, Ms. Tudas opined that MS. GORDON is capable of safely returning to the practice of nursing. MS. GORDON'S August 1,2011 addiction psychiatric evaluation was performed by Alvin D. Pelt, M.D. MS. GORDON was diagnosed with Opiate Dependence in full-sustained remission, Depressive Disorder and Anxiety Disorder. During her evaluation, MS. GORDON reported to Dr. Pelt that she was prescribed Wellbutrin, Zoloft and Lorazepam for Depression, anxiety and insomnia. Dr. Pelt recommended that MS. GORDON should continue with counselinglun-covering therapy and discontinue using prescribed Lorazepam. Dr. Pelt reported that MS. GORDON was at high risk of cross addiction due to MS. GORDON's continued prescribed use of Lorazepam. Dr. Pelt also recommended that MS. GORDON continue undergoing random drug screens and continue attending at least three 12 Step recovery meetings per week. Dr. Pelt further reported that he would reevaluate MS. GORDON after she discontinued using Lorazepam.
In his August 24, 2011 statement to the Board, Dr. Pelt reported that he re-evaluated MS. GORDON on August 22, 2011 and at that time, MS. GORDON reported to him that she is tapering Tramadol and Lorazepam. Dr. Pelt opined that MS. GORDON is now capable of safely returning to the practice of nursing.
F.
G.
Lori A. Sullivan, M.D, is MS. GORDON'S primary treating physician. In her August 23, 2011 statement to the Board, Dr. Sullivan reported that she no longer prescribes Lorazapam or Clonozepam or any other controlled substance for MS. GORDON except under very limited short-term conditions.
H.
MS. GORDON understands that violations of the terms, conditions and limitations of this Consent Agreement may result in further suspension and possible permanent revocation of her license to practice nursing as a registered nurse in Ohio.
Jodi Lynn Gordon, R.N. Page 3
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. GORDON knowingly and voluntarily agrees with the Board to the following terms, conditions, and limitations: Upon meeting the requirements for renewal, MS. GORDON'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 period of at least three (3)years:
1.
2.
MS. GORDON shall obey all federal, state, and local laws, and all laws and rules governing the practice of nursing in Ohio. MS. GORDON shall appear in person for interviews before the full Board or its designated representative as requested by the Board or its designee.

3.
Within ninety (90) days prior to submitting a request for release from the probationary terms, conditions and limitations of this Consent Agreement, MS. GORDON agrees that she will submit a request to the Bureau of Criminal Identification and Investigation (BCII) to conduct a criminal records check of MS. GORDON, including a check of Federal Bureau of Investigation (F73I) records, and shall cause BCII to submit MS. GORDON's criminal records check reports to the Board. MS. GORDON agrees that a request for release from the probationary 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.

4.
MS. GORDON 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. GORDON's history of chemical dependency, relapse, and recovery status. MS. GORDON shall self-administer prescribed drugs only in the manner prescribed. MS. GORDON shall abstain completely from the use of alcohol. MS. GORDON shall continue 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. GORDON shall be negative, except for substances prescribed, administered, or dispensed to her by another so authorized by law who has full knowledge of MS. GORDON's history of chemical dependency, relapse and recovery status.
MS. GORDON 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. GORDON shall provide satisfactory documentation of such attendance to the Board every six (6) months beginning November 1,2011. MS. GORDON shall participate in continuing individual counseling at intervals deemed appropriate by Ms. Tudas, or another mental health provider approved in advance by the Board or its designee until released. MS. GORDON shall have the mental health provider submit written reports regarding MS. GORDON'S progress, status, and compliance with her treatment plan to the Board on a quarterly basis beginning November 1, 2011. MS. GORDON shall provide the chemical dependency professional with a copy of this Consent Agreement, the attached November 2010 Consent Agreement and the attached July 2010 Notice prior to October 21,2011. MS. GORDON shall inform the Board, in writing, within five (5) business days of discontinuing participation in individual counseling, and prior to said discontinuation, shall inform the Board, in writing, of the name(s) of another mental health provider(s) and intervals of treatment for approval by the Board or its designee.
9.
If requested by the Board or its designee and within ninety (90) days of such a request, MS. GORDON shall, at her expense, obtain a comprehensive evaluation from Dr. Pelt or another psychiatrist who is who is approved in advance by the Board and certified by the American Board of Medical Specialties (ABMS) in Addiction Psychiatry. Prior to the evaluation, MS. GORDON shall provide the evaluating psychiatrist with a copy of this Consent Agreement, the attached November 2010 Consent Agreement and the attached July 2010 Notice. Further, MS. GORDON 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, any additional restrictions that should be placed on MS. GORDON's license, and a statement as to whether MS. GORDON is capable of practicing nursing according to acceptable and prevailing standards of safe nursing care. 10.
If an addiction psychiatrist evaluation is requested, MS. GORDON 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. GORDON 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. GORDON's license and that the terms, conditions, and limitations may be incorporated in an addendum to this Consent Agreement.
Pain Management Evaluation & Treatment

11.
If requested by the Board or its designee and within ninety (90) days of such a request, MS. GORDON shall, at her expense, obtain a comprehensive evaluation by a physician who is certified by the American Board of Medical Specialties (ABMS) in Pain Medicine and who is approved in advance by the Board. MS. GORDON shall provide the Board with complete documentation of this evaluation. Prior to the evaluation, MS. GORDON shall provide the physician with a copy of this Consent Agreement, the attached November 2010 Consent Agreement and the attached July 2010 Notice. Further, MS. GORDON shall execute releases to permit the physician to obtain any information deemed appropriate and necessary for the evaluation. The physician shall submit a written opinion to the Board that includes diagnoses, and recommendations for treatment and monitoring, any additional restrictions that should be placed on MS. GORDON's license, and a statement as to whether MS. GORDON is capable of practicing nursing according to acceptable and prevailing standards of safe nursing care. If a pain management evaluation is requested, MS. GORDON shall provide the Board with satisfactory documentation of compliance with all aspects of the treatment plan developed by the physician until released. MS. GORDON agrees that the Board may use the abovedescribed physician's recommendations and conclusions from the evaluation as a basis for additional terms, conditions, and limitations on MS. GORDON's license and that the terms, conditions, and limitations may be incorporated by an addendum to this Consent Agreement.
12.

13.
Within sixty (60) days of the effective date of this Consent Agreement, MS. GORDON shall provide a copy of this Consent Agreement, the attached November 2010 Consent Agreement, and the attached July 2010 Notice to all treating practitioners and shall provide to the Board a list of all treating practitioners, including addresses and telephone numbers. Further, MS. GORDON shall be under a continuing duty to provide a copy of this Consent Agreement and the 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.
14.
MS. GORDON 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. GORDON throughout the duration of this Consent Agreement.
Within twenty-four (24) hours of release from hospitalization or medical treatment, MS. GORDON shall notify the Board of any and all medication(s) or prescription(s) received.
15.
16.
Prior to accepting employment as a nurse, each time with every employer, MS. GORDON shall notify the Board in writing.
17.
MS. GORDON is under a continuing duty to provide a copy of this Consent Agreement, the attached November 2010 Consent Agreement, and the attached July 2010 Notice to any new employer prior to accepting employment as a nurse. MS. GORDON shall have her employer(s) submit written reports regarding job performance on a quarterly basis beginning within thirty (30) days of accepting nursing employment. Further, MS. GORDON 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 attachments, including the date they were received.

18.
MS. GORDON shall report to the Board, in writing, any violation of this Consent Agreement within thirty (30) days of the occurrence of the violation.
19.
MS. GORDON shall sign release of information forms allowing health professionals and other organizations to submit the requested documentation directly to the Board. MS. GORDON 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. GORDON 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. GORDON 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. GORDON 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. GORDON shall verify that the reports and documentation required by this Consent Agreement are received in the Board office. MS. GORDON 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.
20.
21.
22.
23.
24.
25.
Nursine Refresher Course or Orientation Upon request by the Board or its designee, MS. GORDON 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. Tem~orarv Narcotic Restriction Unless otherwise approved in advance by the Board or its designee, MS. GORDON shall not administer, have access to, or possess (except as prescribed for MS. GORDON'S use by another so authorized by law who has full knowledge of MS. GORDON'S history of chemical dependency, relapse and recovery status) any narcotics, other controlled substances, or mood altering drugs for a minimum of twelve (12) months in which MS. GORDON is working in a position that requires a nursing license. At any time after the twelve-month period previously described, MS. GORDON may submit a written request to the Board to have this restriction re-evaluated. In addition, MS. GORDON shall not count narcotics or possess or carry any work keys for locked
Jodi Lynn Gordon, R.N. Page 8 medication carts, cabinets, drawers, or containers. MS. GORDON shall not call in or order prescriptions or prescription refills for narcotics, other controlled substances, or mood altering drugs.
Permanent Practice Restrictions MS. GORDON further knowingly and voluntarily agrees with the Board to the following Unless otherwise approved in advance by the Board or its designee, MS. GORDON 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. GORDON 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. GORDON 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. GORDON agrees that her license to practice nursing as a registered nurse will be automatically suspended if it appears to the Board that MS. GORDON has violated or breached any terms or conditions of the Consent Agreement. Following the automatic suspension, the Board shall notify MS. GORDON via certified mail of the specific nature of the charges and automatic suspension of her license. Upon receipt of this notice, MS. GORDON 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. GORDON 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.

The terms, limitations, and conditions, of this Consent Agreement, other than the permanent practice restrictions, may be modified or terminated, in writing, at any time upon the agreement of both MS. GORDON and the Board. The Board may only alter the probationary period imposed by this Consent Agreement if: (1) the Board determines that MS. GORDON has complied with all aspects of this Consent Agreement; and (2) the Board determines that MS. GORDON is able to practice according to acceptable and prevailing standards of safe nursing care without Board monitoring, based upon an interview with MS. GORDON and review of the reports as required herein. Any period during which MS. GORDON 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. GORDON acknowledges that she has had an opportunity to ask questions concerning the terms of this Consent Agreement and that ail questions asked have been answered in a satisfactory manner. MS. GORDON waives all of her rights under Chapter 119, ORC, as they relate to matters that are the subject of this Consent Agreement. MS. GORDON waives any and all claims or causes of action she may have against the Board, and its members, officers, employees andlor agents arising out of matters, which are the subject of this Consent Agreement.
The remainder of this page has been intentionally left blank.
Jodi Lynn Gordon, RN. Page 10
EFE'ECTIVE DATE MS. GORDON 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.
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DATE ~ t t o r n e p o r Gordon Ms.
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DATE
CONSENT AGREEMENT BETWEEN JODI LYNN GORDON, R.N. AND OHIO BOARD OF NURSING
This Consent Agreement is entered into by and between JODI LYNN GORDON, R.N. (MS. GORDON) 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. GORDON 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 paaies, 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 resbictions 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@)(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)(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.
MS. GORDON has been licensed to practice nursing as a registered nurse in the State of Ohio, RN-311931, since July 2004. MS. GORDON requested to place her license on inactive status in February 2010.

C.
MS. GORDON knowingly and voluntarily admits to the factual and legal allegations set forth in the Notice of Opportunity for Hearing issued to her by the Board on July 30, 2010 (July 2010 Notice), a copy of which is attached hereto and incorporated herein. MS. GORDON states that this is the second time she took drugs from work for self-administration. MS. GORDON entered the Board's Alternative Program and successfully completed it in August 2009. MS. GORDON states, in her personal statement dated February 2010, that she had four years of sobriety until her relapse following a miscarriage in 2009. MS. GORDON has submitted a letter from her personal physician of twenty years stating that she was prescribed Percocet after her miscarriages in April and August 2009. Her physician also states that she is aware of MS. GORDON'S relapse and her efforts to continue her recovery.
F.
MS. GORDON submitted a letter, dated June 15, 2010, from her counselors from Wellspring Counseling, Columbus, Ohio, stating that MS. GORDON has sought counseling for Depression and Anxiety. MS. GORDON states that from September through December 2009, MS. GORDON did not deny any patient their validly prescribed medication. AGREED CONDITIONS
G.
Wherefore, in consideration of the foregoing and mutual promises hereinafter set forth, and in Lieu of any formal proceedings at this time, MS. GORDON knowingly and voluntarily agrees with the Board to the following terms, conditions, and limitations:
1 .
MS. GORDON'S license to practice nursing as a registered nurse is hereby suspended for an indefinite period of time, but not less eighteen (18) months from the date she placed her license on inactive status. MS. GORDON may submit a written request for reinstatement after September 1, 2011, if the conditions for reinstatement have been satisfied.
Conditions for Reinstatement

2.
MS. GORDON shall obey all federal, state, and local laws, and all laws and rules governing the practice of nursing in Ohio. MS. GORDON shall appear in person for interviews before the full Board or its designated representative as requested by the Board or its designee.
3.

4.
Within six (6) months prior to requesting reinstatement, MS. GORDON agrees that she will submit a request to the Bureau of Criminal Identification and Investigation (BCII) to conduct a criminal records check of MS. GORDON, including a check of Federal Bureau of Investigation (FBI) records, and shall cause BCII to submit MS. GORDON's criminal records check reports to the Board. MS. GORDON 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 reinstatement, MS. GORDON 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.
5.

6.
Within three (3) months prior to requesting reinstatement from the Board or its designee, MS. GORDON shall, at her expense, obtain an addiction psychiatric evaluation from a Board approved addiction specialist, who is certified by the American Board of Medical Specialties (ABMS) in Addiction Psychiatry and is approved in advance by the Board, and shall provide the Board with complete documentation of such evaluation. Prior to the evaluation, MS. GORDON shall provide the addiction specialist with a copy of this Consent Agreement and the attached July 2010 Notice. MS. GORDON shall execute releases to permit the addiction specialist to obtain any information deemed appropriate and necessary for the evaluation. The addiction specialist 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. GORDON's license, and a statement as to whether MS. GORDON is capable of practicing nursing according to acceptable and prevailing standards of safe nursing care.
7.
MS. GORDON shall provide the Board with satisfactory documentation of compliance with al aspects of the treatment plan developed by the addiction specialist l until released. Further, MS. GORDON agrees that the Board may use the addiction
specialist's recommendations and conclusions from the evaluation as a basis for additional terms, conditions, and limitations on MS. GORDON's license and that the terms, conditions, and limitations shall be incorporated in an addendum to this Consent Agreement.
Monitoring of Rehabitation and Treatment

8.
MS. GORDON 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. GORDON's history of chemical dependency and recovery status. MS. GORDON shall self-administer the prescribed drugs only in the manner prescribed.

9.
MS. GORDON shall abstain completely from the use of alcohol.

For a minimum, continuous period of six (6) months immediately ppior to requesting reinstatement, MS. GORDON 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. GORDON shall provide satisfactory documentation of such attendance to the Board prior to reinstatement. For a minimum, continuous period of six (6) months immediately prior to requesting reinstatement, MS. GORDON shall submit, at her expense and on the day selected, blood or urine specimens for drug andlor alcohol analysis at a collection site specified by the Board at such times as the Board may request. Upon and after MS. GORDON'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. GORDON shall be negative, except for substances prescribed, administered, or dispensed to her by another so authorized by law who has full knowledge of MS. GORDON'S history of chemical dependency and recovery status.
a. Within thirty (30) days prior to initiating drug screening, MS. GORDON shall provide a copy of this Consent Agreement and the attached 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 beating 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. GORDON. b. After initiating drug screening, MS. GORDON shall be under a continuing duty to provide a copy of this Consent Agreement and the attached July 2010 Notice, prior to initiating beatment, to additional beating practitioners, and to update the list of beating practitioners with the Board within forty-eight (48) hours of being tteated by another practitioner. Further, MS. GORDON 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 beatment.
10.
11.
Reporting Requirements of Lieensee

12.
MS. GORDON shall report to the Board, in writing, any violation of this Consent
Agreement within thiiy (30) days of the occurrence of the violation.
Jodi Lynn Gordon, R.N. Page 5 13.
MS. GORDON shall sign release of information forms allowing health professionals and other organizations to submit requested documentation or information directly to the Board.
14.
MS. GORDON 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. GORDON shall not submit or cause to be submitted any false, misleading, or
15.
16.
MS. GORDON 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.
MS. GORDON 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.
18. 19.
MS. GORDON shall verify that the reports and documentation required by this
Consent Agreement are received in the Board office.
MS. GORDON shall inform the Board within five (5) business days, in writing, of
any change in address andlor telephone number.
Nursine Refresher Course or Orientation Upon the request of the Board or its designee, MS. GORDON 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. Temooraw Narcotic Restrictions Unless otherwise approved in advance by the Board or its designee, MS. GORDON shall not administer, have access to, or possess (except as prescribed for MS. GORDON's use by another so authorized by law who has full knowledge of MS. GORDON's history of chemical dependency and recovery status) any narcotics, other controlled substances, or mood altering drugs for a minimum of TWEVLE (12) months in which MS. GORDON is working in a position that requires a nursing license. At any time after the twelve-month period ppwiously described, MS. GORDON may submit a written request to the Board to have this restriction re-evaluated. In addition, MS. GORDON shall not count narcotics or possess or carry any work keys for locked medication carts, cabinets, drawers, or
Jodi Lynn Gordon, R.N. Page 6 containers. MS. GORDON shall not call in or order prescriptions or prescription refills for any narcotics, other controlled substances, or mood altering drugs. Permanent Practice Restrictions MS. GORDON further knowingly and voluntarily agrees with the Board to the following
PERMANENT LICENSURE RESTRICTIONS:

Unless otherwise approved in advance, in writing, by the Board or its designee, MS. GORDON 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 stafting agencies or pools; (4) as an independent provider where the nurse provides nursing care in the patient's residence 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. GORDON to provide nursing services provided in the patient's residence for fees, compensation, or other consideration or as a volunteer. Unless otherwise approved in advance, in writing, by the Board or its designee, MS. GORDON 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 l i i t e d 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. GORDON 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 restriction(s), may be modified or terminated, in writing, at any time upon the agreement of both MS. GORDON and the Board. The Board may only alter the indefinite suspension imposed if: (I) MS. GORDON submits a written request for reinstatement; (2) the Board determines that MS. GORDON has complied with all conditions of reinstatement; (3) the Board determines that MS. GORDON is able to practice according to acceptable and prevailing standards of safe nursing care based upon an interview with MS. GORDON and review of the documentation specified in this Consent Agreement; and (4) MS. GORDON has entered into a Consent Agreement with the Board for
Jodi Lynn Gordon, K.N. Page 7 probationary terms, conditions, and limitations determined by the Board for a minimum period of three (3) years following reinstatement.
ACKNOWLEDGMENTS/LIABnITY RELEASE
MS. GORDON acknowledges that she has had an opportunity to ask questions concerning the
MS. GORDON waives all of her rights under Chapter 119, ORC, as they relate to matters that
are the subject of this Consent Agreement.
MS. GORDON waives any and all claims or causes of action she may have against the Board,
and its members, officers, employees andlor 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.
FFFECTIVE DATE
MS. GORDON 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.
IlI3/10
DATE
DATE Attorney for Jodi Lynn Gordon, R.N.
BERTHA LOVELACE. President Ohio Board of Nursing
DATE
Case iY1010376
Ohio Board s f Nursing

17 Soutli Higb Street, Suite 400 July 30,2010
4
,,,.,,,,,ing,0hi0.gov
Columbus, Ohio 43215-7410 * (614) 466-3947

Jodi Lynn Gordon, R.N. 1020 Rowland Ave. Columbus, OH 43228 Dear Ms. Gordon: 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 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. Beginning in September 2009 and through December 2009, while working as a nurse at Dublin Methodist Hospital in Dublin, Ohio, you diverted Percocet and Difaudid for your own personal use. On or about February 8, 2010, when meeting with an investigator from Ohio Health Corporate Security, you admitted that you diverted the narcotics one to two times during your shifts, and that you did so by keeping some of the medication that you removed for patients for yourself and that you self-administered the diverted narcotics at your homelresidence.
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)(13), ORC, authorizes the B o a ~ d discipline a licensee for obtaining or attempting to 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. 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.
Jodi Lynn Gordon, R.N Page 2 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-@nursinfr.ohio.frov.
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 registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation.
Sincerely,
Anne Barnett, RN, BSN, CWS Supervising Board Member Certified Mail Receipt No. 7009 1680 0001 8226 8271 Attorney Certified Mail Receipt No. 7009 1680 0001 8226 8288 cc: Melissa L. Witburn, Assistant Attorney General Elizabeth Y. Collis, Attorney for Ms. Gordon
Case #11-003108
July 27, 2012

Anmarie Gum PO Box 52 7788 Main Street Clinton, Ohio 44216 Dear Ms. Gum: On or about May 23, 2012, 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 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 April 25, 2012, in Summit County Court of Common Pleas Case Number CR 12 01 0098, 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)/(2)/(3), ORC; and one (1) count of Illegal Processing of Drug Documents, a felony of the fifth degree, in violation of Section 2925.23(A), ORC, and were found eligible for Intervention in Lieu of Conviction. The acts underlying this case occurred on or about March 4, 2011 while you were working as a nurse at Akron General Medical Center and involve you obtaining or exerting control over Vicodin/Hydrocodone without the consent of Akron General Medical Center or person authorized to give consent, and/or beyond the scope of consent, and/or by deception. Further acts underlying this case involve you on or about March 4, 2011 making a false statement in any prescription, order, report, or record involving Vicodin/Hydrocodone. 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
Anmarie Gum Page 2 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)(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 March 4, 2011, you withdrew two (2) tablets of Hydrocodone/Acet and one (1) tablet of Ibuprofen 400mg for Patient #1, identified on the attached Patient Key [Patient Key is confidential, to be withheld from public disclosure]. You did not document administering or wasting these tablets. Patient #1 did not have an order for Hydrocodone/Acet or Ibuprofen 400mg.
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), 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. 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, 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
Anmarie Gum Page 3 registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely,
Anmarie Gum Page 4
Patient Key (This Key is confidential pursuant to Section 4723.28(I) of the Ohio Revised Code, and is to be withheld from public disclosure) 1. James Ewing
Case #11-003108
May 23, 2012

Anmarie Gum, R.N. PO Box 52 7788 Main Street Clinton, OH 44216 Dear Ms. Gum: 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 April 25, 2012, in Summit County Court of Common Pleas Case Number CR 12 01 0098, 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)/(2)/(3), ORC; and one (1) count of Illegal Processing of Drug Documents, a felony of the fifth degree, 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: 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)/(2)/(3), ORC, and Illegal Processing of Drug Documents, a felony of the fifth degree, in violation of Section 2925.23(A), ORC, constitute felony drug abuse offenses as defined in Section 2925.01, ORC.
Anmarie Gum, R.N. Page 2 WHEREFORE, PURSUANT TO SECTION 3719.121(C), ORC, YOU ARE HEREBY NOTIFIED THAT YOUR LICENSE TO PRACTICE NURSING AS A REGISTERED NURSE, RN-346524, 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. 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 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 registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely,
Case #12-000114
July 27, 2012
Cindy Lynne Haitz, R.N. 3027 State Route 132 #40 Amelia, Ohio 45102 Dear Ms. Haitz: 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 June 15, 2012, in Clinton County Court of Common Pleas Case Number CRI 2012-5014, 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-241374, IS HEREBY SUSPENDED. Continued practice after receipt of this
Cindy Lynne Haitz, R.N. Page 2 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 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 15, 2012, in Clinton County Court of Common Pleas Case Number CRI 2012-5014, 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 March 23, 2011, through October 20, 2011, and involve you obtaining or exerting control over Oxycodone without the consent of Continental Manor, or person authorized to give consent. 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 August 29, 2011, you submitted an on-line application for the renewal of your license to practice nursing as a registered nurse (Application). Under the Compliance section of the Application, you were asked: [H]ave you been convicted of, found guilty of, pled guilty to, pled no contest to, pled not guilty by reason of insanity to, entered an Alford plea, received treatment or intervention in lieu of conviction or received diversion for a misdemeanor in Ohio, another state, commonwealth, territory, province, or country? This does not include traffic violations unless they are DUI/OVI. You answered No to this question. However, on or about January 26, 2010 in Clermont County Municipal Court Case Number 10CRB00204, you pled guilty to one (1) count of Misuse of Credit Card, a misdemeanor of the fourth degree, in violation of Section 2913.21, ORC.
Cindy Lynne Haitz, R.N. Page 3 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)(1), Ohio Administrative Code, 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 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. 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 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,
Case# 12-002649
July 27, 2012

Jessica Ann Hartley, L.P.N. 1316 High Street Portsmouth, Ohio 45662 Dear Ms. Hartley: You are hereby notified that 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. Under the November 2011 Consent Agreement, your license to practice as a licensed practical nurse was suspended, with the suspension stayed subject to probationary terms, conditions, and limitations for a minimum period of three (3) years. A. Item 8. of the November 2011 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. HARTLEY 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. HARTLEY shall be negative, except for substances prescribed, administered, or dispensed to her by another so authorized by law who has received a copy of this Consent Agreement prior to prescribing to MS. HARTLEY. Despite this provision, on the following dates, you failed to call Firstlab, the Boards random drug screen program administrator, to determine if you had been selected to provide a specimen: March 12, 2012, March 25, 2012, April 4, 2012, April 25, 2012, May 21 July 1, 2012. On the following dates, you were selected to provide a urine specimen and failed to do so: March 12, 2012, May 2, 2012, May 25, 2012, June 15, 2012, and June 16, 2012. On or about May 21, 2012, Firstlab suspended your account for non-payment and as of July 2, 2012, your account remains suspended. On or about June 6, 2012, you emailed the Board stating that: I have some financial challenges and have been unable to pay the $41 firstlab fee and $28 site collection fee and have been discharged from the firstlab services. The finances and time need [sic] to comply with this order I just dont have.
Jessica Ann Hartley, L.P.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 November 2011 Consent Agreement, you are hereby notified that it appears to the Board that you have violated Item 8. of the November 2011 Consent Agreement. YOU ARE FURTHER NOTIFIED THAT YOUR LICENSE TO PRACTICE NURSING AS A LICENSED PRACTICAL NURSE, PN #116558 IS HEREBY 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(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 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. Under the November 2011 Consent Agreement, your license to practice as a licensed practical nurse was suspended, with the suspension stayed subject to probationary terms, conditions, and limitations for a minimum period of three (3) years. 2. Item 8. of the November 2011 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. HARTLEY 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. HARTLEY shall be negative, except for substances prescribed, administered, or dispensed to her by another so authorized by law who has received a copy of this Consent Agreement prior to prescribing to MS. HARTLEY. Despite this provision, on the following dates, you failed to call Firstlab, the Boards random drug screen program administrator, to determine if you had been selected to
Jessica Ann Hartley, L.P.N. Page 3 provide a specimen: March 12, 2012, March 25, 2012, April 4, 2012, April 25, 2012, May 21 July 1, 2012. On the following dates, you were selected to provide a urine specimen and failed to do so: March 12, 2012, May 2, 2012, May 25, 2012, June 15, 2012, and June 16, 2012. On or about May 21, 2012, Firstlab suspended your account for non-payment and as of July 2, 2012, your account remains suspended. On or about June 6, 2012, you emailed the Board stating that: I have some financial challenges and have been unable to pay the $41 firstlab fee and $28 site collection fee and have been discharged from the firstlab services. The finances and time need [sic] to comply with this order I just dont have. 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 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 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,
Jessica Ann Hartley, L.P.N. Page 4 Certified Mail Receipt No. 7012 1010 0002 4225 4948 Attorney Certified Mail Receipt No. 7012 1010 0002 4225 4955 cc: Henry G. Appel, Assistant Attorney General Richard E. Wolfson, Esq.

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Colutnbus, Ohio 43215-7410
To Whom It May Concern: You recently requested records regarding Jessica Ann Hal-tley, P.N. # 116558. Enclosed are records in response to your request. Information has been redacted, per Section 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
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CONSENT AGREEMENT BETWEEN JESSICA ANN HARTLEY, L.P.N. AND OHIO BOARD OF NURSlNC
This Consent Agreement is entered into by and between JESSICA ANN HARTLEY, L,P.N. (MS. HAlITLEY) and the Ohio Board of Nursing (Board), the state agency cl~argcdwith enforcing Chapter 4723. of the Ohio Revised Code (ORC), and all administrative rules prumulgated 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: March 18,201 1 Notice of Opportunity for Hearing (iUarch 201 1 Koticc). This Consent Agreement contains the entire agreement between the parties, there being no other agreement of any kind, verbal or otbe~wise, which varies the tenns of this Consent Agrccmcnt.
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, OIIC, to deny, permanently revoke, revoke, suspend, or place restrictions on any license issued by the Board; reprimand or otherwise discipline a licensee; or unpose a fine of five hundred dollars ($500.00) or less per violation. Section 4723.28(B)(4), ORC, authorizes the Bead to discipline a licensee for conviclion 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 itiln~orality or moral turpitude. Section 4723.28(8)(8), ORC, authorizes the Board to discipline a licensee for self-administering or otherwise taking into the body any dangerous dm& as defined in Section 4729.0L, ORC, in any way not in accordance with a legal, valid prescription issued for that individual.
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B.
C.
D.
MS. HARTLEY's license to practice nursing as a licensed practical nurse, PN-116558, in the State of Ohio, was initially issued in September 2004. MS. HARTLEY ktiowingly and voluntarily admits to the factual and legal allegations set forth in the March 2011 Notice. MS. HARTLEY knowingly and voluntarily admits to the following:
1. MS. HARTLEY admits that she abused crack cocaine in 2007 while enrolled in Shawnee State University's educational program to obtain a degree in registered nursing. completed Intensive 2. In December 2007, MS. HARTLEY successfullj~ Group chemical dependence therapy with the Counseling Center, Scioto County, Ohio.
4. MS. HARTLEY also has submitted documentation evidencing her attendance at AA meetings, and MS. HARTLEY states that she continues to regularly participate in AA meetings. MS. HARTLEY provided a letter in support from her Pastor stating that he provides spiritual counseling for MS. HARTLEY and that MS. HARTLEY continues to work the steps of AA.
5. In September 2011, MS. HARTLEY was evaluated for chemical dependency at Paint Valley Mental Health Center. Paint Valley recommended that MS. HARTLEY continue to attend AA meetings and counseling sessions.
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. HARTLEY knowingly and voluntarily agrees with the Board to the following terms, conditions, and limitations: MS. HARTLEY's license to practice nursing as a licensed practical uurse shall be suspended indefinitely. Such suspension
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Jcssica Ann Hartley, L.P.N. Page 3 shall be stayed, subjcct to the following PROBATIONARY terms, conditions, and limitations for a minimunl period of three (3) years:
1.
2. 3.
MS. 'XARTLEY shall obey all federal, state, and local laws, and all laws anti t l s governing the practice of nursing in Ohio. ue MS. HARTLEY shall appear in person for interviews before the full Board or its designated repr.esentative as requested by the Board or its designee.
MS. HARTLEY s/~all work in a position that reqrrires a ?zursirrg license not
rttitil she s~rbmitsn written reqrrest to work a a nurse and obtniris ~vritte~z s approvalfronz rlie Board or its designee. M S . HARTLEY must be in full colnpliance with this Consellt Agreement prior to requesting to work as ti nurse.
4.
MS. HARTLEY agrees that she will submit a rcqucst to the Bureau of Criminal Identification and Investigation @CII) to conduct a criminal records check of MS. HARTLEY, including a check of Federal Bureau of Investigation (FBI) records, and shall cause BCII to submit MS. HARTLEY's criminal records check reports to the Board. MS. HARTLEY's completed criminal records check, including the FBI check, must be received by the Board prior to MS. HARTLEY requesting to work as a nurse.
5.
Prior to requesting to wurk as a nurse, MS. HARTLEY shall, in addition to the requirements of licensure renewal, successfully complete ~ n d submit satisfactory documentation of successful completion of the following continuing nursing education, or another compmable course approved in advance by the Board or its designee, all taken subsequent to the effective date of this Consent Agreement: fifteen ((15) hours of chemical dependency and five (5) hours of professiooalism.
Monitoring
6.
MS. HARTLEY shall abstain completely froin the personal use or possession of drugs, except those prescribed, administcrcd, or dispensed to her by another so authorized by la\\' who has received a complete copy of this Consent Agreement prior to prescribing for MS. HARTLEY. MS. HARTLEY shall self-administer the prescribed drugs only in the rrnanner prescribed.
MS. HAKTLEY shall abstain co~npletely &om the use of alcohol or products containing alcohol.
7.
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8.
For a minimu~n, continuous period of three (3) montlls immediately prior to requesting t o work a s a nurse and continuing throughout the probationary period, MS. IIARTCEY shall submit, at her expense and on the day selected, blood or urine specimens for drug andlor alcohol analysis at a collection site specified by the Board at such times as the Board may request. Refusal to subnlit 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 hlS. HARTLEY 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. HAKTLEY. Within three (3) months immediately prior to requesting to work as a nurse, MS. HARTLEY 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. HAKTLEY shall provide the chemical dependency professional with a copy of this Consent Agreement and assessments, evaluations, and treatment records from The Counseling Center and Star. Further, MS. IIARTLEY shall exccutc 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 a11d monitoring, any additional restrictions that should be placed on MS. FIAKTLEY's license to practice, and stating whether MS. HARTLEY is capable of practicing nursing according to acceptable and prevailing standards of safe nursing care.
9.
10.
MS. HARTLEY shall provide the Board with satisfactory documentation of compliance with all aspects of the treatment plan developed by the chemical dependency pmfessional described above until released. Further, MS. HARTLEY 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. IIARTLEY's license and that the terms, conditions, and limitations may be incorporated in an addendum to this Consent Agreement.
For a minimum, continuous period of three (3) months immediately prior to requesting to work as a nurse, MS. HARTLEY shall attend a minimum of one (I) meeting per week of a support or peer group meeting approved in advance by the Board, or a Twelve Step program, and MS. WRTLEY shall provide satisfactory documentation of such attendance to the Board prior to requesting to work as a nurse and every six (9months thereafter.
11.
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Jessica Ann Hartley, L.P.N. Page 5 Counseling 12.
MS. BARTLEY shall continue to participate in alcoI~ol/chemicaldependency cou~~seling intervals dec~ned at appropriate by her current licensed counselor or anorher cou~lselorapproved in advance by the Board or its designee. MS. HARTLEY shall provide the connselor with a copy of this Consent Agreement within thirty (30) days prior to requesting to work a s a nurse. MS. HARTLEY shall have the counselor provide the Board with quaaerly reports beginning within sixty (60) days following the date MS. HARTLEY is approved to work as a nurse and documenting compliance with all aspects of her current treatment plan developed by her counselor until released. Further, MS. HARTLEY agrees that the Board may use the counselor's recommendations and conclusions from the reports as a basis for additional terms, conditions, and limitations on MS. HARTLEY's license and that the terms, conditions, and limitations shall be incorporated by an addendum to this Consent Agreement.

13.
Prior to initiating drug screening, MS. HARTLEY 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 duty to provide numbers. Further, MS. HARTLEY shall be under a coutini~ing 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. HARTLEY 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 presclibed, administered, or dispensed to MS. HARTLEY throughout the duration of this Consent Agreement. Within twenty-four (24) hours of release from hospitalization or medical treatment, MS. HARTLEY shall notify the Board of any and all medication(s) or prescription(s) received.
14.
15.
16.
17.
Prior to accepting employment as a nurse, each time and with every employer, MS. HARTLEY shall notify the Board, in writing.
MS. HARTLEY is under a continuing duty to provide a copy of this Consent Agreement to any new employer prior to accepting nursing en~ployment. MS. HARTLEY shall have her employer(s), if working in a position where a
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Jessica Ann I-IatIey, L P N . Page 6 nursing license is required, submit written reports regarding job performance on a quarterly basis beginning within thirty (30) days of accepting nursing employment. MS. RARTLEY shall have her employer(s) send documentation to the Board, along with the first ernployer report, of receipt of a copy of this Consent Agreement, including the date the Consent Agreement was received. Reporting Requirements of Licensee
18.
MS. HARTLEY shall report to the Board, in writing, any violation of this
19.
MS. HARTLEY shall sign release of information forms allowing health professionals and other organizations to submit the requested documentation dicectly to the Board. MS. HARTLEY sl,all submit auy and all infonnation that the Board may request regarding her ability to practice according to acceptable a11d prevailing stnndards of safe nursing practice.
20.
21.
MS. HARTLEY 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.
22.
MS. HARTLEY shall submit the reports and documentation required by this Consent Agreement on forms specified by the Board. All reporting and
comnunications required by this Consent Agreement shall be made to the Compliance Unit of the Board.
23.
MS. HARTLEY 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.
24.
25.
MS. HARTLEY shaU verify that the reports and documentation required by
this Consent Agreement are received in the Board office. MS. HARTLEY shall inform the Board within five (5) business days, in writing, of any change in employment slatus or of any change in residential or home address or telephone number.
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Jessica Ann Hartley ,L.P.N. Page 7 Nuvsinv Refresl~er Course Upon request by the Board or its designee, MS. HARTLEY shall, prior to working in a position where a nursing license is required, complete and submit satisfactoly documentation of completion of a refresher course or an extensive orientation to be approved in advance by the Board or its designee. Temaorary Practice Restrictions
MS. HARTLEY 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 tlrraugh State agencies or agents ofthe State; or (5) for an individual or group of individuals who directly engage MS. HARTLEY to provide nursing services for fees, compensation, or other consideration or as a volunteer. MS. HARTLEY 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 Hursing, Nurse Manager, Vice President of Nursing.
FAILURE TO CObIPLY
MS. HARTLEY agrees that her licerise to practice nursing as a licensed practical nurse will be automatically suspended if it appears to the Board that MS. HARTLEY has violated or breached any terms or conditions of the Consent Agreement. Following the automatic suspension, the Board shall notify &IS. HARTLEY via certified mail of the specific nature of the charges and automatic suspension of her license. Upon receipt of this notice, bIS. RARTI,EY may request a hearing regarding the charges.
The above described terms and conditions shall constitute "restrictions placed on a iicense" for purposes of Section 4723.28(B), ORC. If, in the discretion of the Board. IMS. RARTLEY 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 tlie laws of Ohio occurring before the effective date of this Consel~t Agreement.
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. HARTLEY and the Board. The Board may only alter the probationary period imposed by this Consent Agreement if: (1) the Board determines that MS. HARTLEY has complied with all aspects of this Consent Agreement; and (2) the Board determines that hIS. HARTLEY is able to practice according to
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Jessica Ann Hartley, L.P.N, Page 8 acceptable and prevailing standards of safe nursing care without Board monitoring, based upon an intervjew with MS. HARTLEY and review of the reports as required herein. Any period during which MS. HARTLEY does not work in a position for which a nursing license is required shall not count to\r,ard fulfilling the probationary period imposed by this Consent Agreement.
ACKNOWLEDGMENTS I LIABILITY RELEASE
MS. HARTLEY acknowledges that slie hs had an opportunity to ask questions concerning the a
MS. HARTLEY waives all of her rights under Chapter 119, ORC, as they relate to matters that
MS. HAKTLEY waives any and all clain~s causes of action slie may have against the Board, or and its members, officers, employees andlor 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 cot~lply with the Administrative Procedures Act, Chapter 119, ORC.
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Jessica Ann Hartley, LP.N.
Page 9
MS. HARTLEY understands that this Consent Agreement is subject to ratification by the Board prior to signalre by the Board President and shall become effective upon the last date of signature below.
DATE
1 ;
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Case # 201 1-000953
17 South Iligl~ Streel. Suite 400 * C'olunlbi~\. Ohio 43215-7410
(614)466-3937
March 18,2011

Jessica Ann Hartley, L.P.N. 1316 High Street Portsmouth, OH 45662 Dear Ms. Hartley: 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:
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 hearing, the request must be made in writing and on this matter. If you wish to request sucl~ 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 heariug, 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, O H 43215-7410, o r to the email address, hcaringQllursir~g.ohio.~ov.
Jessica Ann Hartley, L.P.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 the Notice of Opportunity for Hearing, to deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursilig 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,
c &
d.l2tL-L.
Judith A. Church, R.N., C.N.P. Supervising Board Member Certified Mail Receipt No. 7010 1870 0002 0349 9742 Attorney Certified Mail Receipt No. 7011 0110 0001 5955 7760 cc: Melissa L. Wiiburn, Assistant Attorney General Richard E. Wolfson, Attorney for Jessica Ann Hartley, L.P.N.
Case 12-000550
July 27, 2012

Marcelle Marie Haslage, L.P.N. 855 Douglas Street Vermilion, Ohio 44089 Dear Ms. Haslage: 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, while working as a nurse at Kingston of Vermilion Skilled Nursing and Rehabilitation Center (Kingston of Vermilion), in Vermilion, Ohio, you submitted a drug screen specimen, which was positive for opiates, specifically, morphine. You did not have a current, valid prescription for morphine. On or about February 16, 2012, you met with a Board Compliance Agent regarding the February 13, 2012 drug screen and admitted to having selfadministered a morphine tablet that you obtained from a friend or relative. 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. While employed as a licensed practical nurse at Kingston of Vermilion, the following occurred: On or about February 10, 2012, you signed out a Fentanyl 25 mcg patch for Patient #1 as ordered for that patient [see Attached Patient Key to Remain Confidential and Not Subject to Public Disclosure]. You documented on Patient #1s Medical Administration Record that you had administered the Fentanyl patch on February 10, 2012 to the patients left chest. The patient was discovered to have a Clonidine 0.2 mg patch on his left chest and the Fentanyl 25 mcg patch that you signed out for Patient #1 was unaccounted for. Section 4723.28(B)(19), ORC, authorizes the Board to discipline a licensee for failure to practice
Marcelle Marie Haslage, L.P.N. Page 2 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. Rule 4723-406(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(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 licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely,
Marcelle Marie Haslage, L.P.N. Page 3 Certified Mail Receipt No. 7012 1010 0002 4225 1374 Attorney Certified Mail Receipt No. 7012 1010 002 4225 1381 cc: Henry G. Appel, Assistant Attorney General Jack W. Bradley, Esq.
Case# 12-001560
July 27, 2012

Kevin Hayes, TC1, OCDT Applicant 13507 Claiborne Road Cleveland, Ohio 44112 Dear Mr. Hayes: 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 temporary dialysis certificate one and any future certificates granted upon successful completion of the application process to practice as a dialysis technician in the State of Ohio would be suspended indefinitely and that such suspension would be stayed subject to the following probationary terms, conditions and limitations for a minimum period of at least one (1) year. A. You were issued a temporary dialysis certificate one to practice as a dialysis technician in the State of Ohio on January 30, 2012. B. Item 4. of the January 2012 Consent Agreement states, Within ninety (90) days from the effective date of this Consent Agreement, MR. HAYES, 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. Despite this provision, as of June 15, 2012, you have failed to submit to the Board documentation of satisfactory completion of two (2) hours of critical thinking and two (2) hours of professionalism. C. Item 7. of the January 2012 Consent Agreement states, Within ninety (90) days of the effective day of this Consent Agreement, MR. HAYES 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. HAYES shall provide the chemical dependency professional with a copy of this Consent Agreement. Further, MR. HAYES shall execute releases to permit the
Kevin Hayes, TC1, OCDT Applicant Page 2 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. HAYESs certificate to practice as a dialysis technician, and a statement as to whether MR. HAYES is capable of practicing as a dialysis technician according to acceptable and prevailing standards of safe dialysis care. Despite this provision, as of June 15, 2012, you have failed to submit to the Board documentation of a completed chemical dependency 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 dialysis technician certificate 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 4. and 7. of the January 2012 Consent Agreement. YOU ARE FURTHER NOTIFIED THAT YOUR TEMPORARY DIALYSIS ONE CERTIFICATE TO PRACTICE AS A DIALYSIS TECHNICIAN, TC1-03792, 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), 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 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 temporary dialysis certificate one and any future certificates granted upon successful completion of the application process to practice as a dialysis technician in the State of Ohio would be suspended indefinitely and that such suspension would be stayed subject to the following probationary terms, conditions and limitations for a minimum period of at least one (1) year. 2. You were issued a temporary dialysis certificate one to practice as a dialysis technician in the State of Ohio on January 30, 2012. 3. Item 4. of the January 2012 Consent Agreement states, Within ninety (90) days from the effective date of this Consent Agreement, MR. HAYES, in
Kevin Hayes, TC1, OCDT Applicant Page 3 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. Despite this provision, as of June 15, 2012, you have failed to submit to the Board documentation of satisfactory completion of two (2) hours of critical thinking and two (2) hours of professionalism. 4. Item 7. of the January 2012 Consent Agreement states, Within ninety (90) days of the effective day of this Consent Agreement, MR. HAYES 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. HAYES shall provide the chemical dependency professional with a copy of this Consent Agreement. Further, MR. HAYES 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. HAYESs certificate to practice as a dialysis technician, and a statement as to whether MR. HAYES is capable of practicing as a dialysis technician according to acceptable and prevailing standards of safe dialysis care. Despite this provision, as of June 15, 2012, you have failed to submit to the Board documentation of a completed chemical dependency 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 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 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.
Kevin Hayes, TC1, OCDT Applicant Page 4 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 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. Sincerely,
Case #11-004433
Obi8 Board of Nursing

17 South High Streel, Suite 400
o
www.nursing.ohio.gov
r
Colo~nbus, Ohio 43215-7410
(614) 466-3947
CONSENT AGREEMENT BETWEEN KEVIN HAYES, TC1 APPLICANT, OCDT APPLICANT AND OHIO BOARD OF NURSING
This Consent Agreement is entered into by and between KEVIN HAYES, TC1 APPLICANT, OCDT APPLICANT (MR. HAYES) 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 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 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 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 October 24, 2011, MR. HAYES submitted to the Board an Application for a Temporary Certificate and Certificate to Practice as a Dialysis Technician in Ohio (Application).
B.
Kevin Hayes, TC1 Applicant, OCDT Applicant Page 2
C.
MR. HAYES knowingly and voluntarily admits that in 2008 and in Rocky River Municipal Court, MR. HAYES was convicted of one (1) misdemeanor count of Drug Abuse that stemmed from a law enforcement officer finding Marijuana in MR. HAYES'S vehicle during a routine traffic stop.
In his personal statement, MR. HAYES reported that he is drugfree and that the Marijuana found in his vehicle was not his and belonged to a friend.
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, MR. HAYES knowingly and voluntarily agrees with the Board to the following terms, conditions, and limitations: MR. HAYES'S temporary certificate one and any future certificates granted upon successful completion of the application process to practice as a dialysis technician in the State of Ohio are suspended indefinitely by this Consent Agreement. Such suspensions are stayed, subject to the following probationary terms, conditions, and limitations for a minimum period of at least one ( I ) year:
1.
MR. HAYES shall obey all federal, state, and local laws, and all laws and rules governing the practice of dialysis technicians in Ohio. MR. HAYES shall appear in person for interviews before the full Board or its designated representative as requested by the Board or its designee.
2.

3.
Within ninety (90) days prior to submitting a request for release from the probationary terms, conditions and limitations of this Cousent Agreement, MR. HAYES agrees that he will submit a request to the Bureau of Criminal Identification and Investigation (BCII) to conduct a criminal records check of MR. HAYES, including a check of Federal Bureau of Investigation (FBI) records, and shall cause BCII to submit MR. HAYES'S criminal records check reports to the Board. MR. HAYES agrees that a request for release from the probationary 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.
Kevin Hayes, TC1 Applicant, OCDT Applicant Page 3 Continuing Education Hours
4.
Within ninety (90) days from the effective date of this Consent Agreement, MR. HAYES, 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.
Monitoring and Chemical Dependency Evaluation

5.
MR. HAYES 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 who has full knowledge of MR. HAYES'S history. MR. HAYES shall selfadminister prescribed drugs only in the manner prescribed. MR. HAYES shall abstain completely from the use of alcohol, if recommended by a chemical dependency professional, as referenced in Paragraph 7. below. Within ninety (90) days of the effective day of this Consent Agreement, MR. HAYES 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. HAYES shall provide the chemical dependency professional with a copy of this Consent Agreement. Further, MR. HAYES 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. HAYES'S certificate to practice as a dialysis technician, and a statement as to whether MR. HAYES is capable of practicing as a dialysis technician according to acceptable and prevailing standards of safe dialysis care. MR. HAYES 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. HAYES agrees that the Board may utilize the professional's recommendations and conclusions from the evaluation as a basis for additional tenns, conditions, and limitations on MR.
HAYES'S certificate to practice as a dialysis technician and that the terms, conditions, and limitations may be incorporated in an addendum to this Consent Agreement. Treating Practitioners and Reporting 9. Within sixty (60) days of the effective date of this Consent Agreement, MR. HAYES 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. HAYES 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. HAYES 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. HAYES throughout the duration of this Consent Agreement.
Within twenty-four (24) hours of release from hospitalization or medical treatment, MR. HAYES shall notify the Board of any and all medication(s) or prescription(s) received.
10.
11.
12.
Prior to accepting employment as a dialysis technician, each time with every employer, MR. HAYES shall notify the Board of the name and address of the employer in writing. Within thirty (30) days following the effective date of this Consent Agreement, MR. HAYES shall provide his employer(s) with a copy of this Consent Agreement. MR. HAYES 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 dialysis technician certificate is required. MR. HAYES shall have his employer(s), if working in a position where a certificate to practice as a dialysis technician is required, submit written reports regarding job performance on a quarterly basis beginning March 1, 2012 or within thirty (30) days of accepting employment as a dialysis technician. MR. HAYES shall have his employer(s) send documentation to the Board, along with the first employer report, of
13.
receipt of a copy of this Consent Agreement, including the date the Consent Agreement was received.
Reporting Requirements of Certificate Holder

14.
MR. HAYES shall report to the Board, in writing, any violation of this Consent Agreement within thirty (30) days of the occurrence of the violation. MR. HAYES shall sign release of information forms allowing health professionals and other organizations to submit the requested documentation directly to the Board. MR. HAYES 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. HAYES 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. HAYES 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. MR. HAYES 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. HAYES shall verify that the reports and documentation required by this Consent Agreement are received in the Board office. MR. HAYES 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.
16.
17.
18.
19.
20.
21.
Temporarv Practice Restrictions MR. HAYES further knowingly and voluntarily agrees with the Board to the following TEMPORARY CERTIFICATE RESTRICTIONS: MR. HAYES shall not practice as a dialysis technician (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
Kevin Hayes, TC1 Applicant, OCDT Applicant Page 6 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. HAYES 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. HAYES 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. HAYES has violated or breached any terms or conditions of the Consent Agreement. Following the automatic suspension(s), the Board shall notify MR. HAYES 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. HAYES 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. HAYES 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.

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. HAYES and the Board. The Board may only alter the probationary period imposed by this Consent Agreement if: (1) the Board determines that MR. HAYES has complied with all aspects of this Consent Agreement; and (2) the Board determines that MR. HAYES is able to practice according to acceptable and prevailing standards of safe dialysis technician care without Board monitoring, based upon an interview with MR. HAYES and review of the reports as required herein. Any period during which MR. HAYES 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.
ACKNOWLEDGMENTSlLIABILITY RELEASE
MR. HAYES 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. HAYES waives all of his rights under Chapter 119, ORC, as they relate to matters
that are the subject of this Consent Agreement.
MR. HAmS
waives any and all claims or causes of action he may have against the Board, and its members, officers, employees andlor agents nrising out of matters, which are the subject of this Consent Agreement. This Conserrt Agreement shall be considered a public record as that term is used i n Section 149.43, ORC. The information contained herein may be reported to approprinte orgnnizntions, data banks and govenunental bodies. This Consent Agreement is not an adjudication order as discussed in Chapter 119, ORC. Any action initiated by the Board bnsed on nlleged violntions of this Consent Agreement shall comply with the Administrative Procedures Act, Chapter 119, ORC.
MR. HAYES understands that this Consent Agreement is subject to ratification by the
Board prior to eignhture by the Board President and shall become effective upon the last date of signature below,
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OCDTAPPLICANT
i KEVIN I~LY'I~s, S
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BERTHA LoVE~ACE, Prmident Ohio Board oP Nuising I
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01/17/2012
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Case #12-001162
July 27, 2012

Dawn Nicole Hazelton, R.N. 51 Dartmouth Road Springfield, Ohio 45504 Dear Ms. Hazelton: 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 March 15, 2012, in Franklin County Court of Common Pleas Case Number 11CR-08-4335, you pled guilty to and were subsequently found guilty of one (1) count of Theft by Deception, a misdemeanor of the first degree, in violation of Section 2913.02, ORC. The acts underlying this criminal case occurred from on or about August 21, 2010, to on or about September 15, 2010, in Franklin County, Ohio and consisted of you billing for services not rendered while working, in part, as an independent provider, home health nurse.
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, a misdemeanor committed in the course of practice. 2. Your Medicaid Provider Agreement (No. 2683976) was voluntarily terminated with the Ohio Department of Job and Family Services effective January 27, 2011.
Section 4723.28(B)(1), ORC, authorizes the Board to deny a license or otherwise 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.
Dawn Nicole Hazelton, R.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 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 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; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely,
Case# 12-001642
July 27, 2012

Darcy Anne Hempker, R.N. 224 Leston Avenue Kenton, Ohio 43326 Dear Ms. Hempker: You are hereby notified that, on or about November 20, 2009, you entered into a Consent Agreement (November 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 upon meeting the requirement for renewal, 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 at least September 2012. Attached to and incorporated within the November 2009 Consent Agreement is a September 22, 2006 Consent Agreement (September 2006 Consent Agreement). A. Item 5. of the November 2009 Consent Agreement states, MS. HEMPKER shall abstain completely from the use of alcohol. Item 6. of the November 2009 Consent Agreement states, MS. HEMPKER shall continue 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. HEMPKER shall be negative, except for substances prescribed, administered, or dispensed to her by another so authorized by law who has full knowledge of MS. HEMPKERs history of chemical dependency and recovery status. Despite these provisions, on March 31, 2012, you provided a urine specimen for analysis to Firstlab, the Boards random drug/alcohol screen program administrator, that tested positive for Ethyl Glucuronide (Alcohol). You submitted a written statement dated April 17, 2012, to the Board admitting to consuming a couple of drinks of Alcohol at a wedding on March 30, 2012. Also, on the following dates, you failed to call Firstlab, the Boards random drug/alcohol screen program administrator, to determine if you had been selected
Darcy Anne Hempker, R.N. Page 2 to provide a urine specimen: June 11, 2011; October 22, 2011; and March 12, 2012. Furthermore, on the following dates, you were selected to provide a urine specimen for analysis and failed to do so: November 29, 2010; January 31, 2011; and February 15, 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. In accordance with the paragraph under FAILURE TO COMPLY of the November 2009 Consent Agreement, you are hereby notified that it appears to the Board that you have violated Items 5. and 6. of the November 2009 Consent Agreement. YOU ARE FURTHER NOTIFIED THAT YOUR LICENSE TO PRACTICE NURSING AS A REGISTERED NURSE, RN-233710, 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 November 20, 2009, you entered into a Consent Agreement (November 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 upon meeting the requirement for renewal, 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 at least September 2012. Attached to and incorporated within the November 2009 Consent Agreement is a September 22, 2006 Consent Agreement (September 2006 Consent Agreement). 2. Item 5. of the November 2009 Consent Agreement states, MS. HEMPKER shall abstain completely from the use of alcohol. Item 6. of the November 2009 Consent Agreement states, MS. HEMPKER shall continue 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
Darcy Anne Hempker, R.N. Page 3 require a daily call-in process. The specimens submitted by MS. HEMPKER shall be negative, except for substances prescribed, administered, or dispensed to her by another so authorized by law who has full knowledge of MS. HEMPKERs history of chemical dependency and recovery status. Despite these provisions, on March 31, 2012, you provided a urine specimen for analysis to Firstlab, the Boards random drug/alcohol screen program administrator, that tested positive for Ethyl Glucuronide (Alcohol). You submitted a written statement dated April 17, 2012, to the Board admitting to consuming a couple of drinks of Alcohol at a wedding on March 30, 2012. Also, on the following dates, you failed to call Firstlab, the Boards random drug/alcohol screen program administrator, to determine if you had been selected to provide a urine specimen: June 11, 2011; October 22, 2011; and March 12, 2012. Furthermore, on the following dates, you were selected to provide a urine specimen for analysis and failed to do so: November 29, 2010; January 31, 2011; and February 15, 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. 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
Darcy Anne Hempker, R.N. Page 4 registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely,
Case #09-5007

CONSENT AGREEMENT BETWEEN DARCY ANNE HEMPKER, R.N. AND OHIO BOARD OF NURSING
17 South High Street, Suite 400 * Colmnbus, Ohio 43215-7410 * (614) 466-3947
This Consent Agreement is entered into by and between DARCY ANNE HEMPKER, R.N. (MS. HEMPKER) 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. HEMPKER 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. MS. HEMPKER admits to violating Section 4723.28, ORC, as set forth in the attached Consent Agreement. On September 3, 1991, MS. HEMPKER was initially issued a license to practice nursing in Ohio as a registered nurse, RN233710, and she voluntarily placed her license on inactive status in 2005. Further, on October 13, 2005, MS. HEMPKER entered into the Board's Alternative Program for Chemical Dependency (AP Program) and was terminated from the AP program on May 30, 2006 due to noncompliance. On September 22, 2006, MS. HEMPKER and the Board entered into a Consent Agreement in which her license was indefinitely suspended (September 2006
B.
Darcy Anne Hempker, R.N. Page 2
Consent Agreement). A copy of the September 2006 Consent Agreement is attached hereto and incorporated herein. C. Under the terms of the September 2006 Consent Agreement, MS. HEMPKER is now eligible to request reinstatement of her license and she has submitted such a request in writing. MS. HEMPKER provided the Board with evidence from Hardin County Court of Common Pleas that in Case No. 20052079CR1, MS. HEMPKER was released from the terms of her Intervention in Lieu of Conviction on August 6, 2008. Further, MS. HEMPKER obtained a chemical dependency evaluation performed by Mimi Zarzar, Clinical Services Coordinator at the W.O.R.T.H. Center on January 22, 2008, where MS. HEMPKER completed chemical dependency treatment. Ms. Zarzar recommended that MS. HEMPKER participate in a 12 Step Program and to continue with counseling. On or about October 9, 2009, MS. HEMPKER obtained a chemical dependency evaluation at ASTOP, Inc. from Dee Bowsher, BS, LCDCIII, SWA, in Lima, Ohio. MS. HEMPKER was diagnosed is Opioid Dependence in Sustained Full Remission, Alcohol Dependence in Sustained Full Remission and Cocaine Abuse in Sustained Full Remission and no further treatment recommendations were made. Ms. Bowsher opined that MS. HEMPKER is capable of safely returning to the practice of nursing. On or about October 13, 2009, MS. HEMPKER reported to the Board Staff that she has not used narcotics since March 2005 and that she has abstained from alcohol use since July 2007.
D.
E.
F.
MS. HEMPKER understands that any violations of this Consent Agreement andlor any further violations of the laws and rules governing the practice of nursing may result in further disciplinary action, up to and including permanent revocation of her Ohio 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. HEMPKER knowingly and voluntarily agrees with the Board to the following terms, conditions, and limitations: Upon meeting the requirements for renewal, MS. HEMPKER's license to practice nursing as a registered nurse shall be reinstated and suspended indefinitely. Such
Darcy Anne Hempker, R.N. Page 3 suspension shall be stayed, subject to the following PROBATIONARY terms, conditions, and limitations until at least September 2012:
1.
MS. HEMPKER shall obey all federal, state, and local laws, and all laws and rules governing the practice of nursing in Ohio. MS. HEMPKER shall appear in person for interviews before the full Board or its designated representative as requested by the Board or its designee. Within sixty (60) days following the effective date of this Consent Agreement, MS. HEMPKER agrees that she will submit a request to the Bureau of Criminal Identification and Investigation (BCII) to conduct a criminal records check of MS. HEMPKER, including a check of Federal Bureau of Investigation (FBI) records, and shall cause BCII to submit MS. HEMPKER7s criminal records check reports to the Board. MS. HEMPKER agrees that a request to work as a nurse in Ohio will not be considered by the Board until the completed criminal records check, including the FBI check, has been received by the Board.
2.
3.
Monitoring of RehabiIitation and Treatment

4.
MS. HEMPKER shall abstain completely from the persona1 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. HEMPKER's history of chemicaI dependency and recovery status. MS. HEMPKER shall self-administer prescribed drugs only in the manner prescribed. MS. HEMPKER shall abstain completely from the use of alcohol. MS. HEMPKER shall continue submitting, at her expense and on the day selected, blood or urine specimens for dmg andlor 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 shaI1 require a daily call-in process. The specimens submitted by MS. HEMPKER shall be negative, except for substances prescribed, administered, or dispensed to her by another so authorized by law who has full knowledge of MS. HEMPKER7s history of chemical dependency and recovery status.
7.
MS. HEMPKER 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. HEMPKER shall provide satisfactory documentation of such attendance to the Board every six (6) months beginning January 1, 2010. Upon request by the Board or its designee and within sixty (60) days of such request, MS. HEMPKER 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. HEMPKER shall provide the chemical dependency professional with a copy of this Consent Agreement. Further, MS. HEMPKER 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. HEMPKER's license to practice, and a statement as to whether MS. HEMPKER is capable of practicing nursing according to acceptable and prevailing standards of safe nursing care. If an evaluation is requested, MS. HEMPKER 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. HEMPKER 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. HEMPKER'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. HEMPKER shall provide a copy of this Consent Agreement and the attached September 2006 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. HEMPKER shall be under a continuing duty to provide a copy of this Consent Agreement and the attachment, 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.
11.
MS. HEMPKER 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. HEMPKER throughout the duration of this Consent Agreement.
Within twenty-four (24). hours of release from hospitalization or medical treatment, MS. HEMPKER shall notify the Board of any and all medication(s) or prescription(s) received.
12.
13. Prior to accepting employment as a nurse, each time with every employer, MS. HEMPKER shall notify the Board in writing. Prior to accepting nursing employment, MS. HEMPKER shall provide her employer(s) with a copy of this Consent Agreement, the attached and the attached September 2006 Consent Agreement. Further, MS. HEMPKER is under a continuing duty to provide a copy of this Consent Agreement and the attachment to any new employer prior to accepting employment to work as a nurse. MS. HEMPKER shall have her employer(s) submit written reports regarding job performance on a quarterly basis commencing thirty (30) days after the beginning of nursing employment. MS. HEMPKER 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 attachment, including the date they were received.
14.

15.
MS. HEMPKER shall report to the Board, in writing, any violation of this Consent Agreement within thirty (30) days of the occurrence of the violation. MS. HEMPKER shall sign release of information forms allowing health professionals and other organizations to submit the requested documentation directly to the Board. MS. HEMPKER 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. HEMPKER 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.
16.
17.
18.
19.
MS. HEMPKER 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. HEMPKER 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. HEMPKER shall verify that the reports and documentation required by this Consent Agreement are received in the Board office. MS. HEMPKER 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.
20.
21.
22.
Nursing Refresher Course or Orientation Prior to working in a position where a nursing license is required, MS. HEMPKER shall complete and submit satisfactory documentation of completion of a nursing refresher course or an extensive orientation to be approved in advance by the Board or its designee. Tem~orarv Narcotic Restriction MS. HEMPKER shall not administer, have access to, or possess (except as prescribed for MS. HEMPKER's use by another so authorized by law who has full knowledge of MS. HEMPKER's history of chemical dependency and recovery status) any narcotics, other controlled substances, or mood altering drugs for a minimum of period of eighteen (18) months in which MS. HEMPKER is working in a position that requires a nursing license. At any time after the eighteen-month period previously described, MS. HEMPKER may submit a written request to the Board to have this restriction reevaluated. In addition, MS. HEMPKER shall not count narcotics or possess or carry any work keys for locked medication carts, cabinets, drawers, or containers. MS. HEMPKER shall not call in or order prescriptions or prescription refills. Permanent Practice Restrictions MS. HEMPKER 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. HEMPKER 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
Darcy Anne Hempker, R.N, Page 7 group of individuals who directly engage MS. HEMPKER 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. HEMPKER 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, VicePresident of Nursing.
FAILURE TO COMPLY MS. HEMPKER agrees that her license to practice nursing as a registered nurse will be automatically suspended if it appears to the Board that MS. HEMPKER has violated or
breached any terms or conditions of the Consent Agreement. Following the automatic suspension, the Board shall notify MS. HEMPKER via certified mail of the specific nature of the charges and automatic suspension of her license. Upon receipt of this notice, MS. HEMPKER 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. HEMPKER 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.

The terms, limitations, and conditions, of this Consent Agreement, other than the permanent practice restrictions, may be modified or terminated, in writing, at any time upon the agreement of both MS. HEMPKER and the Board. The Board may only alter the probationary period imposed by this Consent Agreement if: (1) the Board determines that MS. HEMPKER has complied with all aspects of this Consent Agreement; and (2) the Board determines that MS. HEMPKER is able to practice according to acceptable and prevailing standards of safe nursing care without Board monitoring, based upon an interview with MS. HEMPKER and review of the reports as required herein. Any period during which MS. HEMPKER 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.
$MS.HEM?-
acknowlsdgco that uhc has had a opportunity t . o questions reooc~ming rm of Ws Consent A g r c c m t and that all questions apkeb have bcan the e tlaaawcrtd in a sntiafwtory manner.
!'W.I1&MPKER w a i v e all of her rights under Chapter 119, ORC, s mmms that are the subject a this Conmnt Agmxtsnt, f
la
they relate to
rMS. HEbUKRR wltlrea any and all claims or c a w s of action she may havb against the 1 Board, and its rnembcra, offkeru, smployccs andlor agents wising out 01 rn$tlcrs. which r u che subject o this Consent Agromr*nt. e f
v
This Consent Agncrant ahall be conaidered a public record a3 thaf term is used in Section 149.43, ORC. Tbc informMion coatlined herein may ba npoMd td appropriate i orpnnizations, dam baors and g o v u m n e u bcdics.
''I'M6 Consvnlt Aprwment in hot an adjudication onlcr ss disrwrad in Chaptci. 119, ORC. Any action initiated by the Bawd basal on a l l e m violations of this Conse* Agreement shall comply with the Administrsrivt Procedures Act, Chapm 1 19, ORC.
- Uls b a r d prior to s i p m m by the Baard President and &all becams effecdn upon the
laot dam d signature below.
M . ?iEMl%ERunderstands Uur this Chn8enI Agreemeal i s subjsct to # t i f i ~ t i o c l by S
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DATE
Case # 05-0833,OS-0846,OS-2169 & 06-1339
CONSENT AGREEMENT BETWEEN DARCY ANNE HEMPKER, R.N. AND OHIO BOARD OF NURSING
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5.l This Consent Agreement is entered into by and between DARCY ANNE HEMPKER, R.N. (MS. HEMPKER) and the Ohio Board of Nursing (Board), the state a g e n c ~ c h & e d with enforcing Chapter 4723. of the Ohio Revised Code (ORC), and all administrative rules promulgated thereunder.
;
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MS. HEMPKER 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 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 4723.28(B)(8), ORC, authorizes the Board to discipline a licensee for self-administering or othenvise 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 inoney 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
Darcy Anne Hempker, R.N. Page 2 discipline a licensee for failure to practice in accordance with acceptable and prevailing standards of safe nursing care. Section 4723.28(B)(25), ORC, authorizes the Board to discipline a licensee for failure to comply with the terms and conditions of participation in the chemical dependency monitoring program established under Section 4723.35, 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, Rule 4723-6-03(A), Ohio Administrative Code, requires a participant in the Alternative Program for Chemical Dependency to comply with all of the terms and conditions of the participant's agreement with the Alternative Program for Chemical Dependency for the time period specified in the agreement. B.
MS. HEMPKER's license to practice nursing as a registered nurse in the State of Ohio, RN-233710, is inactive. MS. HEMPKER has been licensed as a registered nurse in Ohio since 1991. MS. HEMPKER knowingly and voluntarily admits to the following:
1. On or about November 2,2005, in Hardin County Court of Common Pleas Case Number 2005 CRI 2079, MS. HEMPKER pled guilty to one (1) count of Theft of Drugs, to wit: Demerol, a felony of the fourth degree, in violation of Section 2913,02(A)(2), (B)(6), ORC, and was found eligible for Intervention in Lieu of Conviction. The acts underlying Case Number 2005 CRI 2079 occurred in or about March 2005, while MS. HEMPKER was employed as a registered nurse in the emergency department at Hardin County Memorial Hospital in Kenton, Ohio, and involve MS. HEMPKER's theft of Demerol for her personal use. MS. HEMPKER was confronted regarding discrepancies after she passed out at work on March 26, 2005. MS. HEMPKER signed out Demerol for patients without physicians' orders, without documentation of administration of the Demerol andlor without wasting remaining Demerol. MS. HEMPKER admitted diverting Demerol since February 2005 and self-injecting up to 600 mgs of Demerol a day during and after work. MS. HEMPKER also admitted that, prior to her Demerol use, she began using more of her prescribed Vicodin than was ordered by her treating physician and was using pain medications prescribed for a member of her family.
C.
MS. HEMPKER was cooperative with the Board's investigation and she immediately made her nursing license inactive.
2. On October 13, 2005, effective through October 13, 2009, M S . HEMPKER entered into an Alternative Program Participant Agreement (Agreement) with the Board's Alternative Program for Chemical Dependency (Program).
Darcy Anne Hempker, R.N, Page 3
a.
MS. HEMPKER was assessed at ASTOP in Lima, Ohio in April 2005. MS. HEMPKER was diagnosed with Opioid Dependence and Alcohol Abuse and subsequently received treatment at Lutheran Social Services Behavioral Health Care in Lima, Ohio. MS. HEMPKER tested positive for Ethyl Glucuronide (alcohol) on December 29, 2005, March 23, 2006 and April 6, 2006, in violation of her Agreement. She admitted consuming beer prior to the December 29,2005 and April 6,2006 screens. MS. HEMPKER failed to, submit a specimen for screening on April 25,2006 and May 8,2006, in violation of her Agreement. MS. HEMPKER was terminated from the Program on May 30, 2006, based on her failure to comply with the terms and conditions of her Agreement. AGREED CONDITIONS
b.
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. HEMPKER knowingly and voluntarily agrees with the Board to the following terms, conditions, and limitations:
1.
MS. HEMPKER's license to practice nursing as a registered nurse is hereby suspended for an indefinite period of time, but not less than one year. M S . HEMPKER may submit a written request for reinstatement anytime after August 2007.

2.
MS. HEMPKER shall obey all federal, state, and local laws, and all laws and rules governing the practice of nursing in Ohio, and shall comply with her sentence in Hardin County Court of Common Pleas Case Number 2005 CRI 2079. MS. HEMPKER shall appear in person for interviews before the full Board or its designated representative as requested by the Board.
Prior to reinstatement, MS. HEMPKER 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.
MS. HEMPKER 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. HEMPKER's history of chemical dependency and recovery status. MS. HEMPKER shall self-administer the prescribed drugs only in the manner prescribed. MS. HEMPKER shall abstain completely from the use of alcohol. Within six (6) months prior to seeking reinstatement by the Board, MS. HEMPKER shall, at her own expense, seek a chemical dependency evaluation by a
Board approved chemical dependency professional and shall provide the Board with complete docurnentation of this evaluation. Prior to the evaluation, MS. HEMPKER shall provide the chemical dependency professional with a copy of this Consent Agreement. Further, MS. HEMPKER 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. HEMPKER's license to practice, and stating whether MS. HEMPKER is capable of practicing nursing according to acceptable and prevailing standards of safe nursing care.
6.
7.
8.
MS. HEMPKER shall provide the Board with satisfactorv documentation of compliance with all aspects of the treatment plan developed by the chemical dependency professional described above until released. Further, MS. HEMPKER 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. HEMPKER'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 ten (10) months immediately prior to requesting reinstatement, MS. HEMPKER shall submit, at her expense and on the
day selected, blood or urine specimens for drug andlor alcohol analysis at a collection site specified by the Board at such times as the Board may request. Upon and after MS. HEMPKER'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. HEMPKER shall be negative, except for substances prescribed, administered, or dispensed to her by another so authorized by law who has full knowledge of MS. HEMPKER's history of chemical dependency and recovery status.
9.
Darcy Anne Hempker, R.N. Page 5 a. Within thirty (30) days prior to MS. HEMPKER initiating drug screening, MS. HEMPKER 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. HEMPKER.
b. After initiating drug screening, MS. HEMPKER 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. HEMPKER 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.
For a minimum, continuous period of ten (10) months immediately prior to requesting reinstatement, MS. HEMPKER shall attend a minimum of one (I) 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.

11.
MS. HEMPKER shall report to the Board in writing, any violation of this Consent Agreement within thirty (30) days of the occurrence of the violation. MS. HEMPKER shall sign release of information forms allowing health professionals and other organizations to submit requested documentation or information directly to the Board. MS. HEMPKER 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. HEMPKER 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. HEMPKER 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.
12.
13.
14.
15.
Darcy Anne Hempker, R.N. Page 6 16.
MS. HEMPKER 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, Ohio 43215-7410.
17.
MS. HEMPKER shall verify that the reports and documentation required by this
Consent Agreement are received in the Board office.
18.
MS. HEMPKER shall inform the Board within three (3) business days, in writing, of
any change in address and/or telephone number.
Refresher Course or Orientation Upon request by the Board or its designee, MS. HEMPKER 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 approved in advance by the Board or its designee.
Temporarv Narcotic Restrictions Upon reinstatement of her license, MS. HEMPKER shall not administer, have access to, or possess (except as prescribed for MS. HEMPKER's use by another so authorized by law who has full knowledge of MS. HEMPKER's history of chemical
or dependency) any narcotics, other controlled s~lbstances, rnood altering drugs for a minimum period of eighteen (18) months in which MS. HEMl'KER is working in a position-that requires a nursing license. At any time after the eighteenminth period previously described, MS. HEMPKER may submit a written request to the Board to have this restriction re-evaluated. In addition, MS. HEMPKER shall not count narcotics or possess or carry any work keys for locked medication carts, cabinets, drawers, or containers. MS. HEMPKER shall not call in or order prescriptions or prescription refills
Permanent Practice Restrictions MS. HEMPKER 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. HEMPKER 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. H E M P K E R 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. HEMPKER shall not function in a position or employment where the job duties or
requirements involve management of nursing, nursing responsibilities, or supervising
Darcy Anne Hempker, R.N Page 7 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. HEMPKER 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.
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. HEMPKER and the Board. The Board may only alter the indefinite suspension imposed if: (1) MS. HEMPKER submits a written request for reinstatement; (2) the Board determines that MS. HEMPKER has complied with all conditions of reinstatement; (3) the Board determines that MS. HEMPKER is able to practice according to acceptable and prevailing standards of safe nursing care based upon an interview with MS. HEMPKER and review of the docuinentation specified in this Consent Agreement; and (4) MS. HEMPKER has entered into a Consent Agreement with the Board for probationary terms, conditions, and fimitatiol~s determined by the Board for a minimum period of three (3) years following reinstatement.
MS. HEMPKER acknowledges that she has had an opportunity to ask questions concerning the
MS. HEMPKER waives all of her rights under Chapter 119, ORC, as they relate to matters that
MS. HEMPKER 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.
Darcy Anne Hempker, 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 governments1 bodies.
EFFECTIVE DATE MS. HEMPKER 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.
DATE
F-iL!?
Case # 11-002376, 11-004922
July 27, 2012

Ashley Marie Hunter, R.N. 950 Gardner Rd. Kettering, Ohio 45429 Dear Ms. Hunter: 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. As set forth in Attachment A, while working as a nurse at Miami Valley Hospital in Kettering, Ohio, you failed to account for the administration of narcotics, withdrew narcotics without a physician order, and administered narcotics 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)(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 4723-4-06(E), 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. 2. On or about November 3, 2011, while working as a nurse at Knox Community Hospital in Mount Vernon, Ohio, you submitted a drug screen specimen that was positive for Opiates and Marijuana. 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. 3. On or about March 23, 2012 you told a Board Compliance Agent that you frequently used Vicodin that was prescribed to your grandmother.
Ashley Marie Hunter, R.N. Page 2 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. 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,
Ashley Marie Hunter, R.N. Page 3 ATTACHMENT A
PATIENT # Patient #1
Physician Order Percocet (Oxycodone) 1 to 2 tablets every 4 hours as needed Morphine 4 to 8mg every two hours as needed
Medication Withdrawal Percocet (Oxycodone) 1/17/11 14:18 (1 tablet) 18:35 (2 tablets) Morphine 1/17/11 8 mg. at 18:35 None None
MAR
Comments No waste. Percocet, 3 tablets unaccounted for.
Morphine, 8 mg. unaccounted for. None Nurses notes document the Patient was discharged at 14:04. The 18:35 removal of Percocet and Morphine were removed by override.
Patient #2
Dilaudid Dilaudid (Hydromorphone) (Hydromorphone) 0.5 mg every 2 2 mg. on hours as needed 3/31/11 at 8:17 (1.5 mg waste) 10:08 (1.5 mg waste) 12:08 (1.5 mg waste) 14:47 (1.5 mg waste) 4/2/11 at 15:36 (1.5 mg waste)
2.5 mg. unaccounted for. None
None
Ashley Marie Hunter, R.N. Page 4
Patient #4
Fentanyl (Sublimaze) 30 mcg. every 5 minutes as needed during dressing change
Fentanyl (Sublimaze) 100 mcg. 5/23/11 at 16:40 None
No waste. 100 mcg. unaccounted for. Nurses notes document the Patient was discharged at 14:49. Dose administered too soon. 6/6/11 at 10:16 11:26
Patient #7
Morphine Morphine 4 to 8 mg. every 2 8 mg. hours as needed 6/6/11 at 10:12 11:24 Percocet (Oxycodone) 1 to 2 tablets every 4 hours as needed Percocet (Oxycodone) 2 tablets 6/5/11 at 15:11
Patient #8
Percocet, 2 tablets unaccounted for None
Dilaudid Dilaudid (Hydromorphone) (Hydromorphone) 2 mg. 0.5 to 1 mg. every 3 hours as needed 6/5/11 at 15:11
Dilaudid, 2 mg. unaccounted for None
Case # 09-4908
July 27, 2012

Leslie Ann Hutson, R.N. 1449 Plainfield Dr. Lima, Ohio 45805 Dear Ms. Hutson: 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. As set forth in Attachment A, while working as a nurse at Baton Rouge Medical and Rehab Center in Lima, Ohio (Baton Rouge), you failed to account for the administration of controlled substances. On or about October 1, 2009, you told a Board Compliance Agent that, while working as a nurse at Baton Rouge, There is no time to document correctly; yes, I have documentation issues 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. 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.
Leslie Ann Hutson, 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 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,
Judith A. Church, R.N., C.N.P. Supervising Member Certified Mail Receipt No. 7012 1010 0002 4225 1763 Attorney Certified Mail Receipt No. 7012 1010 0002 4225 1770 cc: Henry G. Appel, Assistant Attorney General Lawrence S. Huffman, Esq.
Leslie Ann Hutson, R.N. Page 3
ATTACHMENT A
PATIENT # Patient #1
Physician Order Oxycodone (Percocet)
Medication Withdrawal Oxycodone (Percocet) None
MAR
Comments No waste 6 tablets unaccounted for
1 to 2 tablets 2 tablets on: every 4 to 6 hours as needed 9/14/09 at 8:45 PM 9/17/09 at 9:30 AM 9/19/09 at 8:30 AM
Patient #1
Hydrocodone (Vicodin)
Hydrocodone (Vicodin) None
No waste 2 tablets unaccounted for
1 tablet four times 1 tablet on: daily as needed for pain 9/21/09 at 9:40 AM 9/21/09 at 2:00 PM Patient #1 Alprazolam (Xanax) 1 to 2 tablets by mouth as needed Alprazolam (Xanax)
No waste None 2 tablets unaccounted for
1 tablet on: 9/7/09 at 1:40 PM 9/22/09 at 8:00 PM
Patient #1
Clonazepam (Klonopin) 1 tablet 4 times daily (routine)
Clonazepam (Klonopin) None 1 tablet on: 9/10/09 at 2:30 PM
No waste 1 tablet unaccounted for
Case # 11-004997
July 27, 2012

Jessica Lynette Jacklin, R.N. 3823 Winding Path Canal Winchester, Ohio 43110 Dear Ms. Jacklin: 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 August 2011, you submitted a cover letter and resume to Ohio American Health Care, Inc. (OAHC), a nursing school located in Columbus, Ohio, seeking to be employed as Director of Nursing for the [OAHC] school of Nursing. Your cover letter falsely states that you taught at Central Ohio Technical College (COTC) as an adjunct Clinical Instructor for Medical Surgical courses. Your resume falsely states that you were a Clinical Instructor at COTC from 2010 to September 2011; and further falsely reports that your duties with COTC included instructing nursing students at The Ohio State University Medical Center East (OSU). You completed a Faculty Data Form for OAHC in which you falsely state that your professional experience included employment with COTC in the clinical instruction of RN students from August 2009 until August 2011. 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), 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: (2) Current employers; (3) Prospective employers when applying for positions requiring a nursing license. 2. On or about October 12, 2011 you told a Board Education Surveyor (Surveyor) that you were hired by COTC as a Clinical Instructor. You further falsely stated to the Surveyor that while working for COTC you had instructed students at OSU. 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
Jessica Lynette Jacklin, R.N. Page 2
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 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,
Judith A. Church, R.N., C.N.P. Supervising Member Certified Mail Receipt No. 7012 1010 0002 4225 1589 Attorney Certified Mail Receipt No. 7012 1010 0002 4225 1596 cc: Henry G. Appel, Assistant Attorney General James M. McGovern, Esq.
Case #11-004614
July 27, 2012

Charlotte Renee Kennedy, L.P.N. 808 E. Russ Road Greenville, Ohio 45331 And 201 Taffy Court Union City, Ohio 45390 Dear Ms. Kennedy: 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 May 29, 2012, in Darke County Court of Common Pleas Case Number 12-CR-00033, you pled guilty to four (4) counts of Theft of Drugs, felonies of the fourth degree, in violation of Section 2913.02(A)(2),(B)(6), ORC; one (1) count of Deception to Obtain a Dangerous Drug, a felony of the fourth degree, in violation of Section 2925.22(A),(B)(2)(a), ORC; and two (2) counts of Deception to Obtain a Dangerous Drug, felonies of the fifth degree, in violation of 2925.22(A),(B)(3)(a), 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)(2),(B)(6), ORC; Deception to Obtain a Dangerous Drug, a felony of the fourth degree, in violation of Section 2925.22(A),(B)(2)(a), ORC; and Deception to Obtain a Dangerous Drug, felonies of
Charlotte Renee Kennedy, L.P.N. Page 2 the fifth degree, in violation of 2925.22(A),(B)(3)(a), 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-109309, 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 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 May 29, 2012, in Darke County Court of Common Pleas Case Number 12-CR-00033, you pled guilty to four (4) counts of Theft of Drugs, felonies of the fourth degree, in violation of Section 2913.02(A)(2),(B)(6), ORC; one (1) count of Deception to Obtain a Dangerous Drug, a felony of the fourth degree, in violation of Section 2925.22(A),(B)(2)(a), ORC; and two (2) counts of Deception to Obtain a Dangerous Drug, felonies of the fifth degree, in violation of 2925.22(A),(B)(3)(a), ORC, and were found eligible for Intervention in Lieu of Conviction. The acts underlying this case occurred in or about September 2011 through November 2011 and involve you obtaining Oxycodone/APAP and Hydrocodone/APAP beyond the scope of consent of the owner or person authorized to give consent. Further acts underlying this case occurred in or about March, April, September and October 2011 and involve you procuring prescriptions for dangerous drugs, being Oxycodone/Acetaminophen and Hydrocodone/Acetaminophen. 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. While working as a licensed practical nurse at Gade Healthcare Center in Greenville, Ohio, you withdrew narcotics and failed to document administration or waste as set forth in Attachment A. On or about November 28, 2011, you admitted to a Board Compliance Agent that you failed to document the administration of narcotics on several occasions.
Charlotte Renee Kennedy, L.P.N. Page 3 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. 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 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,
Charlotte Renee Kennedy, L.P.N. Page 4 ATTACHMENT A PATIENT # Patient #1 Physician Order Oxycodone/APAP 5/325mg. 1 tablet by mouth every 4 hours as needed for moderate pain. 2 tablets every 4 hours for severe pain. WITHDRAWAL FROM CMRS Oxycodone/APAP 5/325mg. 09/18/11 @ 1:30p (2 tabs.) 10/16/11 @ 12:30p (2 tabs.) 10/18/11 @ 2:00p (2 tabs.) 10/29/11 @ 3:00p (2 tabs.) 10/30/11 @ 8:00a (2 tabs.) 10/30/11 @ 2:00p (2 tabs.) 11/01/11 @ 8:00p (2 tabs.) 11/13/11 @ 8:30p (2 tabs.) Patient #2 Oxycodone/APAP 5/325mg. 1 tablet by mouth every 4 to 6 hours as needed for pain. Oxycodone/APAP 5/325mg. 09/30/11 @ 9:00p (1 tab.) 10/02/11 @ 8:00a (1 tab.) 10/15/11 @ 11:30a (1 tab.) 10/18/11 @ 7:00a (1 tab.) Orders changed on 10/28/11: 1 to 2 tablets by mouth every 6 hours as needed for pain. Hydrocodone/APAP 5/325mg., 1 or 2 tablets every 4 to 6 hours as needed for pain. 11/13/11 @ 10:30p (2 tabs.) Hydrocodone/APAP 5/325mg. 09/21/11 @ 8:30p (1 tab.) 10/18/11 @ 11:00a (1 tab.) 11/11/11 @ 9:00p (1 tab.) Patient #4 Hydrocodone/APAP Hydrocodone/APAP 5/500mg. None. None. None. None. None. None. None. None. None. None. None. None. None. None. None. None. MAR/Waste
Patient #3
Charlotte Renee Kennedy, L.P.N. Page 5 5/500mg., 1 tablet every 4 hours as needed for pain. 11/02/11 @ 8:00a (1 tab.) 11/11/11 @ 9:00p (1 tab.) 11/12/11 @ 9:00p (1tab.) None. None. None.
Case# 12-002103
July 27, 2012

Delishia D. Keys, L.P.N. 2208 Oak Avenue SE Massillon, Ohio 44646 Dear Ms. Keys: You are hereby notified that, on or about July 29, 2011, you entered into a Consent Agreement (July 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 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 for a minimum period of at least one (1) year. A. You were issued a license to practice nursing as a licensed practical nurse in the State of Ohio on August 2, 2011. B. Item 2. of the July 2011 Consent Agreement states, MS. KEYS 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, on or about May 15, 2012, you failed to appear at the Boards office for your scheduled personal interview with your Board Monitoring Agent. You were sent a letter dated April 24, 2012, to your address of record notifying you of this scheduled personal interview. C. Item 5. of the July 2011 Consent Agreement states, Within ninety (90) days from the effective date of this Consent Agreement, MS. KEYS 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 other comparable courses approved in advance by the Board, taken subsequent to the effective date of this Consent Agreement: 5.4 hours of Professional Accountability and Legal Liability for Nurses and 10 hours of Managing Difficult Patients, and 20 hours of Anger Kills (How to Overcome the Boiling Point). Despite this provision, as of June 18, 2012, you have failed to submit to the Board satisfactory documentation of successful completion of the following continuing nursing education, or other comparable courses approved in advance by the
Delishia D. Keys, L.P.N. Page 2 Board: 5.4 hours of Professional Accountability and Legal Liability for Nurses and 10 hours of Managing Difficult Patients, and 20 hours of Anger Kills (How to Overcome the Boiling Point. 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 July 2011 Consent Agreement, you are hereby notified that it appears to the Board that you have violated Items 2. and 5. of the July 2011 Consent Agreement. YOU ARE FURTHER NOTIFIED THAT YOUR LICENSE TO PRACTICE NURSING AS A LICENSED PRACTICAL NURSE, PN-145337, 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 July 29, 2011, you entered into a Consent Agreement (July 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 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 for a minimum period of at least one (1) year. 2. You were issued a license to practice nursing as a licensed practical nurse in the State of Ohio on August 2, 2011. 3. Item 2. of the July 2011 Consent Agreement states, MS. KEYS 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, on or about May 15, 2012, you failed to appear at the Boards office for your scheduled personal interview with your Board Monitoring Agent. You were sent a letter dated April 24, 2012, to your address of record notifying you of this scheduled personal interview. 4. Item 5. of the July 2011 Consent Agreement states, Within ninety (90) days from the effective date of this Consent Agreement, MS. KEYS shall, in
Delishia D. Keys, L.P.N. Page 3 addition to the requirements of licensure renewal, successfully complete and submit satisfactory documentation of successful completion of the following continuing nursing education, or other comparable courses approved in advance by the Board, taken subsequent to the effective date of this Consent Agreement: 5.4 hours of Professional Accountability and Legal Liability for Nurses and 10 hours of Managing Difficult Patients, and 20 hours of Anger Kills (How to Overcome the Boiling Point). Despite this provision, as of June 18, 2012, you have failed to submit to the Board satisfactory documentation of successful completion of the following continuing nursing education, or other comparable courses approved in advance by the Board: 5.4 hours of Professional Accountability and Legal Liability for Nurses and 10 hours of Managing Difficult Patients, and 20 hours of Anger Kills (How to Overcome the Boiling Point. 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.
Delishia D. Keys, L.P.N. Page 4 Sincerely,
Case #2011-00018 1
Ohio Board 09 Nursing

17 South High Street, Suile 400
Columnbus, Ohio 43215-7410 * (614) 466-3947
CONSENT AGREEMENT BETWEEN DELISHIA D. KEYS, L.P.N. APPLICANT AND OHIO BOARD OF NURSING
This Consent Agreement is entered into by and between DELISHIA D. KEYS, L.P.N. APPLICANT (MS. KEYS) 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. KEYS 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. In January 2011, MS. KEYS submitted to the Board an Application for Licensure by Examination to Practice in Ohio as a Licensed Practical Nurse.
B.
Delishia D. Keys, L.P.N. Applicant Page 2
C.
MS. KEYS knowingly and voluntarily admits that in Massillon Municipal Court Case No. 2006 CRB 01279, MS. KEYS was convicted of the misdemeanor charges of Disorderly Conduct and or Criminal Damaging in 2006. Both convictions stemmed from the same incident, where MS. KEYS engaged in a physical altercation with another woman and damaged the women's household furniture and electronic equipment. MS. KEYS currently owes outstanding fines and court costs in this case.
In a separate and unrelated case, also in 2006, MS. KEYS was convicted of misdemeanor charges of Assault and Criminal Damaging. Both convictions stemmed from the same incident that occumed in 2004 and in which MS. KEYS assaulted her then boyfriend and damaged to the boyfriend's vehicle. MS. KEYS currently owes outstanding fines and court costs in this case. In 1999, in Canton Municipal Court, MS. KEYS was convicted of the misdemeanor charge of Giving False Information to the Police, after she gave a law enforcement office a false name. MS. KEYS completed the terms of this case in 2001.
D.
MS. KEYS was permitted to take the NCLEX-PN, and on or about April 27,201 1, MS. KEYS passed the exam. MS. KEYS is aware that her prior misdemeanor convictions may restrict her opportunity to work as a nurse in certain settings. AGREED CONDITIONS
E.
Wherefore, in consideration of the foregoing and mutual promises hereinafter set forth, and in lieu of any formal proceedings at this time, MS. KEYS knowingly and voluntarily agrees with the Board to the following terms, conditions, and limitations: Upon meeting the requirements for licensure, MS. KEYS shall be granted a license to practice nursing as a licensed practical nurse in the State of Ohio. MS. KEYS'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 at least one ( I ) year: 1.
MS. KEYS shall obey all federal, state, and local laws, and all laws and rules governing the practice of nursing in Ohio. MS. KEYS shall appear in person for interviews before the full Board or its designated representative as requested by the Board or its designee.
2.
Delishia D. Keys, L.P.N. Applicant Page 3 3.
Prior to submitting a request for release from the probationary terms, conditions and limitations of this Consent Agreement, MS. KEYS shall submit satisfactory documentation to the Board from Massillon Municipal Court indicating that MS. KEYS has completed with all of the terms in Case No. 06 CRB 01279 and in Case No. 2004 CRB 01510.

4.
Within ninety (90) days prior to submitting a request for release from the probationary terms, conditions and limitations of this Consent Agreement, MS. KEYS agrees that she will submit a request to the Bureau of Criminal Identification and Investigation (BCII) to conduct a criminal records check of MS. KEYS, including a check of Federal Bureau of Investigation (FBI) records, and shall cause BCII to submit MS. KEYS'S criminal records check reports to the Board. MS. KEYS agrees that a request for release from the probationary 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.

5.
Within ninety (90) days from the effective date of this Consent Agreement, MS. KEYS 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 other comparable courses approved in advance by the Board, taken subsequent to the effective date of this Consent Agreement: 5.4 hours of Professional Accountability and Legal Liability for Nurses and 10 hours of Managing Difficult Patients, and 20 hours of Anger Kills (How to Overcome the Boiling Point).
Psychiatric EvaIuation & Treatment

6.
Upon request by the Board or its designee and within ninety (90) days of such a request, MS. KEYS shall, at her own 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. KEYS 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
Delishia D. Keys, L.P.N. Applicant Page 4 placed on MS. KEYS's license, and a statement as to whether MS. KEYS is capable of practicing nursing according to acceptable and prevailing standards of safe nursing care.
If an evaluation is requested, MS. KEYS shall provide the Board with satisfactory documentation of compliance with all aspects of the treatment plan developed by the psychiatrist until released. Further, MS. KEYS 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. KEYS's license and that the terms, conditions, and limitations may be incorporated in an addendum to this Consent Agreement. Employment Conditions
8.
Prior to accepting employment as a nurse, each time with every employer, MS. KEYS shall notify the Board. MS. KEYS 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. KEYS 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 September 1, 2011 or within thirty (30) days of accepting nursing employment. MS. KEYS 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.
9.

10.
MS. KEYS shall report to the Board, in writing, any violation of this Consent Agreement within thirty (30) days of the occurrence of the violation. MS. KEYS shall sign release of information forms allowing health professionals and other organizations to submit the requested documentation directly to the Board. MS. KEYS 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.
11.
12.
Delishia D. Keys, L.P.N. Applicant Page 5 13.
MS. KEYS 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. KEYS 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. KEYS 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. KEYS shall verify that the reports and documentation required by this Consent Agreement are received in the Board office. MS. KEYS 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.
14.
15.
16.
17.
Temvorarv Practice Restrictions MS. KEYS 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. KEYS to provide nursing services for fees, compensation, or other consideration or as a volunteer. MS. KEYS 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. KEYS agrees that her license to practice nursing as a licensed practical nurse will be automatically suspended if it appears to the Board that MS. KEYS has violated or breached any terms or conditions of the Consent Agreement. Following the automatic suspension, the Board shall notify MS. KEYS via certified mail of the specific nature of the charges and automatic suspension of her license. Upon receipt of this notice, MS. KEYS may request a hearing regarding the charges.
Delishia D. Keys, L.P.N. Applicant Page 6 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. KEYS 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.

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. KEYS and the Board. The Board may only alter the probationary period imposed by this Consent Agreement if: (1) the Board determines that MS. KEYS has complied with all aspects of this Consent Agreement; and (2) the Board determines that MS. KEYS is able to practice according to acceptable and prevailing standards of safe nursing care without Board monitoring, based upon an interview with MS. KEYS and review of the reports as required herein. Any period during which MS. KEYS 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.
MS. KEYS 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. KEYS waives all of her rights under Chapter 119, ORC, as they relate to matters that are the subject of this Consent Agreement. MS. KEYS waives any and all claims or causes of action she may have against the
Board, and its members, officers, employees andlor 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.
Delishia D. Keys. L.P.N. Applicant Page 7
EFFECTIVE DATE
MS. KEYS understands that this Consent Agreement is subject to ratification by the Board prior to signature by the Board President and shall bccome effective upon the last date of signature below.
DELXSMA L.P.N. APPL~~ANT D. KEYS,
DATE
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BERTHA LOVELACE, President Ohio Bonrd of Nursing
DATE
Case# 12- 002663
July 27, 2012

Janet Ann Koblitz, R.N. 3637 Juniper Street Grove City, Ohio 43123 Dear Ms. Koblitz: You are hereby notified that, on or about March 16, 2012, you entered into a Consent Agreement (March 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 6. of the March 2012 Consent Agreement states, MS. KOBLITZ shall abstain completely from the use of alcohol or products containing alcohol. Item 7. of the March 2012 Consent Agreement states, Within forty-five (45) days of the effective date of this Consent Agreement and continuing throughout the probationary period, MS. KOBLITZ 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. KOBLITZs 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. KOBLITZ 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. KOBLITZ. Despite these provisions, on May 3, 2012, you provided a urine specimen for analysis to Firstlab, the Boards random drug/alcohol screen program administrator, that tested positive for Ethyl Glucuronide (Alcohol). Regarding this positive result, you submitted a statement to the Board, dated June 4, 2012, indicating that you used Purel wipes, and, at a party on April 29, 2012, consumed fruity sherbet punch, which in hindsight may have had alcohol in it, and some desserts that may have contained alcohol as well.
Janet Ann Koblitz, R.N. Page 2 On June 19, 2012, you provided a urine specimen for analysis to Firstlab, the Boards random drug/alcohol screen program administrator, that tested positive for Ethyl Glucuronide (Alcohol). On June 3, 2012, you failed to call Firstlab, the Boards random drug/alcohol screen program administrator, to determine if you had been selected to provide a urine specimen. 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 March 2012 Consent Agreement, you are hereby notified that it appears to the Board that you have violated Items 6. and 7. of the March 2012 Consent Agreement. YOU ARE FURTHER NOTIFIED THAT YOUR LICENSE TO PRACTICE NURSING AS A REGISTERED NURSE, RN-257274, 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 16, 2012, you entered into a Consent Agreement (March 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 6. of the March 2012 Consent Agreement states, MS. KOBLITZ shall abstain completely from the use of alcohol or products containing alcohol. Item 7. of the March 2012 Consent Agreement states, Within forty-five (45) days of the effective date of this Consent Agreement and continuing throughout the probationary period, MS. KOBLITZ 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. KOBLITZs 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
Janet Ann Koblitz, R.N. Page 3 purposes of Section 4723.28(B), ORC. This screening shall require a daily call-in process. The specimens submitted by MS. KOBLITZ 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. KOBLITZ. Despite these provisions, on May 3, 2012, you provided a urine specimen for analysis to Firstlab, the Boards random drug/alcohol screen program administrator, that tested positive for Ethyl Glucuronide (Alcohol). Regarding this positive result, you submitted a statement to the Board, dated June 4, 2012, indicating that you used Purel wipes, and, at a party on April 29, 2012, consumed fruity sherbet punch, which in hindsight may have had alcohol in it, and some desserts that may have contained alcohol as well. On June 19, 2012, you provided a urine specimen for analysis to Firstlab, the Boards random drug/alcohol screen program administrator, that tested positive for Ethyl Glucuronide (Alcohol). On June 3, 2012, you failed to call Firstlab, the Boards random drug/alcohol screen program administrator, to determine if you had been selected to provide a urine specimen. 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,
Janet Ann Koblitz, R.N. Page 4 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,
Judith A. Church, R.N., C.N.P. Supervising Member Certified Mail Receipt No. 7012 1010 0002 4225 2029 Attorney Certified Mail Receipt No. 7012 1010 0002 4225 2036 cc: Henry G. Appel, Assistant Attorney General Elizabeth Y. Collis, Esq.
Case #09-2367
O h i s Board of Nursing
CONSENT AGREEMENT BETWEEN JANET ANN KOBLITZ, R.N. AND OHIO BOARD OF NURSING
www.n~~ssing.o~io.go~~
0
17 South High Street, Suite 400 * (:ol~iii~bus; Ohio 432 15-74 10
(614) 46(i-3947
This Consent Agreement is entered into by and between JANET ANN KOBLITZ, R.N. (MS. KOBLITZ) 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)(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 or use of drugs, alcol~ol, otber chemical substances that impair the ability to practice. MS. KOBLITZ was initially licensed to practice nursing as a registered nurse in the State of Ohio, RN-257274 in February 1995. MS. KOBLITZ's license to practice as a registered nurse is active. MS. KOBLITZ admits and acknowledges the following:
B.
C.
Janet Ann Koblitz, R.N. Page 2
1. On November 3,2008, in Franklin Coullty Municipal Court, Case No. 2008 TRC 162054, MS. KOBLITZ pled guilty to one coullt of Operating a Vehicle under the Influence, in violation of 4511,19(A)(l)(H), and was sentenced to three days in jail, fine, and continued reports. 2. On May 5 , 2009, in Franklin County Municipal Court, Case No. 2009 TRC 125559, MS. KOBLITZ pled guilty to one count of Reckless Operation, amended from Operating a Vehicle under the Influence, in violation of 451 1.20(A), and was sentenced to a fine.
D.
MS. KOBLITZ states that she received treatment for Alcohol abuse from
the Woods at Parkside in late 2008 through early 2009, but then relapsed in the spring of 2009 using Nyquil. Further treatment was not recommended by Parkside.
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. KOBLITZ knowingly and voluntarily agrees with the Board to the following terms, conditions, and limitations: MS. KOBLITZ's license to practice nursing as a registered nurse shall be suspended indefinitely. Such suspel~sionshall be stayed, subject to the following PROBATIONARY terms, conditions, and limitations for a minimum period of two (2) years: 1.
MS. KOBLITZ shall obey all federal, state, and local laws, and all laws and
rules governing the practice of nursing in Ohio.
2.
MS. KOBLITZ shall appear in perso11 for interviews before the full Board or
its designated representative as requested by the Board or its designee.
3.
MS. KOBLITZ agrees that she will submit a request to the Bureau of
a Criminal ldentification and Investigation (BCII) to col~duct criminal records check of MS. KOBLITZ, including a check of Federal Bureau of Investigation (FBI) records, and shall request BCII to submit MS. KOBLITZ's criminal records check reports to the Board. MS. KOBLITZ's completed criminal records check, including the FBI check, must be received by the Board prior to release from these probationary terms.
4.
Within six (6) months of the effective date of this Consent Agreement, MS. KOBLITZ shall, in addition to the requirements of licensure renewal, successfully complete and submit satisfactory documentation of successful colnpletion of the following continuing nursing education, or another
Janet Ann Koblitz, R.N Page 3
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 two (2) hours of Ethics.
Monitoring
5.
MS. KOBLITZ 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. KOBLITZ. MS. KOBLITZ shall self-administer the prescribed drugs only in the manner prescribed. MS. KOBLITZ 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. KOBLITZ shall submit, at her expense and on the day selected, blood, breath, hair, or urine specimens for drug andlor alcohol analysis at a collection site specified by the Board at such times as the Board may request. Upon and after MS. KOBLITZ's initiation of drug screening, refusal to submit such specimen, or failure to subinit 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. KOBLITZ 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. KOBLITZ.
a. Prior to MS. KOBLITZ initiating drug screening, MS. KOBLITZ 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.
6.
7.
KOBLITZ.
b. After initiating drug screening, MS. KOBLITZ 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. KOBLITZ shall notify the Board of any and all medication(s) or prescription(s) received within twenty-four (24) hours of release froin hospitalization or medical treatment.
8.
Within thirty (30) days of the effective date of this Consent Agreement and continuing throughout the probationary period, MS. KOBLITZ 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. KOBLITZ shall provide satisfactory docume~ltation 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. Upon the request of the Board or its designee and within sixty (60) days of that request, MS. KOBLITZ shall, at her expense, obtain a chemical dependency evaluation by a Board approved chemical dependency professional and shall provide the Board with colnplete docu~nentation this of evaluation. Prior to the evaluation, MS. KOBLITZ shall provide the chemical dependency professional with a copy of this Consent Agreement and assessments, evaluations, and treatment records from the Woods at Parkside. Further, MS. KOBLITZ shall execute releases to permit the chemical dependency professioiial to obtain any infonnation 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. KOBLITZ's license to practice, and stating whether MS. KOBLITZ is capable of practicing nursing according to acceptable and prevailing standards of safe nursing care. If a chemical dependency evaluation is requested, MS. KOBLITZ 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. KOBLITZ 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. KOBLITZ's license and that the terms, conditions, and limitations may be incorporated in an addendum to this Consent Agreement.
9.
10.
Employment Coliditions
11.
MS. KOBLITZ 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 nursing employment. MS. KOBLITZ, within fifteen (15) day of the effective date of the Consent Agreement, if working in a position it1 which a nursing license is required, shall provide her employer(s) with a copy of this Consent Agreement. Further, MS. KOBLITZ is under a continuing duty to provide a copy of this Consent
12.
Agreement to any new employer prior to accepting nursing employment. MS. KOBLITZ 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. KOBLITZ shall have her empioyer(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.
13.
MS. KOBLITZ shall report to the Board, in writing, any violation of this
14.
MS. KOBLITZ shall sign release of information forms allowing health

15.
MS. KOBLITZ shall submit any and all inforination that the Board may
request regarding her ability to practice according to acceptable and prevailing standards of safe nursing practice.
16.
MS. KOBLITZ shall not submit or cause to be submitted any false,

17.
MS. KOBLITZ 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.
18.
MS. KOBLITZ shall submit the reports and docuinentation 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.
19.
MS. KOBLITZ shall verify that the reports and documentation required by
this Consent Agreement are received in the Board office.
20.
MS. KOBLITZ 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.
Nursing Refresher Course Upon the request of the Board or its designee, MS. KOBLITZ shall complete and submit satisfactory documentation of completion of nurse refresher courses or an extensive orientation to be approved in advance by the Board, or its designee. Temporary Practice Restriction Unless otherwise approved in advance, in writing, by the Board or its designee, MS. KOBLITZ 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. KOBLITZ to provide nursing services for fees, compensation, or other consideration or who engage MS. KOBLITZ as a volunteer. Unless otherwise approved in advance, in writing, by the Board or its designee, MS. KOBLITZ 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. KOBLITZ agrees that her license to practice nursing as a registered nurse will be automatically suspended if it appears to the Board that MS. KOBLITZ has violated or breached any terms or conditions of the Consent Agreement. Following the automatic suspension, the Board shall notify MS. KOBLITZ via certified mail of the specific nature of the charges and automatic suspension of her license. MS. KOBLITZ 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. KOBLITZ 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. KOBLITZ and the Board. The Board may only alter the probationary period imposed by this Consent Agreement if: (1) the Board determines that MS. KOBLITZ has complied with all aspects of this Consent Agreement;
and (2) the Board determines that MS. KOBLITZ is able to practice according to acceptable and prevailing standards of safe nursing care without Board monitoring, based upon an interview with MS. KOBLITZ and review of the reports as required herein. Any period during which MS. KOBLITZ 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.
MS. KOBLITZ acknowledges that she has had an opportunity to ask questions concerning the
MS. KOBLITZ waives all of her rights under Chapter 119, ORC, as they relate to matters that
MS. KOBLITZ waives any and all claims or causes of action she may have against the Board,
and its members, officers, employees andlor 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 1 19, ORC.
[remainder ofpage intentionally left blank]
., .
EFFECTIVE DATE
MS. KOBLITZ understands that this Consent Agreement is subject to ratification by the Board
)-I%-@
DATE
M&l(e, aara
BERTHA LOVELACE, President Ohio Board of Nursing DATE
Case #11-005182
July 27, 2012

Christine Kathy Leimbach (aka Hanley) 13 Sycamore Drive, Apt. J Norwalk, Ohio 44857 Dear Ms. Leimbach: On or about May 23, 2012, 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 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 19, 2012, in Lorain County Court of Common Pleas Case Number 12CR084272, you pled guilty to two (2) counts of Theft to wit: dangerous drugs, felonies of the fourth degree, in violation of Section 2913.02(A)(3), ORC; and two (2) counts of Illegal Processing of Drug Documents, felonies of the fourth degree, in violation of Section 2925.23(A), ORC, and were found eligible for Intervention in Lieu of Conviction. The acts underlying this case occurred on or about December 16, 2011, and involve you obtaining dangerous drugs by deception. Further acts underlying this case involve you making a false statement in any prescription, order, report, or record involving Percocet. 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 December 19, 2011, you admitted to a Board Compliance Agent that you diverted four (4) Oxycodone tablets from two (2)
Christine Kathy Leimbach (aka Hanley) Page 2 patients at Mercy Hospital, in Lorain, Ohio, where you worked as a nurse. You admitted that you consumed the diverted Oxycodone while working. 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)(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 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.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,
Christine Kathy Leimbach (aka Hanley) Page 3
Case #11-005182
May 23, 2012

Christine Kathy Leimbach (aka Hanley), L.P.N. 13 Sycamore Drive, Apt. J Norwalk, OH 44857 Dear Ms. Leimbach: 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 19, 2012, in Lorain County Court of Common Pleas Case Number 12CR084272, you pled guilty to two (2) counts of Theft to wit: dangerous drugs, felonies of the fourth degree, in violation of Section 2913.02(A)(3), ORC; and two (2) counts of Illegal Processing of Drug Documents, felonies of the fourth degree, 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: 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 to wit: dangerous drugs, a felony of the fourth degree, in violation of Section 2913.02(A)(3), ORC, and Illegal Processing of Drug Documents, a felony of the fourth degree, in violation of Section 2925.23(A), ORC, constitute felony drug abuse offenses as defined in Section 2925.01, ORC.
Christine Kathy Leimbach (aka Hanley), 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, PN-124830, 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 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,
Case #11-003355
July 27, 2012

Cynthia Eileen Leyde, R.N. 1079 Pearl St. Sharon, PA 16146 Dear Ms. Leyde: 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 July 26, 2011, while working as a nurse for the Sharon Regional Health System, you reported to work at Patient #1s home in Masury, Ohio while under the influence of alcohol. Patient #1s family determined that you were not safe to practice and asked you to leave the home. On or about September 1, 2011, you told a Board Compliance Agent that on July 26, 2011 you consumed about a quarter of a bottle of vodka prior to going to Patient #1s home. 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. 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.
Cynthia Eileen Leyde, 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 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,
Case #12-000463
July 27, 2012

Jeanine Michele Lilly, L.P.N. 1002 Reedy Drive Wadsworth, Ohio 44281 and 493 Farr Avenue Wadsworth, Ohio 44281 Dear Ms. Lilly: 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 June 6, 2012, in Summit County Court of Common Pleas Case Number CR 12-03-0735, you pled guilty to two (2) counts of Theft of Drugs, felonies of the fourth degree, in violation of Section 2913.02(A)(1)/(2)/(3), ORC; one (1) count of Illegal Processing of Drug Documents, a felony of the fifth degree, in violation of Section 2925.23(A), ORC; and one (1) count of Illegal Processing of Drug Documents, a felony of the fourth degree, 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: 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.
Jeanine Michele Lilly, L.P.N. Page 2 Theft of Drugs, felonies of the fourth degree, in violation of Section 2913.02(A)(1)/(2)/(3), ORC; Illegal Processing of Drug Documents, a felony of the fifth degree, in violation of Section 2925.23(A), ORC; and Illegal Processing of Drug Documents, a felony of the fourth degree, in violation of Section 2925.23(A), 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-118516 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). 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 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, 2012, in Summit County Court of Common Pleas Case Number CR 12-03-0735, you pled guilty to two (2) counts of Theft of Drugs, felonies of the fourth degree, in violation of Section 2913.02(A)(1)/(2)/(3), ORC; one (1) count of Illegal Processing of Drug Documents, a felony of the fifth degree, in violation of Section 2925.23(A), ORC; and one (1) count of Illegal Processing of Drug Documents, a felony of the fourth degree, in violation of Section 2925.23(A), ORC, and were found eligible for Intervention in Lieu of Conviction. The acts underlying this case occurred on or about February 14, 2012, and involve you obtaining Hydrocodone (Vicodin) and Oxycodone (Percocet) without the consent of the owner to wit: Sumner on Ridgewood or person authorized to give consent and/or beyond the scope of consent of the owner or person authorized to give consent and/or by deception. Further acts underlying this case occurred on or about February 14, 2012, and involve you making false statements in prescriptions, orders, reports or records involving Hydrocodone (Vicodin) and Oxycodone (Percocet). 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.
Jeanine Michele Lilly, L.P.N. Page 3 2. On or about February 23, 2012, you admitted to a Board Compliance Agent that, while working as a licensed practical nurse at Sumner on Ridgewood, you diverted narcotics from the facility for selfadministration without a legal, valid prescription. You admitted that you diverted two (2) to three (3) pills a day for about two (2) or three (3) months. You stated that you self-administered these diverted narcotics to supplement prescribed Vicodin.
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)(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. 3. On or about February 23, 2012, you admitted to a Board Compliance Agent that, while working as a licensed practical nurse at Sumner on Ridgewood, your documentation was poor and you failed to properly document the administration of narcotics on several occasions.
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. 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.
Jeanine Michele Lilly, L.P.N. Page 4 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,
Case #2012-000627
July 27, 2012

Megan Jani Lilly, L.P.N. 740 Dan Avenue Canal Fulton, Ohio 44614 Dear Ms. Lilly: 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 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 16, 2012, while employed as a licensed practical nurse at Keystone Pointe, LaGrange, Ohio, you were interviewed regarding money missing from staff and residents at the facility. You admitted that you stole $40.00 from a staff member, $40.00 from Patient #1 [see attached Patient Key to Remain Confidential and Not Subject to Public Disclosure], and $250.00 from Patient #2. On or about March 29, 2012, you stated to a Board Compliance Agent that stole the money because you were going through a separation and were very short on money. 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, Ohio Administrative Code Rule 4723-4-06(L), states 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. 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. Accordingly, the Board is authorized to impose one or more of the sanctions cited in Section 4723.28, ORC.
Megan Jani Lilly, 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 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, 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,
Case #11-004601
July 27, 2012

Lori Denise Loges, R.N. 5829 Old Columbus Cincinnati Road Selma, Ohio 45368 Dear Ms. Loges: 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 May 15, 2012, in Clark County Court of Common Pleas Case Number 11-CR-878, you pled no contest 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, 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, 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-307913, 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).
Lori Denise Loges, R.N. Page 2 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 15, 2012, in Clark County Court of Common Pleas Case Number 11-CR-878, you pled no contest 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, ORC. The acts underlying this case occurred on or about September 9, 2011, and involve you obtaining a dangerous drug without the consent of the owner or person authorized to give consent. 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 November 22, 2011, you admitted to a Board Compliance Agent that, while working as a registered nurse at Springfield Regional Medical Center, you diverted Dilaudid from the facility for selfadministration without a legal, valid prescription. You stated that this diversion occurred for about three (3) months. You admitted that you diverted two (2) to three (3) vials of Dilaudid a day and that you worked six (6) days per week. You admitted that you self-administered the diverted Dilaudid.
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)(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. 3. On or about November 22, 2011, you admitted to a Board Compliance Agent that, while working as a registered nurse at Springfield Regional Medical Center, you administered narcotics to patients without documenting it.
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,
Lori Denise Loges, R.N. Page 3 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. 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 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,
Case# 12-002349
July 27, 2012

Nicole L. Long (F.K.A. Nicole L. Ansley), L.P.N. 3108 Marion Waldo Road Marion, Ohio 43302 Dear Ms. Long: You are hereby notified that, on or about November 19, 2010, you entered into a Consent Agreement (November 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 November 2012. A. You were issued a license to practice nursing as a licensed practical nurse in the State of Ohio on November 23, 2010. B. Item 1. of the November 2010 Consent Agreement states, MS. LONG shall obey all federal, state, and local laws, and all laws and rules governing the practice of nursing in Ohio. MS. LONG shall comply with all the terms of community control imposed by the Marion Municipal Court Case No. TRC 0908954A and Case No. CRB 1000245A. Item 5. of the November 2010 Consent Agreement states, MS. LONG shall abstain completely from the use of alcohol. Despite these provisions, on or about May 8, 2012, in Marion County Municipal Court Case No. TRC 11 9278, you pled no contest and were convicted of one (1) count of Operating a Vehicle Under the Influence of Alcohol or Drugs, a firstdegree misdemeanor, in violation of 4511.19(A)(1)(A), Ohio Revised Code (ORC). The acts underlying your conviction occurred on or about November 27, 2011 at 1:53 am and include you refusing to perform field sobriety testing or submit a Breathalyzer test after the Officer detected a strong order of Alcohol on your person and you admitted to the Officer that you had consumed beer. C. Item 6. of the November 2010 Consent Agreement states, Within sixty (60) days following the effective date of this Consent Agreement, MS. LONG 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
Nicole L. Long (F.K.A. Nicole L. Ansley), L.P.N. Page 2 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. LONG shall be negative, except for substances prescribed, administered, or dispensed to her by another so authorized by law who has full knowledge of MS. LONGs history of chemical dependency and recovery status. Despite this provision, on the following dates, you failed to call Firstlab, the Boards random drug/alcohol screen program administrator, to determine if you had been selected to provide a urine specimen: April 29, 2011; May 1, 2011; May 22, 2011; June 11, 2011; June 25, 2011; July 17, 2011; August 5-7, 2011; August 14, 2011; August 27-28, 2011; September 7, 2011; September 11, 2011; October 1-2, 2011; October 9, 2011; October 15-16, 2011; November 6, 2011; January 15, 2012; March 3, 2012; and May 12, 2012. Furthermore, on February 20, 2012, you were selected to provide a urine specimen for analysis and failed to do so. D. Item 7. of the November 2010 Consent Agreement states, Within sixty (60) days following the effective date of this Consent Agreement, MS. LONG 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. LONG shall provide satisfactory documentation of such attendance to the Board every six (6) months beginning January 1, 2011. Despite this provision, you have failed to submit support or peer group meeting documentation to the Board since April 4, 2011. E. Item 8. of the November 2010 Consent Agreement states, Upon request by the Board or its designee and within sixty (60) days of such request, MS. LONG 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. LONG shall provide the chemical dependency professional with a copy of this Consent Agreement. Further, MS. LONG 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. LONGs license to practice, and a statement as to whether MS. LONG is capable of practicing nursing according to acceptable and prevailing standards of safe nursing care.
Nicole L. Long (F.K.A. Nicole L. Ansley), L.P.N. Page 3 You were sent a letter dated February 29, 2012, from a Board Compliance Agent requesting that you obtain a chemical dependency evaluation and submit documentation of the completed evaluation to the Board no later than May 1, 2012. Despite this provision, as of July 2, 2012, you have failed to submit documentation of a completed chemical dependency evaluation to the Board. 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 November 2010 Consent Agreement, you are hereby notified that it appears to the Board that you have violated Items 1., 5., 6., 7. and 8. of the November 2010 Consent Agreement. YOU ARE FURTHER NOTIFIED THAT YOUR LICENSE TO PRACTICE NURSING AS A LICENSED PRACTICAL NURSE, PN-142874, 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 November 19, 2010, you entered into a Consent Agreement (November 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 November 2012. 2. You were issued a license to practice nursing as a licensed practical nurse in the State of Ohio on November 23, 2010. 3. Item 1. of the November 2010 Consent Agreement states, MS. LONG shall obey all federal, state, and local laws, and all laws and rules governing the practice of nursing in Ohio. MS. LONG shall comply with all the terms of community control imposed by the Marion Municipal Court Case No. TRC 0908954A and Case No. CRB 1000245A. Item 5. of the November 2010 Consent Agreement states, MS. LONG shall abstain completely from the use of alcohol.
Nicole L. Long (F.K.A. Nicole L. Ansley), L.P.N. Page 4 Despite these provisions, on or about May 8, 2012, in Marion County Municipal Court Case No. TRC 11 9278, you pled no contest and were convicted of one (1) count of Operating a Vehicle Under the Influence of Alcohol or Drugs, a firstdegree misdemeanor, in violation of 4511.19(A)(1)(A), ORC. The acts underlying your conviction occurred on or about November 27, 2011 at 1:53 am and include you refusing to perform field sobriety testing or submit a Breathalyzer test after the Officer detected a strong order of Alcohol on your person and you admitted to the Officer that you had consumed beer. 4. Item 6. of the November 2010 Consent Agreement states, Within sixty (60) days following the effective date of this Consent Agreement, MS. LONG 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. LONG shall be negative, except for substances prescribed, administered, or dispensed to her by another so authorized by law who has full knowledge of MS. LONGs history of chemical dependency and recovery status. Despite this provision, on the following dates, you failed to call Firstlab, the Boards random drug/alcohol screen program administrator, to determine if you had been selected to provide a urine specimen: April 29, 2011; May 1, 2011; May 22, 2011; June 11, 2011; June 25, 2011; July 17, 2011; August 5-7, 2011; August 14, 2011; August 27-28, 2011; September 7, 2011; September 11, 2011; October 1-2, 2011; October 9, 2011; October 15-16, 2011; November 6, 2011; January 15, 2012; March 3, 2012; and May 12, 2012. Furthermore, on February 20, 2012, you were selected to provide a urine specimen for analysis and failed to do so. 5. Item 7. of the November 2010 Consent Agreement states, Within sixty (60) days following the effective date of this Consent Agreement, MS. LONG 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. LONG shall provide satisfactory documentation of such attendance to the Board every six (6) months beginning January 1, 2011. Despite this provision, you have failed to submit support or peer group meeting documentation to the Board since April 4, 2011. 6. Item 8. of the November 2010 Consent Agreement states, Upon request by the Board or its designee and within sixty (60) days of such request, MS. LONG shall, at her own expense, obtain a chemical dependency evaluation
Nicole L. Long (F.K.A. Nicole L. Ansley), L.P.N. Page 5 by a Board approved chemical dependency professional and shall provide the Board with complete documentation of this evaluation. Prior to the evaluation, MS. LONG shall provide the chemical dependency professional with a copy of this Consent Agreement. Further, MS. LONG 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. LONGs license to practice, and a statement as to whether MS. LONG is capable of practicing nursing according to acceptable and prevailing standards of safe nursing care. You were sent a letter dated February 29, 2012, from a Board Compliance Agent requesting that you obtain a chemical dependency evaluation and submit documentation of the completed evaluation to the Board no later than May 1, 2012. Despite this provision, as of July 2, 2012, you have failed to submit documentation of a completed chemical dependency evaluation to the Board. 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.
Nicole L. Long (F.K.A. Nicole L. Ansley), L.P.N. Page 6 Sincerely,
Judith A. Church, R.N., C.N.P. Supervising Member Certified Mail Receipt No. 7012 1010 0002 4225 4993 Attorney Certified Mail Receipt No. 7012 1010 0002 4225 1909 cc: Henry G. Appel, Assistant Attorney General Richard Cline, Esq.
Case #lo-3491

17 SouLl? Migl~ St~eet,Stute 400
~vw~v.nursi~~g.ohio.go~
(614) 466-3947
Columbus, Ohio 43215-7410
CONSENT AGREEMENT BETWEEN NICOLE L. LONG, L.P.N. APPLICANT F.K.A. NICOLE L. ANSLEY AND OHIO BOARD OF NURSING
This Consent Agreement is entered into by and between NICOLE L. LONG, L.P.N. APPLICANT F.K.A. NICOLE L. ANSLEY (MS. LONG) 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. LONG 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 F O 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)(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 drugs, or alcohol or other chemical substances to an extent that impairs ability to practice.
Nicole L. Long, L.P.N. Applicant F.K.A. Nicole L. Ansiey Page 2 B.
On or about July 1, 2010, MS. LONG submitted to the Board an Application for Licensure by Examination to Practice in Ohio as a Licensed Practical Nurse.
C.
MS. LONG knowingly and voluntarily admits that: 1) In 2004, MS. LONG was convicted of a minor misdemeanor offense Disorderly Conduct; 2) In 2009, in Case No. TRC 090895A, MS. LONG was convicted of Operating a Motor Vehicle While Under the Influence of Alcohol (OVI); 3) In 2010, in Case No. CRB1000245A, MS. LONG was convicted of Persistent Disorderly Conduct. All these cases are due to MS. LONG's consumption of alcohol and are within the jurisdiction of the Marion Municipal Court.
In Wyandot County, MS. LONG has a drunk driving conviction in 1991. In her personal statement to the Board, MS. LONG indicated that previously she made poor decisions and has since learned valuable lessons. MS. LONG reported that she voluntarily obtained and completed chemical dependency treatment in 2010 and has been sober since January 2010.
D.
E.
F.
MS. LONG submitted documents to the Board from her chemical dependency treatment provider, Second Chance Counseling Center. In January 2010, MS. LONG was diagnosed as Alcohol Dependent and was later successfully discharged from chemical dependency treatment. MS. LONG's treatment recommendations include abstaining from alcohol and attending 12 step recovery meetings. MS. LONG was permitted to take the NCLEX-PN, and on or about October 1,2010, MS. LONG passed the NCLEX-PN.
AGREED CONDITIONS
G.
Wherefore, in consideration of the foregoing and mutual promises hereinafter set forth, and in lieu of any formal proceedings at this time, MS. LONG knowingly and voluntarily agrees with the Board to the following terms, conditions, and limitations: Upon meeting the requirements for licensure, MS. LONG shall be granted a license to practice nursing as a liceilsed practical nurse in the State of Ohio. MS. LONG'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 November 2012:
Nicole L. Long, L.P.N. Applicant F.K.A. Nicole L. Ansley Page 3
1.
MS. LONG shall obey all federal, state, and local laws, and all laws and rules governing the practice of nursing in Ohio. MS. LONG shall comply with all of the terms and conditions of community control imposed in Marion Municipal Court Case No. TRC 0908954A and Case No. CRB 1000245A. MS. LONG shall appear in person for interviews before the full Board or its designated representative as requested by the Board or its designee.
Prior to submitting a request for release from the probationary terms, conditions and limitations of this Consent Agreement, MS. LONG shall submit satisfactory documentation to the Board from Marion Municipal Court Case No. TRC 0908954A and Case No. CRB 1000245A indicating that MS. LONG has completed and been released from all of the terms in Case No. TRC 0908954A and Case No. CRB 1000245A.

4.
MS. LONG 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. LONG'S history of chemical dependency and recovery status. MS. LONG shall self-administer prescribed drugs only in the manner prescribed. MS. LONG shall abstain completely from the use of alcohol.
Within sixty (60) days following the effective date of this Consent Agreement, MS. LONG shall begin submitting, at her expense and on the day selected, blood or urine specimens for drug andlor 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. LONG shall be negative, except for substances prescribed, administered, or dispensed to her by another so authorized by law who has full knowledge of MS. LONG'S history of chemical dependency and recovery status. Within sixty (60) days following the effective date of this Conseut Agreement, MS. LONG shall attend a minimum of one (1) meeting
Nicole L. Long, L.P.N. Applicant F.K.A. Nicole L. Ansley Page 4 per week of a support or peer group meeting approved in advance by the Board, or a Twelve Step program, and MS. LONG shall provide satisfactory documentation of such attendance to the Board every six (6)months beginning January 1,2011. Chemical Dependency Evaluation
8.
Upon request by the Board or its designee and within sixty (60) days of such request, MS. LONG 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. LONG shall provide the chemical dependency professional with a copy of this Consent Agreement. Further, MS. LONG shall execute releases to permit the chemical dependency professional to obtain any information deemed appropriate and necessary for the evaluation. The evaluating ~rofessionalshall submit a written o ~ i n i o n the Board that includes to diagnoses, recommendations for treatment and monitoring, any additional restrictions that should be placed on MS. LONG's license to practice, and a statement as to whkther MS. LONG is capable of practicing nursing according to acceptable and prevailing standards of safe nursing care. If the Board o r its designee requests a chemical dependency evaluation, MS. LONG 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. LONG 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. LONG's license and that the terms, conditions, and limitations may be incorporated in an addendum to this Consent Agreement.
Treating Practitioners a n d Reporting
10.
Within sixty (60) days following the effective date of this Consent Agreement, MS. LONG 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. LONG 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.
11.
MS. LONG 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. LONG throughout the duration of this Consent Agreement.
Within twenty-four (24) hours of release from hospitalization or medical treatment, MS. LONG shall notify the Board of any and all medicatioil(s) or prescription(s) received.
12.
13.
Prior to accepting employment as a nurse, each time with every employer, MS. LONG shall notify the Board.
14.
MS. LONG 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. LONG 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 January 1, 2011 or within thirty (30) days of accepting nursing employment. MS. LONG 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.
MS. LONG shall report to the Board, in writing, any violation of this Consent Agreement within thirty (30) days of the occurrence of the violation. MS. LONG shall sign release of information forms allowing health professionals and other organizations to submit the requested documentation directly to the Board. MS. LONG 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. LONG 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.
16.
17.
18.
19.
MS. LONG 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. LONG shall submit the reports and documentation required by this Consent Agreement or any other documents required by the Board to the attention of the Complial~ceUnit, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, OH 43215-7410. MS. LONG shall verify that the reports and documentation required by this Consent Agreement are received in the Board office. MS. LONG 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.
20.
21.
22.
Temporarv Practice Restrictions
MS. LONG 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. LONG to provide nursing services for fees, compensation, or other consideration or as a volunteer. MS. LONG 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. LONG agrees that her license to practice nursing as a licensed practical nurse will be automatically suspended if it appears to the Board that MS. LONG has violated or breached any terms or conditions of the Consent Agreement. Following the automatic suspension, the Board shall notify MS. LONG via certified mail of the specific nature of the charges and automatic suspension of her license. Upon receipt of this notice, MS. LONG 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. LONG 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.

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. LONG and the Board. The Board may only alter the probationary period imposed by this Consent Agreement if: (1) the Board determines that MS. LONG has complied with all aspects of this Consent Agreement; and (2) the Board determines that MS. LONG is able to practice according to acceptable and prevailing standards of safe nursing care without Board monitoring, based upon an interview with MS. LONG and review of the reports as required herein. Any period during which MS. LONG 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.
MS. LONG 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. LONG waives all of her rights under Chapter 119, ORC, as they relate to matters that are the subject of this Consent Agreement. MS. LONG 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 coinply with the Administrative Procedures Act, Chapter 119, ORC.
Nov.
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Nicole L, Long, L.P.N. Applicant F.K.A. Nicole L, Ansley Page 8
MS. LONG understands that this Consent Agreement is subject to ratification by the
M *OLE
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f&o L. LONG, L.P.N. A P P L I ~ ~ T
//-/- /o
DATE
F.K.A.NICOLE L ANSLEY .
BERTHA LOVELACE, President Ohio Board oPNorslng
DATE
11/01/2010
MON 1 4 : 0 6 [TX/RX
NO 51271 m 0 0 9
Case #11-003369, 12-001335
July 27, 2012

Alicia Kim Mahone, L.P.N. 8210 Dorver Dr. Cleveland, Ohio 44105 Dear Ms. Mahone: 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 14, 2012, in Franklin County Court of Common Pleas Case No. 11CR-4337, you were found guilty of: Grand Theft, a felony of the fourth degree; Falsification In A Theft Offense, a felony of the fourth degree; Theft, a felony of the fifth degree; and Falsification In a Theft Offense, a felony of the fifth degree. 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. 2. On or about August 18, 2011, your Medicaid Provider Agreement (No. 2842875) with the Ohio Department of Job and Family Services was suspended. During the period of suspension you are not permitted to provide, arrange for, or order services to Medicaid consumers. Section 4723.28(B)(1), 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 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.
Alicia Kim Mahone, 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,
Case #12-002527
July 27, 2012

Kelly Colleen Malley 17031 Raccoon Trail Strongsville, Ohio, 44136 Dear Ms. Malley: On or about June 5, 2012, 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, Ohio Revised Code (ORC), the Board proposes under authority of Section 4723.28 of the Ohio Revised Code, to deny, permanently revoke, revoke, suspend or place restrictions on your licenses 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 August 25, 2011, in Medina County Court of Common Pleas Case Number 11CR0249, you pled guilty to one (1) count of Theft to wit: Morphine, a felony of the fifth degree, in violation of Section 2913.02(A)(1)(B)(6), ORC, and were found eligible for Intervention in Lieu of Conviction. The acts underlying this case occurred on or about March 22 through 26, 2011 and involve you obtaining Morphine without the consent of the owner or person authorized to give consent. A Community Control Sanction Violation of Supervision Complaint in Case No. 11CR0249 indicates that you tested positive for opiates on September 6, 2011 when drug tested at the Rosary Hall at St. Vincent Charity Medical Center, and a Court Entry dated on or about January 19, 2012 indicates that you admitted to this charge. 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. Section 4723.28(B)(8), ORC, authorizes the Board to discipline a licensee for self-administering or
Kelly Colleen Malley Page 2 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 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, 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 registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely,
Case #12-002527
June 5, 2012

Kelly Colleen Malley, R.N. 17031 Raccoon Trail Strongsville, Ohio, 44136 Dear Ms. Malley: 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 August 25, 2011, in Medina County Court of Common Pleas Case Number 11CR0249, you pled guilty to one (1) count of Theft to wit: Morphine, a felony of the fifth degree, in violation of Section 2913.02(A)(1)(B)(6), 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 to wit: Morphine, a felony of the fifth degree, in violation of Section 2913.02(A)(1)(B)(6), 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-353688, IS HEREBY SUSPENDED. Continued practice after receipt of this
Kelly Colleen Malley, R.N. Page 2 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. 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 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 registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely,
, R.N., C.N.P. Supervising Board Member
Case# 12-002469
July 27, 2012

Alexandra N. Matt, L.P.N. 205 Greenridge Drive Bellefontaine, Ohio 43311 Dear Ms. Matt: You are hereby notified that, on or about November 19, 2010, you entered into a Consent Agreement (November 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 November 2011. A. You were issued a license to practice nursing as a licensed practical nurse in the State of Ohio on November 23, 2010. B. Item 4. of the November 2010 Consent Agreement states, Prior to accepting employment as a nurse, each time with every employer, MS. MATT shall notify the Board. Item 5. of the November 2010 Consent Agreement states, MS. MATT 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. MATT 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 January 1, 2011 or within thirty (30) days of accepting nursing employment. MS. MATT shall have employers(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. Temporary Practice Restrictions of the November 2010 Consent Agreement state, MS. MATT shall not practice nursing as a licensed practical nurse (1) for agencies providing home care in the patients residence; (2) for hospice care programs providing hospice care in the patients 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. MATT to provide nursing services for fees, compensation, or other consideration or as a volunteer. MS. MATT shall not function in a position or employment where the job duties or
Alexandra N. Matt, L.P.N. Page 2 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. Despite these provisions, in or around October 2011, you accepted nursing employment as a home health nurse from Primary Care Nursing Services, a home health agency, in Dublin, Ohio, in violation of your Temporary Practice Restrictions. Furthermore, prior to accepting nursing employment, you failed to notify the Board and you failed to provide a copy of your November 2010 Consent Agreement to Primary Care Nursing Services. C. Item 4. of the November 2010 Consent Agreement states, Prior to accepting employment as a nurse, each time with every employer, MS. MATT shall notify the Board. Item 5. of the November 2010 Consent Agreement states, MS. MATT 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. MATT 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 January 1, 2011 or within thirty (30) days of accepting nursing employment. MS. MATT shall have employers(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. Despite these provisions, on or about May 25, 2012, you accepted nursing employment as a license practical nurse from Logan Acres Care Center in Bellefontaine, Ohio. Prior to accepting nursing employment, you failed to notify the Board and you failed to provide a copy of your November 2010 Consent Agreement to Logan Acres Care Center. 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 November 2010 Consent Agreement, you are hereby notified that it appears to the Board that you have violated Items 4., 5. and the Temporary Practice Restrictions of the November 2010 Consent Agreement. YOU ARE FURTHER NOTIFIED THAT YOUR LICENSE TO PRACTICE NURSING AS A LICENSED PRACTICAL NURSE, PN-142875, 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.
Alexandra N. Matt, 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 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 November 19, 2010, you entered into a Consent Agreement (November 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 November 2011. 2. You were issued a license to practice nursing as a licensed practical nurse in the State of Ohio on November 23, 2010. 3. Item 4. of the November 2010 Consent Agreement states, Prior to accepting employment as a nurse, each time with every employer, MS. MATT shall notify the Board. Item 5. of the November 2010 Consent Agreement states, MS. MATT 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. MATT 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 January 1, 2011 or within thirty (30) days of accepting nursing employment. MS. MATT shall have employers(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. Temporary Practice Restrictions of the November 2010 Consent Agreement state, MS. MATT shall not practice nursing as a licensed practical nurse (1) for agencies providing home care in the patients residence; (2) for hospice care programs providing hospice care in the patients 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. MATT to provide nursing services for fees, compensation, or other consideration or as a volunteer. MS. MATT 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.
Alexandra N. Matt, L.P.N. Page 4 Despite these provisions, in or around October 2011, you accepted nursing employment as a home health nurse from Primary Care Nursing Services, a home health agency, in Dublin, Ohio, in violation of your Temporary Practice Restrictions. Furthermore, prior to accepting nursing employment, you failed to notify the Board and you failed to provide a copy of your November 2010 Consent Agreement to Primary Care Nursing Services. 4. Item 4. of the November 2010 Consent Agreement states, Prior to accepting employment as a nurse, each time with every employer, MS. MATT shall notify the Board. Item 5. of the November 2010 Consent Agreement states, MS. MATT 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. MATT 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 January 1, 2011 or within thirty (30) days of accepting nursing employment. MS. MATT shall have employers(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. Despite these provisions, on or about May 25, 2012, you accepted nursing employment as a license practical nurse from Logan Acres Care Center in Bellefontaine, Ohio. Prior to accepting nursing employment, you failed to notify the Board and you failed to provide a copy of your November 2010 Consent Agreement to Logan Acres Care Center. 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
Alexandra N. Matt, L.P.N. Page 5 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,
~ ~ ~ ~ . ~ ~ ~ ~ i ~ ~ g . o
17 Sotrrll filigli Street, Suite 400 * Columbus, Ohio 43215-7410 * (614) 466-3047
To Whom It May Concern:
You recently requested records regarding Alexandra N. Matt, P.N. #142875. 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 #lo-4364

17 South High S ~ r c cSuite 400 ~,
~vw~v.~~ursing.ohio.gov
(614) 466-3947
Colmnbus, Ohio 47215-7410
CONSENT AGREEMENT BETWEEN ALEXANDRA N. MATT, L.P.N. APPLICANT AND OHIO BOARD OF NURSING
This Consent Agreement is entered into by and between ALEXANDRA N. MATT, L.P.N. APPLICANT (MS. MATT) 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. MS. MATT 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. On or about August 26, 2010, MS. MATT submitted to the Board an Application for Licensure by Examination to Practice in Ohio as a Licensed Practical Nurse.
B.
Alexandra N. Matt, L.P.N. Applicant Page 2
E.
MS. MATT was permitted to take the NCLEX-PN, and on or about October 7,2010, MS. MATT 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. MATT knowingly and voluntarily agrees with the Board to the following terms, conditions, and limitations: Upon meeting the requirements for licensure, MS. MATT shall be granted a license to practice nursing as a licensed practical nurse in the State of Ohio. MS. MATT'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 November 2011: 1.
MS. MATT shall obey all federal, state, and local laws, and all laws and rules governing the practice of nursing in Ohio. MS. MATT shall appear in person for interviews before the full Board or its designated representative as requested by the Board or its designee.
2.

3.
Within ninety (90) days from the effective date of this Consent Agreement, MS. MATT 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 of professionalism.
4.
Prior to accepting employment as a nurse, each time with every employer, MS. MATT shall notify the Board.
5.
MS. MATT 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. MATT 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 January 1, 2011 or within thirty (30) days of accepting nursing employment. MS. MATT 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.

6.
MS. MATT shall report to the Board, in writing, any violation of this Consent Agreement within thirty (30) days of the occurrence of the violation. MS. MATT shall sign release of information forms allowing health professionals and other organizations to submit the requested documentation directly to the Board. MS. MATT 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. MATT 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. MATT 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. MATT 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. MATT shall verify that the reports and documentation required by this Consent Agreement are received in the Board office.
7.
8.
9.
10.
11.
12.
13.
MS. MATT 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.
Tem~orarv Practice Restrictions MS. MATT 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. MATT to provide nursing services for fees, compensation, or other consideration or as a volunteer. MS. MATT 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. MATT agrees that her license to practice nursing as a licensed practical nurse will be automatically suspended if it appears to the Board that MS. MATT has violated or breached any terms or conditions of the Consent Agreement. Following the automatic suspension, the Board shall notify MS. MATT via certified mail of the specific nature of the charges and automatic suspension of her license. Upon receipt of this notice, MS. MATT 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. MATT 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.

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. MATT and the Board. The Board may only alter the probationary period imposed by this Consent Agreement if: (1) the Board determines that MS. MATT has co~nplied with all aspects of this Consent
PATTISON
PAGE
02
Alexandra N. Matt, L.P.N. Applicant Page 5 Agecrnent; and (2) the Board determines tbat MS. MATT is able to practice according to acceptable and prevailing standards of safe nursing care without Board monitoring, bared upon an interview with MS. MATT and review of the reports as required herein. Any period durin~ which MS. MATT does not work in a position for which a nursing license is required shall not a n t toward fuIfiIlling the probationq period imposed by this Consent Agreement.
MS. MATT acknowledges that she has had m opportunity to ask questions concerning the terms of this Conscnt Agreement and that all questions mked have been answered in a satisfactory manner.
MS. MATT waivcs all of her rights under Chap& 119, ORC, as they relate to matters
tbat are the subject of this Consent Agreement.
MS. MATT waives any and all claims or causes of action she may have against the Board, and its members, officers, employees andlor agents d d n g out o mattem, whlch f me the subject of this Consent Agreement.
This Consent Agreement shall be considered a public record as that tern is used in Section 149.43, ORC. The information contained herein may be reported to appropriate organizations, data banks and ~ovemmental bodies. This Consent A ~ e m e nis not an adjudication order as discussed in Chapter 119, ORC. t Any action initiated by the Board based on alleged violations of this Cmwnt Agreement shall comply with the Administrative Procedures Act, Chapter 119, ORC.
MS. MATT undmtands rbat this Consent Agreement is subject to ratification by the Board prior to siguahlre by the Board President and shall become cffectivc upon the last
date of signatw below.
&e~nh~ ALEXANDRA N. MATT, L.P.N. APPLICANT
n. m 4
10 118
DATE
/2010
& &&
Ohio Bnard of Nursing
8fi,@,Ui4,~~
DATE
BERTHA LOVEXACE. Prddent
10/28/2010
THU 1 1 16 [ T X / R X
NO 50991 @ 0 0 2
Case #12-001885
July 27, 2012

Tina Marie McCall, L.P.N. 201 Mill Street New Lexington, Ohio 43764 Dear Ms. McCall: 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 May 3, 2012, in Perry County Court of Common Pleas Case Number 11 CR 0103, you were found guilty of one (1) count of Illegal Cultivation of Marihuana, a felony of the fifth degree, in violation of Section 2925.04(A) and (C)(5)(c), 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. Illegal Cultivation of Marihuana, a felony of the fifth degree, in violation of Section 2925.04(A) and (C)(5)(c), 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-132354, 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.
Tina Marie McCall, L.P.N. Page 2 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 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 3, 2012, in Perry County Court of Common Pleas Case Number 11 CR 0103, you were found guilty of one (1) count of Illegal Cultivation of Marihuana, a felony of the fifth degree, in violation of Section 2925.04(A) and (C)(5)(c), ORC. The acts underlying the above criminal case occurred on or about October 5, 2011, and involve you cultivating marihuana. 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. In an email to the Board, dated May 9, 2012, you admitted that in September 2011, you falsified a report to law enforcement.
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), Ohio Administrative Code, 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: (6) Law enforcement personnel. 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.
Tina Marie McCall, L.P.N. Page 3 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 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,
Case# 12-000068
July 27, 2012

Tammi M. Melvin 5021 Neptune Drive Solon, Ohio 44139 Dear Ms. Melvin: 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. Your license to practice nursing as a registered nurse is currently suspended for indefinite period of time with conditions for reinstatement pursuant to a Default Order issued by the Board on May 20, 2011, (May 2011 Order), a copy of which is attached hereto and incorporated herein. Also attached is a final Default Order dated November 18, 2011 Order (November 2011 Order). On or about March 8, 2012, the Board received your letter requesting reinstatement. 2. You failed to meet your conditions for reinstatement as follows: Item 1. of the May 2011 Order states, MS. MELVIN 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), 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 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
Tammi M. Melvin Page 2 any way not in accordance with a legal, valid prescription issued for that individual. Despite this provision, on or about March 8, 2012, you admitted in a meeting with Board Staff that you had consumed Opana without a prescription. In addition, on or about June 19, 2012, in Cuyahoga County Court of Common Pleas Case No. CR-12-561833-A, you pled guilty to one (1) count of Deception to Obtain A Dangerous Drug, a fourth-degree felony in violation of Section 2925.22(A), ORC, and one (1) count of Illegal Processing of Drug Documents, a fourth-degree felony in violation of Section 2925.23(B)(1), ORC, and were found eligible for Intervention in Lieu of Conviction. 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 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. 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 Opportunity for Hearing, deny, permanently revoke,
Tammi M. Melvin Page 3 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,
Judith A. Church, R.N., C.N.P. Supervising Member Certified Mail Receipt No.: 7012 1010 0002 4225 1435 cc: Henry G. Appel, Assistant Attorney General
BEFORE THE OHIO BOARD OF NURSING

IN THE MATTER OF: TAMMI M. MELVIN, R.N. ORDER: 2275 CASE #09-1168
ORDER
By certified mail letter, dated October 29, 2010, TAMMI M. MELVIN, R.N., was ordered to submit to an examination pursuant to Section 4723.28(G), Ohio Revised Code (ORC). On May 20,201 1, the Board found that MS. MELVIN admitted to the allegations set forth in the October 29,2010 examination order because MS. MELVIN failed to submit to the examination and the failure was not due to circumstances beyond her control. Accordingly, on May 20, 201 1, the Board issued a Default Order suspending MS. MELVIN'S license to practice nursing as a registered nurse for an indefinite period of time with conditions for reinstatement. The May 2011 Default Order also informed MS. MELVIN that she was entitled to a hearing in the matter if the hearing was requested within thirty days of the mailing of the Default Order. A true copy of the May 2011 Default Order is attached hereto and incorporated herein. In accordatlce with Section 119.07, ORC, the May 201 1 Default Order was sent on June 7,201 1, via certified mail, return receipt requested, to MS. MELVIN in East Liverpool, Ohio. The Default Order was re-mailed via certified mail to the address of record for MS. MELVIN on September 12,2011, as it was determined that the first mailing was sent to the incorrect address. Service was obtained at the address of record. MS. MELVIN did not submit a hearing request as specified within Section 119.07, ORC. Upon consideration of the allegations contained in the October 29, 2010 examination order and the findings contained in the May 2011 Default Order, the Board finds that MS. MELVIN has committed acts in violation of the Nurse Practice Act, as set forth in the May 201 1 Default Order, and the Board orders that MS. MELVIN'S license to practice nursing as a registered nurse in the State of Ohio is hereby suspended, as of May 20, 2011, with conditions for reinstatement set forth in the May 2011 Default Order. This Order shall become effective immediately and is hereby entered upon the Journal of the Board for the 18th day of November, 201 1.
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., 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 Commot~ 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
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 18th day of November 2011.
Q 1t 1
betsy J. ~ o u c u e nR.N.,M.S., J.D. , Executive Director
November 18.201 1 Date
1 hereby certify that a true and accurate copy of the foregoing Order, TAMMI M. MELVIN,
R.N., was sent via certified mail, return receipt requested, this
2 " day of November, 2011 to 1'
TAMMI M. MELVIN, R.N., 49631 N. Hollywood Drive, East Liverpool, Ohio 43920.
1 also certify that a copy of the same was sent via regular U.S. mail this 21st day of November, 2011 to Lamont Pugh, SAC, Sanctions & Exclusions, Departmerlt of Health and Human Services, Office of inspector General, Office of investigations, PO Box 81020, Chicago IL 60601-81020.
Betsy J. ~$ou&en, R.N., M.S., J.D. Executive Director hrf cc: Michelie T . Sutter, Assistant Attorney General
Certified Mail Receipt No. 701 1 1150 0002 0937 1136

17 South I-ligh Streek, Suike 400
ww~v.~~~~rsi~~g.ohio~gov
Colt~mbus, Ohio 4321 5-74.10
(6 14) 466-3917
T~i111ni Melvin 1 16856 Cliilon Ave East Liverpool, OH 43920 Deal Ms. Melvin: Enclosed is your DefaulL Order. Please review the document carefully. Please contact Lisa Ferguson-Railios, Compliance Manager at the Board oilice a1 (614)995-3635 if you have any questions Sincerely,
Betsy J . Houcllen, R N , M.S., J D Executive Director
cc:
Melissa Wilburn Assistant Attorney General
Certihed Mail Receipt No. 701 I 01 10 0001 5992 8607

IN THE MATTER OF: TAMMI MICHELLE MELVIN, R.N. ORDER: 2150 CASE #09-1168
DEFAULT ORDER
By certified mail letter, dated October 29, 2010, TAMMI MICHELLE MELVIN, R.N. was ordered lo submit to an examination pursuant to Section 4723.28(G) ORC. The Examination Order was mailed to MS. MELVIN'S address of ~.ecord certified mail. The by Examination Order was signed as received at MS. MELVIN'S address of record.
MS. MELVIN has failed to submit to an examination and the Board has not received
information that the failure to submit to an examination was due to circumstances beyond her control In accordance with Section 4723.28(G) ORC, tlie failure of any individual to submit to a mental or physical examination when directed constitutes an admission of the allegations, unless the failure is due to circumstances beyond the individual's control and a default and final order may be entered witl~outthe taking of testimony or presentation of evidence. The Board finds tl~at MS. MELVIN has failed to submit to an examination when directed, and that the failure was not due to circumstances beyond her control. Section 4723.28(B)(16) provides that the Board can suspend or place restrictions on a license for violation of Chapter 4723 or any rules adopted under that chapter. In accordance with Section 4723 28(B)(16) and Section 4723.28(G) ORC, the OIlio Board of Nursing finds that that MS. MELVIN has admitted the truth of tlie allegations set forth in tlie October 29, 2010 Examination Order issued to MS. MELVIN and that MS. MELVIN is to impaired The Board ORDERS that MS. MELVIN'S licer~se practice nursing as a registered nurse in the State of Ohio is hereby suspended for an indefinite period of time wit11 conditions for reinstatement set forth below:

1 . MS. MELVIN shall obey all federal, state, and local laws, and all laws and rules governing the practice of nursing in Ohio.
2. MS. MELVIN shall appear in person for interviews before the full Board or its designated representative as requested by the Board and prior to reinstatement.
3 . P r i o r to requesting reinstatement by the Board, MS. MELVIN shall submit a request to the Bureau of Criminal ldentification and Investigation (BCIJ) to conduct a criminal records check of MS. MELVIN, includi~iga check of Federal Bureau of Investigation (FBI) records, and shall cause BClI to submit MS. MELVIN'S criminal records check reports to the Board. A request for reinstatement will not be considered by the Board 11ntil tlie completed criminal records check, including tlie FBI check, lias been received by the Board
4. MS. M E L V I N shall, at lier own expense, submit to a chemical dependency examination,

specifically addressing her ability to function in a clinical nursing capacity, by Dr. Richard Whitney, Shepherd Hill Addiction Services, 200 Messimer Drive, Newark, Oliio 43055. Prior. to the evaluation, MS. MELVIN shall provide the Examiner with a copy of this Order and the October 29, 2010 Examination Order, and shall execute releases to permit the Examiner to obtain any information deemed appropriate and necessary for the evaluation. The Examiner shall submit a written opinion to the Board that includes diagnoses, recommendations for treatment and monitoring, and any restrictions that should be placed on MS. MELVIN'S practice. Tlie Examiner shall provide an opinion to the Board regarding whether MS. MELVIN is capable of practicing nursing according to acceptable and prevailing standards of safe nursing care,.
5. MS. M E L V I N shall enter into a Consent Agreement with the Board for probationary
terms, conditions, limitations, and restrictions determined by the Board for a minimum period of time determined by the Board. The probationary terms, conditions, limitations, and restrictions determined by the Board shall include, but not be limited to, completion or continuation of chemical dependency, psychiatric or other mental health treatment recommended and/or restrictions specified by the Examiner, as set forth in paragraph 4 . , above. if the Board and MS. MELVIN ar.e unable to agree to terms, conditions, Limitations, and restrictions in a Consent Agreement, the terms, conditions, Limitations, and restrictions shall be determined after a hearing is held. Reporting Requirements of Licensee
6. MS. M E L V I N shall sign release of information forms allowing healtll professionals and
or other organizations to submit requested doc~~mentation information directly to the Board.
7. MS. M E L V I N shall submit any and all information that the Board may request regarding lier ability to practice according to acceptable and prevailing standards of safe nursing practice.
8. MS. M E L V I N shall not submit or cause to be submitted any false, misleading, or deceptive statements, information, or doct~rnentationto the Board or. to employers or potential employers. 9. MS. M E L V I N shall submit the reports and documentation required by this Order on forms specified by tlie Board. A11 reporting and communications required by this Order shall be made to the Monitoring Unit of the Board
10. MS. MELVIN shall submit the reports and documentation required by this Order to the attention of tlie Compliance Unit, Oliio Board of Nursing, 17 South High Street, Suite 400, Columbus, OH 43215-7410.
I I . MS. MELVIN shall verify that the reports and documentation required by this Order are received in the Board office.
12 MS. MELVIN shall inform the Board within three (3) business days, in writing, of any change in address andlor telephone number.
In accordance wit11 Chapter 119, ORC, MS. MELVIN is hereby informed that MS. MELVIN is entitled to a hearing on this matter If MS. MELVIN wishes to request such hearing, the request must be made in writing and n ~ u s t received in the Board office within thirty (30) days of the be
time of mailing of this notice.
MS. MELVIN is hereby further informed that, if MS. MELVIN timely requests a hearing, MS. MELVIN is entitled to appear a1 such hearing in person, by MS. MELVIN's attorney, or by such other representative as is permitted to practice before the Board, or MS. MELVIN may present MS. MELVIN'S position, arguments, or contentions in writing. At the hearing MS. MELVIN may also present evidence and examine witnesses appearing for and against MS. MELVIN.
Should MS. MELVIN 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, Ollie Board of Nursing, 17 South High Street, Suite 400, Columbus, OH 432157410, or to the email address, hearing@hursing.ohio.gov. This Order. shall become effective immediately and is hereby entered upon the Journal of the Board for the 20th day ofU&y, 2 0 U .
The State ofO11io County of Franklin
I, the undersigned Betsy .I. 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 20th day of w20u.
Executive Director
Date
'Nay 3, a,\
1 Itereby cettify illat a true and accurate copy of tlie foregoing Order, TAMMl MICHELLE
MELVIN, R.N, was sent via certified mail, return receipt requested, this
SL.
day of
J -
to TAMMI MICHELLE MELVIN, at 49631 N . Hollywood
Drive, East Liverpool. Ollio 43920.
I also certify tihat: a copy of the salne was setit via regular U S . illail tiiis 8K day of 3 , Wll to Lamont Pt~gh, SAC, Sanctions & Exclusions, Department
of Health and liumao Services, Office of laspector Gerieral, Office of lnvestigotions, PO Box 8 1020, Chicago 1L 60601-8 1020.
Executive Director.
lirl cc: Melissa L.. Wilbur~~, Assistant Attollley General
Certified Mail Receipt No 701 1 01 10 0001 5992 SG07
Case #12-000785
July 27, 2012

Joseph Sherman Morris, R.N. 3336 Springhaven Catlettsburg, KY 41129 Dear Mr. Morris: 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 September 10 or September 11, 2010 you took Valium in excess of the prescribed amount. In a signed, written statement, you state that you took eight (8) Valium pills, then about seven (7) or eight (8) pills about two to four hours later. 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. In a signed written statement, you acknowledged that on or about September 16, 2010, while working as a nurse, you submitted a drug screen specimen that was positive for benzodiazepines and Oxycodone. You state that you must have taken some Oxycodone pills from a 2005 prescription while under the effects of your Valium overdose on September 10 or September 11. 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. 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.
Joseph Sherman Morris, R.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 registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely,
Case #12-000897
July 27, 2012

Tina Nicole Moyer, L.P.N. 137 South West End Ave. Dayton, Ohio 45417 Dear Ms. Moyer: 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 11, 2012, in Montgomery County Court of Common Pleas Case No. 2011 CR 03333, you pled guilty to one (1) count of Theft, a fifth-degree felony, in violation of Section 2913.02(A)(1), ORC, and were found eligible for Intervention in Lieu of Conviction. The acts underlying your conviction occurred on or about September 15, 2011, and involve you obtaining, or exerting control over, merchandise without the consent of the owner or person authorized to give consent. 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.
Tina Nicole Moyer, L.P.N. Page 2 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@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 the 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,
Judith A. Church, R.N., C.N.P. Supervising Member Certified Mail Receipt No. 7012 1010 0002 4225 1282 cc: Henry G. Appel, Senior Assistant Attorney General
Case #12-002347
July 27, 2012

Margaret Ann Norton, R.N. 1828 Ironwood Drive Fairborn, OH 45324 Dear Ms. Norton: 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 February 26, 2010, in Greene County Court of Common Pleas, as documented in one (combined) Judgment Entry, you were convicted of the following: a) In Case No. 2009-CR-471, one (1) count of Theft, a fifth-degree felony, in violation of Section 2913.02(A)(1), ORC; b) In Case No. 2009-CR-563, one (1) count of Forgery, a fifth-degree felony, in violation of Section 2913.31(A)(3), ORC, and one (1) count of Receiving Stolen Property, a fifth-degree felony, in violation of Section 2913.51(A), ORC; and, c) In Case No. 2009-CR-697, one (1) count of Theft from an Elderly Person, a fourth-degree felony, in violation of Section 2913.02(A)(1), ORC. 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.
Margaret Ann Norton Page 2 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@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 the 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,
Case #11-004204
July 27, 2012

Ayana D K Parks, L.P.N. 324 Harland Drive Columbus, OH 43207 Dear Ms. Parks: 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. On or about October 20, 2011, in Franklin County (Ohio) Court of Common Pleas Case No. 10CR-10-6176, you were found guilty of one (1) count of Theft by Deception, a fifth-degree felony, in violation of Section 2913.02(A)(3), ORC. The acts underlying the criminal conviction referenced above involve you, from on or about June18, 2009 to on or about November 4, 2009, as part of a course of criminal conduct, obtaining monies from the Ohio Department of Job and Family Services (ODJFS). On or about October 27, 2009, you met with special agents with the Ohio Attorney Generals Office Medicaid Fraud Control Unit and admitted that you had billed for nursing services that you did not provide. 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. 2. During your above-noted October 27, 2009 interview with special agents from the Ohio Attorney Generals Office Medicaid Fraud Control Unit, you admitted that you paid a portion of the monies received from your fraudulent billing to your home health care patient, and that the arrangement began at the request of the patient, who had asked you to loan her the money in exchange for not working on Fridays, Saturdays, and Sundays.
Ayana D K Parks, L.P.N. Page 2 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 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; (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. 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@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 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,
Case #11-001050, 11-004478
July 27, 2012

Melody Jane Persinger 238 Marion Street PO Box 125 Green Camp, Ohio 43322 and 3897 Greencamp-Essex Road, Apt. B Marion, Ohio 43322 Dear Ms. Persinger: On or about May 23, 2012, 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 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 15, 2012, in Marion County Court of Common Pleas Case Number 11-CR-638, 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. The acts underlying this case occurred on or about March 10, 2011, and involve you obtaining Oxycontin and Hydrocodone without the consent of the owner or person authorized to give consent. 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.
Melody Jane Persinger Page 2 2. On or about December 9, 2011, you admitted to a Board Compliance Agent that while you were employed as a nurse with Signature Health Services of Marion, LLC, in Marion, Ohio (Signature), you selfadministered more Percocet and Hydrocodone than was prescribed to you to get through the day. You admitted that you were addicted to your prescription medications.
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. 3. On or about December 9, 2011, you admitted to a Board Compliance Agent that in or about March 2011, while you were employed as a nurse with Signature, you diverted Patient #1s OxyContin that were stored in the bathroom. Patient #1 is identified on the attached Patient Key [Patient Key is confidential to be withheld from public disclosure].
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(L), Ohio Administrative Code, states that a licensed nurse shall not misappropriate a client's property. 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. On or about December 9, 2011, you admitted to a Board Compliance Agent that while working as a nurse for Interim Healthcare and after Patient #2 offered, you accepted three (3) or four (4) tablets of Percocet that were prescribed to Patient #2.
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)(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. Accordingly, the Board is authorized to impose one or more of the sanctions as cited in Section 4723.28, ORC.
Melody Jane Persinger Page 3 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.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,
Melody Jane Persinger Page 4 Patient Key (This Key is confidential pursuant to Section 4723.28(I) of the Ohio Revised Code, and is to be withheld from public disclosure) 1. 2. Sandra Martin Marsha Priest
Case # 11-001050, 11-004478
May 23, 2012

Melody Jane Persinger, L.P.N. 238 Marion Street PO Box 125 Green Camp, Ohio 43322 and 3897 Greencamp-Essex Road, Apt. B Marion, OH 43322 Dear Ms. Persinger: 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 15, 2012, in Marion County Court of Common Pleas Case Number 11-CR-638, 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. 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.
Melody Jane Persinger, 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, PN-131277, 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 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,
Judith A. Church, R.N., C.N.P. Supervising Board Member Certified Mail Receipt No.7011 2970 0003 1733 4934 Second Certified Mail Receipt No. 7011 2970 0003 1733 4941 cc: Henry G. Appel, Assistant Attorney General
Case #11-004056
July 27, 2012

Rocky Pitoscia 3632 Mercedes Place Canfield, Ohio 44406 Dear Mr. Pitoscia: On or about May 23, 2012, 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; 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 10, 2012, in Mahoning County Court of Common Pleas Case Number 12 CR 4, you pled guilty to one (1) count of Theft of Drugs, a felony of the fourth degree, in violation of Section 2913.02(A)(2)(B)(6), ORC, and were found eligible for Intervention in Lieu of Conviction. The acts underlying this case occurred on or about October 10, 2011, and involve you obtaining Morphine and Fentanyl beyond the scope of consent of Humility of Mary Health Partners. 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 October 11, 2011, you submitted a specimen that tested positive for Morphine, Fentanyl, and Meperidine (Demerol).
Rocky Pitoscia Page 2 On or about October 13, 2011, you admitted to a Board Compliance Agent that you diverted Morphine, Fentanyl, and any other unauthorized narcotics found in your October 11, 2011, drug screen from St. Elizabeth Medical Center in Youngstown, Ohio, where you worked as a nurse. You admitted that you self-administered the diverted drugs at home. You stated that you were diverting drugs for approximately one (1) month. You stated that you believed that you were chemically dependent upon your prescription Oxycodone and admitted to occasionally self-administering more Oxycodone than was authorized by your prescription. 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)(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 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.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 registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely,
Rocky Pitoscia Page 3
Case #11-004056
May 23, 2012

Rocky Pitoscia, R.N. 548 W. Walnut Street Lowellville, OH 44436 and 3632 Mercedez Place Canfield, OH 44406 Dear Mr. Pitoscia: 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 May 10, 2012, in Mahoning County Court of Common Pleas Case Number 12 CR 4, you pled guilty to one (1) count of Theft of Drugs, a felony of the fourth degree, in violation of Section 2913.02(A)(2)(B)(6), 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)(2)(B)(6), ORC, constitutes a felony drug abuse offense as defined in Section 2925.01, ORC.
Rocky Pitoscia, R.N. Page 2 WHEREFORE, PURSUANT TO SECTION 3719.121(C), ORC, YOU ARE HEREBY NOTIFIED THAT YOUR LICENSE TO PRACTICE NURSING AS A REGISTERED NURSE, RN-351068, 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. 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 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 registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely,
Judith A. Church, R.N., C.N.P. Supervising Board Member Certified Mail Receipt No.7011 2970 0003 1733 4958 Second Certified Mail Receipt No. 7011 2970 0003 1733 4965 cc: Henry G. Appel, Assistant Attorney General
Case #11-004709
July 27, 2012

Nicole Raitz, L.P.N. 2118 North County Road 15 Tiffin, Ohio 44883 Dear Ms. Raitz: 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 February 1, 2012, in Franklin County Court of Common Pleas Case Number 11CR-11-6004, you pled guilty to and were subsequently found guilty of one (1) count of Theft, a fourth-degree felony, in violation of Section 2913.02, ORC. The events underlying your criminal case noted above occurred from on or about October 26, 2010, to on or about June 12, 2011, in Franklin County, Ohio. 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. 2. On or about November 1, 2011, you met with special agents from the Ohio Attorney General's Office Medicaid Fraud Unit and admitted that in 2010 and 2011, while working as an independent provider nurse, you billed for nursing services that you did not provide.
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. 3. Your Medicaid Provider Agreement (No. 3074186) was terminated, effective April 6, 2012, by a Termination of Medicaid Provider Agreement
Nicole Raitz Page 2 Letter issued by the Ohio Department of Job and Family Services (ODJFS April 2012 Letter). Section 4723.28(B)(1), ORC, authorizes the Board to deny a license or otherwise 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 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 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, 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,
Case # 10-4661
July 27, 2012

Ann Katherine Rawnsley, R.N. 6777 Barbara Dr. Huber Heights, Ohio 45424 Dear Ms. Rawnsley: 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 September 30, 2010, while working as a nurse at Crossroads Hospice in Dayton, Ohio you submitted a drug screen specimen that was positive for Amphetemines. 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. 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.
Ann Katherine Rawnsley, 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, 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,
Case #10-0101
July 27, 2012

Ebony Marie Redrick, L.P.N. 3805 Bainbridge Rd Cleveland Hts, Ohio 44118 Dear Ms. Redrick; 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 October 1, 2009, in Cuyahoga County Court of Common Pleas Case No. CR-09-520952-A, you pled guilty to and were subsequently convicted of one (1) count of Identity Fraud, a fourth-degree felony, in violation of Section 2913.49(B)(2), ORC, and two (2) amended count of Attempted, Tampering with Records, both fourth-degree felonies, in violation of Section 2923.02/2913.42(A), ORC. The acts underlying your convictions occurred from on or about April 25, 2007 to on or about October 15, 2007 in Cuyahoga County, Ohio.
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.
Ebony Marie Redrick, 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, 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 the 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,
Case# 12-002104
July 27, 2012

Lisa Ann Rice, OCDT 2601 Colchester Cleveland Heights, Ohio 44106 Dear Ms. Rice: You are hereby notified that, on or about September 24, 2010, you entered into an Addendum to Consent Agreement (September 2010 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 certificate to practice as a dialysis technician 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 2007 Consent Agreement. Attached to and incorporated within the September 2010 Addendum is a Consent Agreement entered into between you and the Board on November 16, 2007 (November 2007 Consent Agreement), in which you agreed with the Board that your temporary dialysis certificate one and any future certificates granted upon successful completion of the application process to practice as a dialysis technician in the State of Ohio would be suspended indefinitely and that such suspension would be stayed subject to the following probationary terms, conditions and limitations until at least November 2008. A. Item 2. of the November 2007 Consent Agreement states, MS. RICE 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, on May 15, 2012, you failed to appear at the Boards office for your personal interview with your Board Monitoring Agent. You were sent a scheduling letter from the Board dated May 1, 2012, to your address of record notifying you of this scheduled personal interview. B. Item 2. Page 3 of the September 2010 Addendum states, By March 1, 2011, in addition to the requirements for certificate renewal, MS. RICE shall successfully complete and submit documentation of satisfactory completion of the following continuing education taken subsequent to the effective date of this Addendum: Six (6) hours of Ethics; Four (4) hours of Critical Thinking; and Four (4) hours of Infection Control. Despite this provision, as of July 2, 2012, you have failed to submit to the Board documentation of satisfactory completion of Six (6) hours of Ethics; Four (4) hours of Critical Thinking; and Four (4) hours of Infection Control.
Lisa Ann Rice, OCDT 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 dialysis technician certificate by the Board. In accordance with the paragraph under FAILURE TO COMPLY of the November 2007 Consent Agreement and the September 2010 Addendum, you are hereby notified that it appears to the Board that you have violated Item 2. of the November 2007 Consent Agreement and Item 2. of the September 2010 Addendum. YOU ARE FURTHER NOTIFIED THAT YOUR CERTIIFCATE TO PRACTICE AS A DIALYSIS TECHINICAN, DT-002883, 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), 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 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 September 24, 2010, you entered into an Addendum to Consent Agreement (September 2010 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 certificate to practice as a dialysis technician 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 2007 Consent Agreement. Attached to and incorporated within the September 2010 Addendum is a Consent Agreement entered into between you and the Board on November 16, 2007 (November 2007 Consent Agreement), in which you agreed with the Board that your temporary dialysis certificate one and any future certificates granted upon successful completion of the application process to practice as a dialysis technician in the State of Ohio would be suspended indefinitely and that such suspension would be stayed subject to the following probationary terms, conditions and limitations until at least November 2008. 2. Item 2. of the November 2007 Consent Agreement states, MS. RICE 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, on May 15, 2012, you failed to appear at the Boards office for your personal interview with your Board Monitoring Agent. You were sent a scheduling letter from the Board dated May 1, 2012, to your address of record notifying you of this scheduled personal interview.
Lisa Ann Rice, OCDT Page 3 3. Item 2. Page 3 of the September 2010 Addendum states, By March 1, 2011, in addition to the requirements for certificate renewal, MS. RICE shall successfully complete and submit documentation of satisfactory completion of the following continuing education taken subsequent to the effective date of this Addendum: Six (6) hours of Ethics; Four (4) hours of Critical Thinking; and Four (4) hours of Infection Control. Despite this provision, as of July 2, 2012, you have failed to submit to the Board documentation of satisfactory completion of Six (6) hours of Ethics; Four (4) hours of Critical Thinking; and Four (4) hours of Infection Control. Section 4723.28(B)(17), Ohio Revised Code, ORC, authorizes the Board to discipline a licensee 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 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 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. Sincerely,
Lisa Ann Rice, OCDT Page 4 Certified Mail Receipt No. 7012 1010 0002 4225 4979 cc: Henry G. Appel, Assistant Attorney General
Case #lo-0135
Ohio Board sf Nursing

17 South High Street, Suile 400
www.nt~rsing.ohio.gov
Q
* Columbus, Ohio 43215-7410
(614) 466-3947
ADDENDUM TO CONSENT AGREEMENT BETWEEN LISA ANN RICE, OCDT AND OHIO BOARD OF NURSING
This Addendum to the Consent Agreement (Addendum) is entered into by and between LISA ANN RICE, OCDT (MS. RICE) 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. MS. RICE voluntarily enters into this Addendum being fully informed of her rights under Chapter 119, ORC, including the right to representation by legal counsel and the right to aformal adjudicative hearing on the issues considered herein.
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 dialysis technician certificate by the Board. 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 dialysis 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 4723-23-14(H)(5), Ohio Administrative Code, states that a dialysis technician shall do the following to promote patient safety: implement measures to provide a safe environment for the patient.
B.
MS. RICE has an active license to practice as an Ohio Certified Dialysis Technician (OCDT), DT. 02883, in the State of Ohio. MS. RICE was initially licensed as OCDT in August 2009. MS. RICE knowingly and voluntarily admits to the following:
C.
Lisa Ann Rice, OCDT Page 2
1. On or about November 16, 2007, MS. RICE entered into a Consent Agreement with the Board (November 2007 Consent Agreement), under which MS. RICE'S temporary certificate one and any future certificates granted upon completion of the application process to practice as a dialysis technician was subject to probationary terms, conditions, and limitations until at least November 2008. A copy of the November 2007 Consent Agreement is attached hereto and incorporated herein.
2. Item 1. on Page 2 of the November 2007 Consent Agreement states, "MS. RICE shall obey all federal, state, and local laws, and all laws and rules governing the practice of dialysis technicians in Ohio." 3. On or about October 1, 2009, MS. RICE was terminated from the Centers for Dialysis Care in Shaker Heights, Ohio as a dialysis technician for failing to follow the infection control policies and failing to meet competency requirements for machine set-up and troubleshooting.
4. Item 12. on Page 3 of the November 2007 Consent Agreement states, "MS. RICE 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."
5. MS. RICE failed to notify the Board of her termination, in violation

of her November 2007 Consent Agreement.
6. On or about November 24, 2009, in a telephone interview with Board staff, MS. RICE stated that she did not realize she had to notify the Board of her termination. MS. RICE further stated that she was tested on a set-up procedure for the machines that she was not trained for and was not used by her employer. MS. RICE denied failing to follow infection control policies.
7. MS. RICE has not worked as a dialysis technician since October 2009. 8. MS. RICE acknowledges that she is fully responsible for each and every obligation imposed by this Addendum and the attached November 2007 Consent Agreement.
Lisa Ann Rice, OCDT Page 3
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. RICE 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 2007 Consent Agreement:
1.
MS. RICE'S certificate to practice as n dialysis technician is hereby subject to a ONE (1) YEAR extension of the PROBATIONARY terms, conditions, and limitations set forth in the November 2007 Consent Agreement until at least September 2011. By March 1, 2011, in addition to the requirements for certificate renewal, MS. RICE shall successfully complete and submit documentation of satisfactory completion of the following continuing education taken subsequent to the effective date of this Addendum: Six ( 6 ) hours of Ethics; Four (4) hours of Critical Thinking; and Four (4) hours of Infection Control.
2.
3.
MS. RICE shall, prior to working in a position where a certificate to practice as a dialysis technician is required, complete and submit satisfactory documentation of completion of an extensive orientation to be approved in advance by the Board or its designee. In addition to the conditions explained in Item 4. on Pages 2 and 3 of the November 2007 Consent Agreement and prior to accepting any position for which a certificate to practice as a dialysis technician is required, MS. RICE shall provide a copy of this Addendum and the attached November 2007 Consent Agreement to her employer(s). Within fifteen (15) days of employment as a dialysis technician, MS. RICE shall have her employer(s) send documentation to the Board of receipt of this Addendum and the attached November 2007 Consent Agreement, including the date they were received. FAILURE TO COMPLY
4.
MS. RICE agrees that her certificate to practice as a dialysis technician will be automatically suspended if it appears to the Board that MS. RICE has violated or breached any terms or conditions of this Addendum or the November 2007 Consent Agreement. Following the automatic suspension, the Board shall notify MS. RICE via certified mail of the specific nature of the charges and automatic suspension of her certificate. Upon receipt of this notice, MS. RICE may request a hearing regarding the charges.
Lisa Ann Rice, OCDT Page 4 The above described terms and conditions shall constitute "restrictions placed on a certificate" for purposes of Section 4723.28(B), ORC. If, in the discretion of the Board, MS. RICE appears to have violated or breached any terms or conditions of this Addendum or the November 2007 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.

The terms, limitations, and conditions of this Addendum and the November 2007 Consent Agreement, may be modified or terminated, in writing, at any time upon the agreement of both MS. RICE and the Board. The Board may only alter the probationary period imposed by this Addendum and the November 2007 Consent Agreement if: (1) the Board determines that MS. RICE has complied with all aspects of this Addendum and the November 2007 Consent Agreement; and (2) the Board determines that MS. RICE is able to practice according to acceptable and prevailing standards of safe dialysis care without Board monitoring, based upon an interview with MS. RICE and review of the reports as required herein. Any period during which MS. RICE does not work in a position for which a certificate to practice as a dialysis technician is required shall not count toward fulfilling the probationary period imposed by this Addendum and by the November 2007 Consent Agreement.
ACKNOWLEDGMENTSLIABILITY RELEASE
Except as noted above, all terms of the November 2007 Consent Agreement remain in effect. MS. RICE 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. RICE waives all of her rights under Chapter 119, ORC, as they relate to matters that are the subject of this Addendum. MS. RICE waives any and all claims or causes of action she may have against the Board, and its members, officers, employees andlor 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.
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,-
.
Lisa Ann Rice, OCDT
Page 5
MS. RICE understands that this Addendum is subject to ratification by the Board prior t o signature by the Board President and shalL,&ome effective upon the ls date o signature at f
below.
.
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ISA ANN RICE, OCDT
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DATE
Case #07-2506
O h i o Board of Nursing
17 South High Street, Suite 400 Columbus, Ohio 43215-7410 a (614) 466-3947
CONSENT AGREEMENT BETWEEN LISA ANN RICE, TC1 APPLICANT AND OHIO BOARD OF NURSING
This Consent Agreement is entered into by and between LISA ANN RICE, T C l APPLICANT (MS. R I C E ) 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. RICE 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 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 in lieu of conviction for, any felony or of any crime involving gross immorality or moral turpitude. On or about August 9,2007, MS. RICE submitted to the Board an Application for a Temporary Certificate One (TC1) to practice in Ohio as a Dialysis Technician. MS. R I C E indicated in the appropriate section that she had a prior felony conviction. Along with her Application, MS. RICE submitted court documentation and a statement to the Board.
B.
Lisa A. Rice, TC1 Applicant Page 2 C.
MS. RICE knowingly and voluntarily admits to the following:

On or about May 26, 1998, in the Cuyahoga County Court of Common Pleas Case No. CR-98-360163, MS. RICE entered a plea of guilty t o and was found guilty of Theft in violation of Section 2913.02, ORC, a felony of the fifth degree. MS. RICE was placed on community control for a period of one (1) year, ordered to pay restitution, fees and court costs.
MS. RICE submitted a statement to the Board and indicated that the events, which led up to her felony Theft conviction, stemmed from a dispute with a family member regarding the use of a credit card. Further, MS. RICE stated that around that time she worked as a personal shopper for a major department store and that she had been given money for a suit that was supposed to have been returned to the store. However, MS. RICE could not present any evidence that the suit was delivered which led to MS. RICE being charged with theft.
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. RICE knowingly and voluntarily agrees with the Board to the following terms, conditions, and limitations: MS. RICE'S temporary certificate one and any future certificates granted upon completion of the application process to practice as a dialysis technician in the State of Ohio are hereby suspended indefinitely. Such suspension is hereby stayed, subject to the following probationary terms, conditions, and limitations until at least November 2008: 1.
MS. RICE shall obey all federal, state, and local laws, and all laws and rules governing the practice of dialysis technicians in Ohio. MS. RICE shall appear in person for interviews before the full Board or its designated representative as requested by the Board or its designee.
2.
3. Prior to accepting employment as a dialysis technician, each time with every employer, MS. RICE shall notify the Board.
4.
MS. RICE shall have her employer(s), if working in a position in which certification as a dialysis technician is required, submit written reports regarding job performance on a quarterly basis beginning
Lisa A. Rice, TC1 Applicant Page 3
January 1, 2008. MS. RICE 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. RICE is under a continuing duty to provide a copy of this Consent Agreement to any new employer prior to accepting employment in any position requiring certification as a dialysis technician. Reporting Requirements of Certificate Holder
5.
MS. RICE shall report to the Board, in writing, any violation of this
6.
MS. RICE shall sign release of information forms allowing health

MS. RICE shall submit any and all information that the Board may
request regarding her ability to practice according to acceptable and prevailing standards of safe dialysis care.
MS. RICE shall not submit or cause to be submitted any false,

MS. RICE 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. 10.
MS. RICE 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.
11.
MS. RICE shall verify that the reports and documentation required by
this Consent Agreement are received in the Board office.
12.
MS. RICE shall inform the Board within five (5) business days, in
Lisa A. Rice, TCI Applicant Page 4
Tem~orary Practice Restrictions MS. RICE shall not practice as a dialysis technician (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 dialysis technician provides dialysis technician care and is reimbursed for services by the State of Ohio through State agencies or agents of the State. FAILURE TO COMPLY MS. RICE agrees that her temporary certificate one and any future certificates to practice as a dialysis technician will be automatically suspended if it appears to the Board that MS. RICE has violated or breached any terms or conditions of the Consent Agreement. Following the automatic suspension, the Board shall notify MS. RICE via certified mail of the specific nature of the charges and automatic suspension of her temporary certificate one and any future certificates. Upon receipt of this notice, MS. RICE 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, MS. RICE 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.

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. RICE and the Board. The Board may only alter the probationary period imposed by this Consent Agreement if: (1) the Board determines that MS. RICE has complied with all aspects of this Consent Agreement; and (2) the Board determines that MS. RICE is able to practice according to acceptable and prevailing standards of safe dialysis technician care without Board monitoring, based upon an interview with MS. RICE and review of the reports as required herein. Any period during which MS. RICE does not work in a position for which certification as a dialysis technician is required shall not count toward fulfilling the probationary period imposed by this Consent Agreement.
ACKNOWLEDGMENTSlLIABILITY RELEASE
MS. RICE 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.
Lisa A. Rice, TCI ~ p p l i & t 'Page 5 I
MS. RICE waives all of k r rights under Chapter 119, ORC,as they relate to rnmt.ttc~ that are the subject of this Cod,sencAgreement
MS. RICE waives any a& all claim or cawes of action she m y have against the Board, and its members, officerrj! employees and/or agents arising out of matters. which are the
subjeor of this Consent Abreement.
T i Consent Agreement shall be conaidered a public record as that rerm i s used in hs Section 149.43,ORC. f i e information contained herein may be reported to appropriare
organizations, data banhiand governmental bodies.
is This Consent ~ ~ r e e r n e n f not an adjudication order within the meaning of Secdon 119.01(D), ORC. Any action initiated by the Board based on alleged violations of this Consent A-geement shallkoomply with dre Adrninisirative Procedures Act, Chapter 119,
ORC.
DATE MS. RICE unduatandsbst lhrs Consent i p e m e n f i s subject to r a t i f i d o n by the

Board prior to signature by the Board ~rcsid$nt shall become effective upon the last and date of signature below.
LISA ANHR I ~ ETCZAPPLICANT ,
DATE
Ohio Board of Nursing 1
Case #12-000605
July 27, 2012

Sharde N. Roberts, L.P.N. 4130 Emerius Dr. Columbus, OH 43219 Dear Ms. Roberts: 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 14, 2012, in Franklin County Court of Common Pleas Case No. 11CR-5027, you pled guilty to and were subsequently found guilty of one (1) count of Theft by Deception, a first-degree misdemeanor, in violation of Section 2913.02(A)(3), ORC. The events underlying your conviction noted above occurred, on or about March 29, 2010 to on or about February 24, 2011, and during the course of you working as an independent provider nurse in Ohio. 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. 2. On or about February 28, 2012, you provided a written statement to the Board in which you admit that while working as an independent provider nurse, you billed for nursing services that you did not provide to your patient.
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. 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.
Sharde N. Roberts, L.P.N. Page 2 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@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 the Notice of Opportunity for Hearing, deny, revoke, permanently revoke, suspend or place restrictions on your license to practice nursing as a licensed practical nurse nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely,
Case # 11-002791
July 27, 2012

Julie Anna Ruark, R.N. 123 Rock Creek Road Quincy, KY 41166 Dear Ms. Ruark: 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 July 13, 2011, while employed as a registered nurse at the Southern Ohio Medical Center (SOMC), you were asked to submit a urine specimen for drug testing. Your urine tested positive for Morphine. You did not have a legal, valid prescription for Morphine. On or about July 14, 2011, you submitted a resignation to SOMC stating that: I have not completed a day satisfactorily to the care the patients deserve in my mind. On or about July 21, 2011, you spoke to a Board Compliance Agent regarding your positive drug screen and resignation from SOMC, and you stated that you diverted Morphine from SOMC and self-administered the drug at home.
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)(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. 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
Julie Anna Ruark, 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 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, 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 registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely,
Judith Church, R.N., C.N.P. Supervising Member Certified Mail Receipt No. 7012 1010 0002 4225 1268 Attorney Certified Mail Receipt No. 7012 1010 0002 4225 1275 cc: Henry G. Appel, Assistant Attorney General Michael R. Moran, Esq.
Cases #11-002680
July 27, 2012

Lapetha Monek Ruffin, L.P.N. 28899 Harvard Rd Orange Village, OH 44122 Dear Ms. Ruffin: 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 October 26, 2011, in Franklin County Court of Common Pleas Case No. 11-CR-06-3239, you pled guilty to and were subsequently found guilty of one (1) count of Theft, a fourth-degree felony, in violation of Section 2913.02, ORC, one (1) count of Falsification in a Theft Offense, a fourth-degree felony, in violation of Section 2911.13(A)(9), ORC, and one (1) count of Tampering with Evidence, a fourth-degree felony, in violation of Section 2921.12, ORC. The events underlying your conviction noted above occurred, from on or about September 22, 2008 to on or about December 17, 2010. 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. 2. On or about June 24, 2011, the Ohio Department of Job and Family Services suspended your Medicaid Provider Agreement No. 2667529.
Section 4723.28(B)(1), 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.
Lapetha Monek Ruffin, L.P.N. Page 2 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@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 the Notice of Opportunity for Hearing, deny, revoke, permanently revoke, suspend or place restrictions on 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,
Case #12-002850
July 27, 2012

Rebecca Michelle Seals, R.N. 12 Planet Court Fairfield, Ohio 45014 Dear Ms. Seals: 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 May 15, 2012, in Hamilton County Municipal Court Case No. 11 CRB 35839, you pled guilty to, and were subsequently convicted of, one (1) count of Possessing Drug Abuse Instruments, a misdemeanor of the second degree, in violation of Section 2925.12, ORC. The acts underlying your conviction occurred on or about November 16, 2011, and involve you possessing a hypodermic or syringe to unlawfully use, administer, or prepare a dangerous drug other than marijuana. 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. 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.
Rebecca Michelle Seals Page 2 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@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 the 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,
Case #11-003286
July 27, 2012

Lisa Ann Sherban 2541 Eastern Avenue Alliance, OH 44601 Dear Ms. Sherban: On or about May 30, 2012, 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 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 18, 2012, in Stark County Court of Common Pleas Case Number 2011CR1673, you pled guilty to two (2) counts of Theft of Drugs, felonies of the fourth degree, in violation of Section 2913.02(A)(2) and/or (A)(3)(B)(6), ORC; and one (1) count of Illegal Processing of Drug Documents, a felony of the fourth degree, in violation of Section 2925.23(A)(F)(1), ORC, and were subsequently found eligible for Intervention in Lieu of Conviction. The acts underlying this case occurred on or about February 17, 2011, and involve you obtaining Oxycodone beyond the scope of consent and/or by deception. Further acts underlying this case occurred on or between July 5, 2011, and July 8, 2011, and involve you obtaining Oxycodone beyond the scope of consent of Astoria Skilled Nursing and Rehabilitation or person authorized to give consent and/or by deception. Further acts underlying this case occurred on or about June 20, 2011, and involve you making a false statement in a prescription, order, report, or record involving Oxycodone/Acetaminophen. 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
Lisa Ann Sherban Page 2 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 October 6, 2011, you admitted to a Board Compliance Agent that you diverted narcotics from Astoria Skilled Nursing and Rehabilitation in Canton, Ohio, where you worked as a nurse. You admitted that you self-administered diverted narcotics. You admitted to trading some of the diverted tablets for other pills.
Section 4723.28(B)(5), 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. 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)(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. 3. On or about September 16, 2011, you admitted to a Board Compliance Agent that while working as a nurse for Interim Healthcare in or about February 2011, you diverted tablets of Oxycodone from a home care patient. You admitted that you took the Oxycodone for your own consumption. You admitted that you replaced the patients Oxycodone tablets with generic Tylenol.
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)(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(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 such other representative as is
Lisa Ann Sherban Page 3 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,
Judith A. Church, R.N., C.N.P. Supervising Board Member Certified Mail Receipt No. 7012 1010 0002 4225 3835 Attorney Certified Mail Receipt 7012 1010 0002 4225 3842 cc: Henry G. Appel, Assistant Attorney General Frederick M. Pitinii, Esq.
Case #11-003286
May 30, 2012

Lisa Ann Sherban, L.P.N. 2541 Eastern Avenue Alliance, OH 44601 Dear Ms. Sherban: 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, 2012, in Stark County Court of Common Pleas Case Number 2011CR1673, you pled guilty to two (2) counts of Theft of Drugs, felonies of the fourth degree, in violation of Section 2913.02(A)(2) and/or (A)(3)(B)(6), ORC; and one (1) count of Illegal Processing of Drug Documents, a felony of the fourth degree, in violation of Section 2925.23(A)(F)(1), ORC, and were subsequently 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)(2) and/or (A)(3)(B)(6), ORC; and Illegal Processing of Drug Documents, a felony of the fourth degree, in violation of Section 2925.23(A)(F)(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-106261, IS HEREBY SUSPENDED. Continued practice after
Lisa Ann Sherban, 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 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 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,
Certified Mail Receipt No. 7012 1010 0002 4225 3217 Attorney Certified Mail Receipt 7012 1010 0002 4225 3224 cc: Henry G. Appel, Assistant Attorney General Frederick M. Pitinii, Esq.
Case #11-001914
July 27, 2012

Crystal Gail Shumaker, L.P.N. 26561 East Fork Road Laurelville, Ohio 43135 and 650 McArthur, Apt. 35 McArthur, Ohio 45651 Dear Ms. Shumaker: 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 April 11, 2012, in Ross County Court of Common Pleas Case Number 12 CR 054, you were found guilty of one (1) count of Aggravated Possession of Drugs (Oxycodone), a felony of the third degree, in violation of Section 2925.11, ORC; and fourteen (14) counts of Illegal Processing of Drug Documents, felonies of the fourth degree, violations of Section 2925.23, 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. Aggravated Possession of Drugs (Oxycodone), a felony of the third degree, in violation of Section 2925.11, ORC; and Illegal Processing of Drug Documents, felonies of the fourth degree, violations of Section 2925.23, ORC, constitute a felony drug abuse offense as defined in Section 2925.01, ORC.
Crystal Gail Shumaker, 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, PN-125556, 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 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 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 11, 2012, in Ross County Court of Common Pleas Case Number 12 CR 054, you were found guilty of one (1) count of Aggravated Possession of Drugs (Oxycodone), a felony of the third degree, in violation of Section 2925.11, ORC; and fourteen (14) counts of Illegal Processing of Drug Documents, felonies of the fourth degree, violations of Section 2925.23, ORC. The acts underlying the above criminal case occurred on or about May 13, 2011 and involve you obtaining, possessing or using Oxycodone. Further acts underlying this case occurred in or about August 2010 through May 2011 and involve you making or uttering, selling, or knowingly possessing false or forged prescriptions for Percocet. 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. While employed as a nurse by Family Healthcare, Inc., Chillicothe, Ohio, you stole a prescription pad for Dr. Gombash and used the pad to obtain multiple prescriptions for drugs for yourself.
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. Accordingly, the Board is authorized to impose one or more of the sanctions as cited in Section 4723.28, ORC.
Crystal Gail Shumaker, L.P.N. Page 3 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 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,
Case #12-001944
July 27, 2012

Lesha M. Smith, L.P.N. 7653 Gayle Drive Franklin, Ohio 45005 Dear Ms. Smith: You are hereby notified that, 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 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 for a minimum period of at least three (3) years. A. You were issued a license to practice nursing as a licensed practical nurse in the State of Ohio on September 29, 2011. B. Item 7. of the September 2011 Consent Agreement states, Within sixty (60) days of the effective date of this Consent Agreement and continuing throughout the probationary period, MS. SMITH shall begin submitting, at her expense and on the day selected, 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. 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. SMITH shall be negative, except for substances prescribed, administered, or dispensed to her by another so authorized by law who has full knowledge of MS. SMITHs history of chemical use. Despite this provision, on the following dates, you failed to call Firstlab, the Boards random drug/alcohol screen program administrator, to determine if you had been selected to provide a urine specimen: December 29, 2011; March 16, 2012; March 21, 2012; March 25, 2012; April 8, 2012; April 14, 2012; April 20, 2012; April 27-30, 2012; May 1-31, 2012; and June 1-10, 2012. Furthermore, on the following dates, you were selected to provide a urine specimen for analysis and failed to do so: April 25, 2012 and May 24, 2012.
Lesha M. Smith, L.P.N. Page 2
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 2011 Consent Agreement, you are hereby notified that it appears to the Board that you have violated Item 7. of the September 2011 Consent Agreement. YOU ARE FURTHER NOTIFIED THAT YOUR LICENSE TO PRACTICE NURSING AS A LICENSED PRACTICAL NURSE, PN-146310, 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 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 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 for a minimum period of at least three (3) years. 2. You were issued a license to practice nursing as a licensed practical nurse in the State of Ohio on September 29, 2011. 3. Item 7. of the September 2011 Consent Agreement states, Within sixty (60) days of the effective date of this Consent Agreement and continuing throughout the probationary period, MS. SMITH shall begin submitting, at her expense and on the day selected, 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. 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. SMITH shall be negative, except for substances prescribed, administered, or dispensed to her by another so authorized by law who has full knowledge of MS. SMITHs history of chemical use.
Lesha M. Smith, L.P.N. Page 3 Despite this provision, on the following dates, you failed to call Firstlab, the Boards random drug/alcohol screen program administrator, to determine if you had been selected to provide a urine specimen: December 29, 2011; March 16, 2012; March 21, 2012; March 25, 2012; April 8, 2012; April 14, 2012; April 20, 2012; April 27-30, 2012; May 1-31, 2012; and June 1-10, 2012. Furthermore, on the following dates, you were selected to provide a urine specimen for analysis and failed to do so: April 25, 2012 and May 24, 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,
Lesha M. Smith, L.P.N. Page 4 Certified Mail Receipt No. 7012 1010 0002 4225 2081 cc: Henry G. Appel, Assistant Attorney General
Case #2011-001414
Board of N ~ n i n g www.nursing.ohio.gov
17 South High Street, Sui~c 400 Columnbus, Ohio 43215-7410 (614) 466-3947
CONSENT AGREEMENT BETWEEN LESHA M. SMITH, L.P.N. APPLICANT AND OHIO BOARD OF NURSING
This Consent Agreement is entered into by and between LESHA M. SMITH, L.P.N. APPLICANT (MS. SMITH) 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. SMITH 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 drugs, or alcohol or other chemical substances to an extent that impairs ability to practice.
Lesha M. Smith, L.P.N. Applicant Page 2 On or about March 21,2011, MS. SMITH submitted to the Board an Application for Licensure by Examination to Practice in Ohio as a Licensed Practical Nurse.
B.
C.
MS. SMITH knowingly and voluntarily admits that in Middletown Municipal Court (Ohio), she has two (2) drunkdriving misdemeanor convictions. One drunk-driving conviction occurred in 2007 and the other in 2000. Both convictions stemmed from MS. SMITH'S underage consumption of alcohol. MS. SMITH has two (2) misdemeanor convictions for Public Intoxication. One conviction occurred in 2006 and the other in 2000. MS. SMITH also has two (2) minor misdemeanor convictions. One conviction was for Public Intoxication in 2004. The other conviction was for Disorderly Conduct in 2002 and stemmed from a physical altercation.
Upon request by the Board, MS. SMITH submitted her courtordered January 2008 chemical dependency that stemmed from her 2007 drunk driving charge. During the chemical dependency evaluation, MS. SMITH reported to her evaluator that she used Marijuana and Alcohol. MS. SMITH was diagnosed with Alcohol Abuse and underwent the recommended outpatient treatment, which she successfully completed in July 2008. In her statement to the Board, MS. SMITH expressed deep remorse for her earlier actions.
D.
E.
F.
MS. SMITH was permitted to take the NCLEX- PN, and on or about July 25,201 1, MS. SMITH passed the exam. MS. SMITH submitted a letter of support from her nursing instructor, Judith A. Fassler, R.N. AGREED CONDITIONS
G.
Wherefore, in consideration of the foregoing and mutual promises hereinafter set forth, and in lieu of any formal proceedings at this time, MS. SMITH knowingly and voluntarily agrees with the Board to the following terms, conditions, and limitations: Upon meeting the requirements for licensure, MS. SMITH shall be granted a license to practice nursing as a licensed practical nurse in the State of Ohio. MS. SMITH'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 at least three (3)years:
Lesha M. Smith, L.P.N. Applicant Page 3
1.
MS. SMITH shall obey all federal, state, and local laws, and all laws and rules governing the practice of nursing in Ohio. MS. SMITH shall appear in person for interviews before the full Board or its designated representative as requested by the Board or its designee.
2.

3.
Within ninety (90) days prior to submitting a request for release from the probationary terms, conditions and limitations of this Consent Agreement, MS. SMITH agrees that she will submit a request to the Bureau of Criminal Identification and Investigation (BCII) to conduct a criminal records check of MS. SMITH, including a check of Federal Bureau of Investigation (FBI) records, and shall cause BCII to submit MS. SMITH's criminal records check reports to the Board. MS. SMITH agrees that a request for release from the probationary 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.

4.
Within ninety (90) days from the effective date of this Consent Agreement, MS. SMITH 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 other comparable courses approved in advance by the Board, taken subsequent to the effective date of this Consent Agreement: five (5) hours of Cannabis Use, Abuse & Dependence, eight (8) hours of Critical Thinking: Managing Stress, and fifteen (15) hours of Women, Alcohol & Drug Use.
Monitoring
5.
MS. SMITH 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. SMITH's history of chemical use. MS. SMITH shall self-administer prescribed drugs only in the manner prescribed. MS. SMITH shall abstain completely from the use of alcohol andlor substances containing alcohol.
Lesha M. Smith, L.P.N. Applicant Page 4 7.
Within sixty (60) days of the effective date of this Consent Agreement and continuing throughout the probationary period, MS. SMITH shall begin submitting, at her expense and on the day selected, hair, blood or urine specimens for drug andlor 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. SMITH shall be negative, except for substances prescribed, administered, or dispensed to her by another so authorized by law who has full knowledge of MS. SMITH's history of chemical use. Within sixty (60) days and prior to working as a nurse, MS. SMITH 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. SMITH shall provide the chemical dependency professional with a copy of this Consent Agreement. Further, MS. SMITH 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. SMITH's license to practice, and a statement as to whether MS. SMITH is capable of practicing nursing according to acceptable and prevailing standards of safe nursing care. MS. SMITH 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. SMITH 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. SMITH's license and that the terms, conditions, and limitations may be incorporated in an addendum to this Consent Agreement.

10.
Within sixty (60) days of the effective date of this Consent Agreement, MS. SMITH 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. SMITH 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. 11.
MS. SMITH 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. SMITH throughout the duration of this Consent Agreement.
Within twenty-four (24) hours of release from hospitalization or medical treatment, MS. SMITH shall notify the Board of any and all medication(s) or prescription(s) received.
12.
13.
Prior to accepting employment as a nurse, each time with every employer, MS. SMITH shall notify the Board.
14.
MS. SMITH 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. SMITH 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. SMITH 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.
MS. SMITH shall report to the Board, in writing, any violation of this Consent Agreement within thirty (30) days of the occurrence of the violation. MS. SMITH shall sign release of information forms allowing health professionals and other organizations to submit the requested documentation directly to the Board.
16.
Lesha M. Smith, C.P.N. Applicant Page 6
17.
MS. SMITH shall submit any and all ii~formation that the Board may request regarding her ability to practice according to acceptable and prevailing standards of safe nursing practice. MS. SMITH 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. SMITH 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. SMITH shall submit the reports and documentation required by this Consent Agreement or any othcr 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. SMITH shall verify that the reports and documentation required by this Consent Agreement are received in the Board office. MS. SMITH 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.
18.
19.
20.
21.
22.
Temporarv Practice Restrictions MS. SMITH further knowingly and voluntarily agrees with the Board to the following TEMPORARY LICENSURE RESTRICTIONS for a minimum period of at least one (1) year: MS. SMITH 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. SMITH to provide nursing services for fees, compensation, or other consideration or as a volunteer. MS. SMITH shall not function in a position or employment where the job duties or requirements involve management of nursing and l~ursing 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. SMITH agrees that her license to practice nursing as a licensed practical nurse will be automatically suspended if it appears to the Board that MS. SMITH has violated or breached any terms or conditions of the Consent Agreement. Following the automatic suspension, the Board shall notify MS. SMITH via certified mail of the specific nature of the charges and automatic suspension of her license. Upon receipt of this notice, MS. SMITH 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. SMITH 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.

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. SMITH and the Board. The Board may only alter the probationary period imposed by this Consent Agreement if: (1) the Board determines that MS. SMITH has complied with all aspects of this Consent Agreement; and (2) the Board determines that MS. SMITH is able to practice according to acceptable and prevailing standards of safe nursing care without Board monitoring, based upon an interview with MS. SMITH and review of the reports as required herein. Any period during which MS. SMITH 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.
MS. SMITH 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. SMITH waives all of her rights under Chapter 119, ORC, as they relate to matters that are the subject of this Consent Agreement. MS. SMITH waives any and all claims or causes of action she may have against the Board, and its members, officers, employees andlor 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 Swtion 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 Agreemenl shall compiy with the Administrative Procedures Act, Chapter 119, ORC.
EFFECTIVE D
MS. SMITH 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.
LESHA M. S m H , L P S . APPLICANT
DATE
&@,~u$,RJ
I
DATE
Case # 10-1647
July 27, 2012

Nancy Marie Smith, L.P.N. 374 N. Main St. Lebanon, Ohio 45068 Dear Ms. Smith: 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 June 26, 2009, you submitted a pre-employment drug screen specimen that was positive for Cannabinoids. 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. 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
Nancy Marie Smith, L.P.N. Page 2 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,
Case 11-004093
July 27, 2012

James Lee Snyder, L.P.N. 1629 Colonial Boulevard NE Canton, Ohio 44714 Dear Mr. Snyder: 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 October 4, 2011, while working as a nurse at St. Luke Lutheran Community, in North Canton, Ohio, you submitted a drug screen specimen that was positive for cocaine. On or about November 15, 2011, you were interviewed by a Board Compliance Agent regarding the October 4, 2011 drug screen and admitted that you self-administered cocaine. 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. 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.
James Lee Snyder, 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, 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,
Case #12-002000
July 27, 2012

Tyler Nelson Spradlin, R.N. 2903 Coles Ridge Portsmouth, Ohio 45662 Dear Mr. Spradlin: You are hereby notified that, on or about March 16, 2012, you entered into a Consent Agreement (March 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 three (3) years. Attached to incorporated within the March 2012 Consent Agreement is a September 23, 2011 Notice of Opportunity for Hearing (September 2011 Notice) with attached 2011 Florida Board Final Order, Settlement Agreement and Administrative Complaint. A. Item 7. of the March 2012 Consent Agreement states, Within forty-five (45) days of the effective date of this Consent Agreement and continuing throughout the probationary period, MR. SPRADLIN shall submit, at his 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 MR. SPRADLINs 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. SPRADLIN shall be negative, except for substances prescribed, administered, or dispensed to him by another so authorized by law who has received a complete copy of this Consent Agreement prior to prescribing for MR. SPRADLIN. Despite this provision, as of July 2, 2012, you have failed to register with Firstlab, the Boards random drug/alcohol screen program administrator, to determine if you had been selected to provide a urine specimen. B. Item 9. of the March 2012 Consent Agreement states, Within three (3) months of the effective date of this Consent Agreement, MR. SPRADLIN shall, at his expense, obtain a chemical dependency evaluation by a Board approved chemical dependency professional and shall provide the Board with
Tyler Nelson Spradlin, R.N. Page 2 complete documentation of this evaluation. Prior to the evaluation, MR. SPRADLIN shall provide the chemical dependency professional with a copy of this Consent Agreement and assessments, evaluations, and treatment records from Glenbeigh at Rock Creek, Ohio. Further, MR. SPRADLIN 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 MR. SPRADLINs license to practice, and stating whether MR. SPRADLIN is capable of practicing nursing according to acceptable and prevailing standards of safe nursing care. Despite this provision, as of July 2, 2012, you have failed to submit to the Board documentation of 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. In accordance with the paragraph under FAILURE TO COMPLY of the March 2012 Consent Agreement, you are hereby notified that it appears to the Board that you have violated Items 7. and 9. of the March 2012 Consent Agreement. YOU ARE FURTHER NOTIFIED THAT YOUR LICENSE TO PRACTICE NURSING AS A REGISTERED NURSE, RN-340553, 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 16, 2012, you entered into a Consent Agreement (March 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 three (3) years. Attached to incorporated within the March 2012 Consent Agreement is a September 23, 2011 Notice of Opportunity for Hearing (September 2011 Notice) with attached 2011 Florida Board Final Order, Settlement Agreement and Administrative Complaint.
Tyler Nelson Spradlin, R.N. Page 3 2. Item 7. of the March 2012 Consent Agreement states, Within forty-five (45) days of the effective date of this Consent Agreement and continuing throughout the probationary period, MR. SPRADLIN shall submit, at his 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 MR. SPRADLINs 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. SPRADLIN shall be negative, except for substances prescribed, administered, or dispensed to him by another so authorized by law who has received a complete copy of this Consent Agreement prior to prescribing for MR. SPRADLIN. Despite this provision, as of July 2, 2012, you have failed to register with Firstlab, the Boards random drug/alcohol screen program administrator, to determine if you had been selected to provide a urine specimen. 3. Item 9. of the March 2012 Consent Agreement states, Within three (3) months of the effective date of this Consent Agreement, MR. SPRADLIN 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. SPRADLIN shall provide the chemical dependency professional with a copy of this Consent Agreement and assessments, evaluations, and treatment records from Glenbeigh at Rock Creek, Ohio. Further, MR. SPRADLIN 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 MR. SPRADLINs license to practice, and stating whether MR. SPRADLIN is capable of practicing nursing according to acceptable and prevailing standards of safe nursing care. Despite this provision, as of July 2, 2012, you have failed to submit to the Board documentation of 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. Accordingly, the Board is authorized to impose one or more of the sanctions as cited in Section 4723.28, ORC.
Tyler Nelson Spradlin, R.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 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 ($500.00) per violation. Sincerely,
Case # 1 1-002061
Ohio Board ofNursing

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CONSENT AGREEMENT BETWEEN TYLER NELSON SPRADLIN, R.N. AND OHIO BOARD OF NURSING
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This Consent Agreement is entered into by and between TYLER NELSON SPqADLIN, R.N. (MR. SPRADLIN) 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 document that is attached hereto and incorporated herein: September 23,201 1 Notice of Opportunity For Hearing (September 201 1 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. Section 4723.28(8)(1), ORC, authorizes the Board to deny a license or otherwise 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. MR. SPRADLIN was initially licensed to practice nursing as a registered nurse in the State of Ohio, RN-340553, in May 2008. MR. SPRADLIN's license to practice as a registered nurse is active. MR. SPRADLIN was initially issued a license to practice nursing as a registered nurse in Florida in July 2008. MR. SPRADLIN's Florida license is currently active with probation.
B.
C.
Tyler Nelson Spradlin, R.N. Page 2
D.
MR. SPRADLIN knowingly and voluntarily admits to the factual and legal allegations set forth in the September 201 1 Notice. MR. SPRADLIN knowingly and voluntarily admits to the following:
1.
E.
While working as a nurse in the emergency department at Pike Community Hospital on or about November 4,201 1, MR. SPRADLIN forged other nurses' signatures on the narcotic log to indicate that his narcotic waste was witnessed. MR. SPRADLIN admitted to the Director of Nursing of Pike Community Hospital that he was falsifying nurses' names on the narcotic log because everyone was busy and unavailable to witness the waste. MR. SPRADLIN was terminated from his employment at Pike Community Hospital on November 4,201 1 . Prior to entering into a two (2) year probation settlement agreement with the Florida Board in 2009, MR. SPRADLIN entered into the Florida Intervention Project for Nurses. MR. SPRADLIN completed six (6) alcoholldrug outpatient education sessions in September 2009. MR. SPRADLIN also attended five (5) Alcoholics Anonymous meetings and completed five (5) reading and writing assignments from recovery literature in 2009. MR. SPRADLIN had a psychiatric evaluatioll completed in Florida it] 2009 that concluded that he did not need any structured treatment but recommended that he receive continued drug monitoring to rule out drug use. MR. SPRADLIN moved to Ohio in October 2010. On or about October 5 , 201 1, MR. SPRADLIN told a Board Investigator that he received two (2) Driving While Under the Influence (DUI) convictions in Florida from incidents occurring in January 2010 and July 2010.
2.
3.
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. SPRADLIN ltnowingly and voluntarily agrees with the Board to the following terms, conditions, and limitations: MR. SPRADLIN'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:
I.
MR. SPRADLIN shall obey all federal, state, and local laws, and all laws and rules governing the practice of nursing in Ohio. MR. SPRADLIN shall appear in person for interviews before the full Board or its designated representative as requested by the Board or its designee. MR. SPRADLIN agrees that he will submit a request to the Bureau of and Investigation (BCII) to conduct a criminal records Criminal ldentificatio~i check of MR. SPRADLIN, including a check of Federal Bureau of Investigation (FBI) records, and shall request BCII to submit MR. MR. SPRADLIN's criminal records check reports to the Board. SPRADLIN'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.
2.
3.
4.
Within six (6) months of the effective date of this Consent Agreement, MR. SPRADLIN 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, taken subsequent to the effective date of this Consent Agreement: ten (10) hours of Documentation; ten (10) hours of Chemical Dependency; five (5) hours of Ethics; and one ( I ) hour of the Scope of Practice for Ohio RNs and LPNs.
Monitoring
5.
MR. SPRADLIN shall abstain completely from the personal use or possession of drugs, except those prescribed, administered, or dispensed to hiin by another so authorized by law who has received a complete copy of this Consent Agreement prior to prescribing for MR. SPRADLIN. MR. SPRADLIN shall self-administer the prescribed drugs only in the manner prescribed. MR. SPRADLIN 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, MR. SPRADLIN shall submit, at his expense and on the day selected, blood, breath, hair, or urine specimens for drug andlor alcohol analysis at a collection site specified by the Board at such times as the Board may request. Upon and after MR. SPRADLIN'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
6.
7.
require a daily call-in process. The specimens submitted by MR. SPRADLIN shall be negative, except for substances prescribed, administered, or dispensed to him by another so authorized by law who has received a complete copy of this Consent Agreement prior to prescribing for MR. SPRADLIN. a. Prior to MR. SPRADLIN initiating drug screening, MR. SPRADLIN 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 thc Board. The medication rcport is to be completed for any and all substanccs prescribed, administered, or dispensed to MR.
SPRADLIN.
b. After initiating drug scrccning, MR. SPRADLIN shall be under a continuing duty to provide a copy of this Consent Agreement, prior to initiating treatment, to additional treating practitioncrs, and to update the list of treating practitioners with the Board within forty-eight (48) hours of being treated by another practitioner. Further, MR. SPRADLIN shall notily the Board of any and all medication(s) or prescription(s) received within twenty-four (24) hours of release from hospitalization or medical treatment.
8.
Within thirty (30) days of the effective date of this Consent Agreement and continuing throughout the probationary period, MR. SPRADLIN shall attend a minimum of one (I) 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 MR. SPRADLIN 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. Within three (3) months of the effective date of this Consent Agreement, MR. SPRADLIN 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. SPRADLIN shall provide the chemical dependency professional with a copy of this Consent Agreement. Further, MR. SPRADLIN 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, recom~nendationsfor treatment and monitoring, any additional restrictions that should be placed on MR. SPRADLIN's license to practice, and stating whether MR. SPRADLIN is capable of practicing nursing according to acceptable and prevailing standards of safe nusing care.
9.
10.
MR. SPRADLIN 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. SPRADLIN 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 MR. SPRADLIN's license and that the terms, conditions, and limitations may be incorporated in an addendum to this Consent Agreement.
11.
MR. SPRADLIN 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 nursing employment. MR. SPRADLIN, within fifteen (15) day of the effective date of the Consent Agreement, if working in a position in which a nursing license is required, shall provide his employer(s) with a copy of this Consent Agreement. Further, MR. SPRADLIN is under a continuing duty to provide a copy of this Consent Agreement to any new employer prior to accepting nursing employment. MR. SPRADLIN shall have his 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. MR. SPRADLIN 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 Consent Agreement was received.
12.
13.
MR. SPRADLIN shall report to the Board, in writing, any violation of this Consent Agreement within thirty (30) days of the occurrence of the violation. MR. SPRADLIN shall sign release of information forms allowing health professionals and other organizations to submit the requested documentation directly to the Board. MR. SPRADLIN shall submit any and all information that the Board may request regarding his ability to practice according to acceptable and prevailing standards of safe nursing practice.
14.
15.
16.
MR. SPRADLIN shall not submit or cause to be submitted any false, misleading, or deceptive statements, information, or docurnentation to the Board or to employers or potential employers. MR. SPRADLIN shall submit the reports and documentation required by this Consent Agreement on forms specified by the Board. All reporting and coinmunications required by this Consent Agreement shall be made to the Compliance Unit of the Board. MR. SPRADLIN 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. SPRADLIN shall verify that the reports and documentation required by this Consent Agreement are received in the Board office. MR. SPRADLIN 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.
Nursing Refresher Course Upon the request of the Board or its designee, MR. SPRADLIN shall complete and submit satisfactory documentation of completion of nurse refresher courses or an extensive orientation to be approved in advance by the Board, or its designee. Tem~orary Practice Restriction MR. SPRADLIN 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 MR. SPRADLIN to provide nursing services for fees, compensation, or other consideration or who engage MR. SPRADLIN as a volunteer. MR. SPRADLIN shall not function in a position or elnployment 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 MR. SPRADLIN agrees that his license to practice nursing as a registered nurse will be automatically suspended if it appears to the Board that MR. SPRADLIN has violated or breached any terms or conditions of the Consent Agreement. Following the automatic suspension, the Board shall notify MR. SPRADLIN via certified mail of the specific nature of the charges and automatic suspension of his license. MR. SPRADLIN 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, MR. SPRADLIN 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.

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. SPRADLIN and the Board. The Board may only alter the probationary period imposed by this Consent Agreement if: ( I ) the Board determines that MR. SPRADLIN has complied with all aspects of this Consent Agreement; and (2) the Board determines that MR. SPRADLIN is able to practice according to acceptable and prevailing standards of safe nursing care without Board monitoring, based upon an interview with MR. SPRADLIN and review of the reports as required herein. Any period during which MR. SPRADLIN 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.
ACKNOWLEDGMENTSLIABILITY RELEASE MR. SPRADLIN 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. SPRADLIN waives all of his rights under Chapter 119, ORC, as they relate to matters that are the subject of this Consent Agreement. MR. SPRADLIN waives any and all claims or causes of action he may have against the Board, and its members, officers, employees andlor agents arising out of matters, which are the subject of this Consent Agreement.
Tyler Nelson Spsadlin, 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. This Consent Agreement is not an adjudicatioti 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 MR. SPRADLIN understands that this Consent Agreement is subject to ratification by the
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Case #11-002061
17 South High Street, Suite 400 * Columbus, Ohio 43215-7410
(614) 466-3947
September 23,201 1

Tyler Nelson Spradlin, R.N. 2903 Coles Ridge Portsmouth, OH 45662 Dear Mr. Spradlin: 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.
The Florida Department of Health, Board of Nursing (Florida Board) issued a Final Order that became effective on April 26, 2011 and a settlement agreement was adopted in which your Florida nursing license to practice nursing as a registered nurse was placed on probation for a two (2) year period. A copy of the 2011 Florida Board Final Order, along with the Settlement Agreement and the Admirzistrarive Complaint are attached hereto and incorporated herein.
Section 4723,28(B)(l), ORC, authorizes the Board to deny a license or otherwise 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 432157410, or to the email address, heariug@nursk.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 Heating, 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.
Judith Church, R.N., C.N.P, Supervising Member Certified Mail Receipt No. 7011 1150 0000 9357 3333
cc:
Michelle T. Sutter, Assistant Attorney General
Rjck Scott
Governor
K FrankFarmer, Jr., M.D., P b D .

Saie Surgean General
I, Rick Swanson, Deputy Agency Clerk and Custodian of Records,
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following to be true and correct as on file with the Department of Health. Attached is a true and correct copy of the Final Order from Case Number 2009.23617 as maintained by the Department of Health. The attached is a regularly received and retained record of the Board of Nursing vs. Tyler Nelson Spradlin; RN9279715 and is received and retained in the ordinary course of business of the Department of Health.
Rick ~ w a n z n l Deputy Agency Clerk STATE OF FLORIDA COUNlY OF LEON Before me, personally appeared Rick Swanson whose identity is personally known to me as Deputy Agency Clerk, and who, acknowledges that hislher signature appears above. Swom and subscribed to, before me, this 7th day of June 201 I.
PJ'4GEVI M T Q N NOTAKYPUUIE-STEiEffFLORIbh
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Gtary PdblicState of Florida
COMMISSIONBOW22154 EXPIRE6 P1112Dt3
Type or Print Name
Division of Medical Quality Assurance. Central Rewrds Unit 4052 Bald Cypress Way, Bin C 01 Tallahassee, FL 32399-3251 Telephone (850) 245-4121
w.doh.state.i7.us
Find Order No. DOH-I 1W -M A FILED DATE U, -&-26~~ Dcparimznt ofHealth -
STATE OF FLORIDA BOARD OF NLlRSING
Deputy A~cncy Clerk
DEPARTMENT OF FBaTH,
Petitioner, vs . Case No. : 2009-23617 :, . .- ; License No.: RN 9279715 . = w > & ... 2 . Oc. 2-it L,
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TYLER NELSON S P W L I N ,
Respondent.
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FINU ORDER
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THIS CAUSE came before the BOARD OF EJISRSING (Baud) pursuant to Sections 120.569 and 120.57(4), Florida Statutes, on April
8,
2011, in Ft. Lauderdale, Florida, for the purpose of considering
a settlement agreement (attached hereto as Exhibit A) entered into between the parties in this cause. Upon consideration of the settlement agreement, the documents submitted in support thereof, the arguments of the parties, and being otherwise fully advised in the premises, it is hereby ORDERED AND ADJUDGED that the settlement agreement as submitted be and is hereby approved and adopted in toto and incorporated herein by reference. The costs are $3,13 8.14
Accordingly, the parties shall adhere to and abide by all the terms and conditions of the settlement agreement. This Final Order shall take effect upon being filed with the Clerk of the Department of Health.
DONE
AND
ORDERED this
d-
day of BOARD OF NURSING
, 2011
JOE R. @K&R,
JR.
Jessie Colin, RN, p i & Chair CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing Final Order has been provided by U.S. Mail to TYLER NELSON SPRADLIN,1321 Rosemount Road, Portsmouth OH 45662; and by interoffice delivery to and by interoffice delivery to Lee Ann Gustafson, Senior Assistant Attorney General, Department of Legal Affairs, PL-01 The Capitol, Tallahassee FL 32399-1050, William Miller, Assistant General Counsel, Department of Health, 4052 Bald Cypress Way, Bin C-65,
alla ah as see, Florida 32399-3265 this
& day of @rLi\
2011.
Cese No. 2009-23617
STATE OF FLORIDA DEPARTMENT OF HEALTH
--DEPARTMENT OF HEkLTH,
Petitioner,
CASE O : -.+ N . -.-
Zdo9-23617
TYLER NELSON SPRADLIN, EM.,

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krsuant to Section .120.57(4), Florlda Statutes, the a&

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named p a t h h=r&
offer ttits Agreement to the ~ o d r dof Nursing as disporltion of the Administratbe
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Comptaint, atjched hereto as Mibit "A", in heir of any other administrative proceedings.
The tern. herein become e M u e . o n l y if and when a Final Order
h p u n g t j Agreemeht hs
is issued by the
Board and filed.
I considering this n
Agreement, the Board may rwiew all lnvestjgative materials regarding this case. I this f
Agreement is rejew, it, and its.pn?sentation

&%her party.
b the M, shali not be used against
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~e.+ondent i a Registeed hlurse in the Sae of Florida holdlng !iterrse s tt
numbcr 9279715.
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456 andlor 464,
2.
The Respondent is charged by an Adminisbative tomplaint filed by the
kpartment and properly sewed upon Respondent wkh violations o Chapf
~8.Bspemmt HenYm U. TYLER MELSON SPEAWIN. R.N. al Cess N u m b 20@23657
Rotida StaMes, A tnre and correct mpy of the Adminiaative Complaint is attached heret~
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a6d incorporated by referawee as Exhibit A

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3.
Respondent neither admi nor denies the fachial' allegations contained in the
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Adnihktratjve Cclmpfaint.
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STIPULATED LAW
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Respondent admits that he is subject to the provisions of Chapters 456
and the jurisdiction oF the Department and the B o d .
2.
Respondent admits' b2it the stipulated facts, if proven tnre, constitute
violations of laws as alleged in the Adrninisbative Complaint
-. . .
3.
Respondent admits that the AgreemmE ?dZ8%f, $p'ropriate and

'
reasonable resolution to thls pending mawe;.
1
'
PROPOSED DSSPOSrrTDN
1 .
' I
The Board o f ~ b s i n g reprimand the license of the Resp~ndent. shall
. .
2.
The Respondent must pay an admiciismtlve fine in the amount o TWO f

tusk not b exceed FOUR
HUNDRED FIFTY WLLARS ($ZSO.OD) and inve&gati*

THOUWD
THIRN-SEVEN
DoLLARS
AND
SEVENTY-FOUR
-
*..' .
CENTS
.fSA037.74l within four (4) years from the date of enby of'the'~i&tOrder. Hwever,
,m;
if the Respondent k in ths Intewntion Project for Nurses (IPN), the payment i due s
to completion of IPN. If the Respondent's license is suspended by the terms of

this agreement, the payment is due && to the application for reinstatement of the
iicense, If the Respondent is placed Jn prchation, the p a p n t i due m s
r
t the o
. ... / ..
completion of the probztionary period.

-2-
The Respondent b s the responsibility to
DapailmS ~i HsaUh r. TYLER NELSON SPRRDLIK R.N.

C a = Nlanbsr Z D g P s 1 7
'
f.I.c+ document financial hardship &m t? the due date of the ..

b ;
Payment must be
mmey order.
Parts1 payments shall b accepted, Payment shail be made to the e
Bbard af ~ u r h and M i e d to, Compfiance Management Unit, Bin 06, P.O. Box 6320, n~
Tallahassee, Rorida 32314-6320, Attention: Nuning ~orirp\ian&Dficei.
.-.
:c...
II
I i
3,
h:
The Respondent shall enroll in and fmessfuly complete mums in
..
Medication Adminishation and Docurnentakbn. 6 s shall be in addiUon to other
nbrmatly required mntinuing e~ucatbnmurses. Verification o f course mntent and

course gmpLetion,must be submitted
k the Nursing Cornpriance Ofcr withii, s k ( 6 ) fie

.>
months from the date of M s .Order. The Board wifl r@$. .

enfordng continuing edmtion requiremments.
4.
,
jufiscj@on.fm&e
. .
purpose of
.- ., ..
The license of NLER NELSDN WRADLtN, BH., is p:tac+ on probation
for Z y e a r ( s ) subject @ the follwing conditions:
f,
i
..
The Respondent must w ~ r k .in a s d n a under direct $u;uww'kio~~ and-onty on a regulayly;~assigg+ unit. Dire@ supervis\an requirer another nurse to be working on. t e h same unit as the Respondent and readily available t,provide assistance and intervention. The Respondent cannot be empbyed by a nurse registry, temporaw nurse employment agency o home health agency, ~ultiple employers are r
proybked, The Respondent cannot be self-employed as a nurse. -
5 . . 'The Respondent's falture to comply wlth the ferms of this Probation
I
I
I
i
without the prior written mmnt of the Board of Nursing shall be a violation of this Probstinn. T h a probation shall not be terminated until the Respondent has complied
with all terms ~f pmbafion. The faiiure to comply with the terms of probation ~t forth
Depamm d tJ,ealfil P l L .NELSON SPRADUN. RU. v,

Cere Nvmbcr 2DDbPS77
.,.
.. . with the Department of Health a g d k the !ksp~ndenYs license, which m y result In a

..
ahwe shatl result in a s u b ~ ~ Uniform t ~ ~ n Complaint Frxm being filed by the Board
additional administrative Rnes, probationary periods, and/or suspeffiiqns being impased against the ResjmndenYs iiceme,
The Rffip~ndentshaii pay all cask necessary to
cnrnpty with the terms of this Order. 5uch costs include, but are not limited to, the cost
of preparation of investigative and probationary reports detailkg the compliance with
r,!
this probation; the cost of ~btaining,and analysis of, any blood or urine specirnek
submitted pursuant to this Order; and administmt'we costs directly asdated
--
with the
Respondent's probati~n.
.. .
6.
, .
1..
l h e terms of the Final Order are effective as oftfie date the Flnal0rde;'is
.
.&
wit3 the clerk for the Department of. Health. The Board offrce wilt send the
Respondent information regarding probationary terms; homer, failure of the
Respondent ta receive such information does not e x w ~ comaliance with the terms of
the Final Order.

7.
. .
.
,
. .. ,
~
The Respondent shall n ~vibtite thapter 456 dr 464, Florida statutes, th;' t . . . .. hies promulgated pursuant thereto, any other state or federai law, rule, or regulation
hlating
! D
'
the phcfie or the abitity to practln nursing. Vidation of an order from
' another statefiur7sdiction shall constitute grounds for violation of VIE ~ o a r d Order
adopting this Agreement.
8 .
It is mpres5ly understood that this Agreement is subject to the appmhi
of ths Board and Department and has no force and effect until an Order is entered
adow~ng Agmnt. the

-4-
~qamm Heam u . M E R NELSON SPPADUN. R.N. of

Cesc N W S U S - 2 3 n 7
9. . This Ag-ent
is &e~uted by the kespo~&t for the purpme

I .
of
woiding further administrative action by the Board o Nursing regarding the acts or f :. .. . . , ' omissions speciRcally set forth in the Adntlnistrative ~om~fain't' ak&?&d hereto. In this
&ard,
Respondent amhorirrs ;he b a r d to i w i e ~ examine ail invest)gatiue fiie and
$herials concerning Respandent prior to, or in conjunctl~nwith, cm;ideration of the

Agreement Furthermore, should this joint Agreement not be accepted by the Board, it
. .
& %reed that presentation to, and consideration of, this Agreement and other
documenk and matt& 'bythe B-rd shall not unfkirly 'or ilie<alfy ~rejudice theBoard or .. ahy OF Its members from further participation, &nsideratloi or res~lukionof these: .. . . .,. . . . . proceedings. Respondent shall offer no wideom, testlmny or argummt that disputes
or contravenes arty tipulated,fact or condusion
af law.
. ..
10.
Respondent and the Department funy understand that fils joint
Agreement and subsequent Rnal Order incorppr&ng same will in no way predude
additional proceedings by th'e m r d andjor Department *.,. ..,.' the Respondent for a d s . against .. ..
or om&lons not speclRcally At ffclth in the Administrative ~on~laint'ktached'hereg: ..
..I
\.
jhis Agre~mentreiates solely to the current dixipiinary proceedings . arising from the .r .
above-mentioned' ~drninistra& campiairit and d&' not"~;kclude further adion by
other divisions, departments, and/or sections of the ~ e ~ a r t m e nincluding but not tj
limited tn the Agency For Health tar6 AdmJnistras~n's Mediaid Program Integrity
omce.
1. 1
The Respondent waives the right b seek any atbmey's fees or costs fmm
the Department in connection with k disciplinary proceeding. k
12.
Respondent. waives all rights ta appeal and further review OF this
Agreement and these proceedings.

Depamnenr or Heam
CLn Numb% 2DDW3S17
*. TYLER N Lm SPRADLIN, RN ES
- 5-
4552
WHEREFORE, t3e parties hereto request the .Bwrd to enkr 'a Rnal Order . .. . . 2. y =. ::.-..: , . ' accepting and implementing the terms contained herein.
L '.
3 5y 1
SIGNED thi&ay
of-dd
/ r n * h a p identin/ b Before me perscrnaiiy appeand . (typt: o iden&ation), and .who under f known to be by 0 aath, acknawledges that hisfher signature appears akxre. r e m ~ t i - , l r ~ d a yn ~ o . l - ~ . , & ~ Sworn t and suhscribgd by Resp~nde o
,
?If
qp m$li
SC
201L.
: BAWbiCLRMDR ,
i H n ! q P tW DLM'm a ,a
. . . 3 . .L ... ....; .
Notary Public
My Commission Eqlres:
..*
APPROVED thb
~L~t~b&AwlbI20u
.::
>
day
;i.-&&---,1). 2 0
.>
FBN: OD17617 Depatment of H~alth . Prosecution Services Unit 4052 Bald Cypress Way, BIN EC-65 Talfahanee, Florida 323993265
Depmknl cl H e a h v. M E R NELSON SPWDUN. RNi4unt-w 2DD%W7
STATE O FLORIDA F DEPARTMEW OF HEALTH

DEPARTMENT OF HEALTH,
Petitioner,
Respondent.
A
ADMIBISRBLT1M GQMPMNT
COMES NOW, Petitioner, Department of Health, by and through
its undersigned counsel, and files this Adminishative Complaint

before the Board of Nursing against Respondent, Tyler Meison Spradlin, R.N., and in support thereof alleges:
1.
Petitioner i the state agency charged with regutating the s
practice of nursing pursuant to Section 20.43, Florida Stab-;

Chapter 456, Fiorida Stabteq and Chapter 464, Florida Statutes,
2.
At
ail times material to this Complainf Respondent was a
registered nurse (RN.) within the state of Rorida, having been issued
license number RN 9279715.
3. . Respondent's address of record is 8612 Venezia Drive,

Apwtment 2318; Orlando, FL 32810,
4.
At all times material to this Complaint, Respondent was
working as a R.N. at Ronda Hospitai, located in Driando, FL.

5.
BMC utilized the Acudose medication dispensing system.
Acudose consists of locked medication a r t s that secure and control

a&
.
.
,
to wntr~lledsubstances through 'a computer system. Each .

-.
cart has a &mputer terminal on top of the cart that is linked
to the
pharmacy.. Nurses. can a c w s Acudose with either an indMdual

password or through a fingerprint scan.
The nurse seiects the
medication neded . and the. patient for whom the medication is

'
intended, and the specific drawer that contains that medication unlock and opens. activity reports mn be generated from Acudose that show all medications removed from the Acudose a t by a r specific nurse. The activity reports indicate the medication, dose, date, time, patient for whom the mediation is intended, and nurse removing the mediation,
6.
In order to accurately record patient care, and to
accuratefy account for conbfled substances, BMC required nurses to

D D H v T y b Spranin, RN. N u m b 20B-23617 ):\P3ANursing\Trwd$+QUnpmk&~~I CoMu@pradiin, T e r , RN, inaccunte recommg.d~c
document the time each mdication was administered to the patient on the patient's medical m r d , controlled. substance was
If a d m or partial dose of a
but not
removed from Acudose,
o administered to the patient, the nuke was required t discard the

controlled substance in the presence of another licensed nurse. The
nurse discarding the controlled substance, and the nurse witness,

both enter their names into the 8cudose computer to document that .the controlled substance was discarded. The discard of a controlled substance is referred to in Acudose as a "waste."
Patient T,C,
7 .
On dr abut June 8, 2009, bpondent was assigned to
care for patient TC.

8.
On or about june 8, 2009, at approximately 8:04 a.m.,,
Respondent removed 2 miHigrams (mg) of hydromarphone from the Acudose machine for patient T.C.
9,
Hydromorphone, brand name DPaudid, is commonly
prescribed to treat pain, According to Section 893.03(2), Florida
statutes,
hydromotphone is a Schedule 1 controlled substance that 1
has a high potential for abuse and has a currently accepted but
DOH v ~ y l & spradlin, RN.
Number: 2OW.23617
3 : ~ E U \ N u ~ s i n g \ T r e v ~ U n p ~CMduCt\Spradlln, Tyler, W, inaanzte re;ordlng.drr nal
severely restricted use in treatment in the United Stakes. Abuse of hydromorphone may lead to severe psychdogical or physical dependence.
'
10. On or about June 8, 2009, -at approximately 8:13 a.m.,
'
Respondent documented adminiskring 1 mg of hydmmorphone to
T.C. but failed to document administering or watitng the other mg of

hydromorphone that was removed from the Acudore machine.
1 . .On'or about June.8, 2009, a t appraximably 3:43 p.m., 1
Respondent removed one 10 milligram (mg) tablet of oxycodone for patient T.C. from the Acudose machine. 12.
Oxycodone 'is commonly prescribed b treat pain.

..
According to section 893.03(2), Florida Statutes, oxymdone is a Schedule I1 conblled substance that has a high potential for abuse
and has a cumntiy accepted but severely re*Icted
medical use ,in
treatment in the United S a e . Abuse'of oxycodone may lead to tts sever psycholcgical or physical dependence.
13.
On or about June 8, 2009, Respondent failed to document
administering or wasting the 10 mg tablet of oxyodone that was removed from the Amdose machine.
DDH v Tykr SpiadUn, RN. Case Number. 2DW23517
3:\~5U\~tnsin~\Trevo~~np-l
Conduc?+p;adUn, Tyler, RN, inarmrate remrding.bc
1 . On or a b u t June 8, 2009, at approxlrnately 3 5 3 p.m., 4

Respondent removed 2 mg of hydromorphone from the Amdose
machine for patient TC.

June 8, 2009, Respondent failed b dccument 15. On,or ~tbout administering or wasting the 2 rng of hydromorphone that he removed from #e'~cudosemachine at 3 5 3 p.m. for patient TC. 1 6 On or about June 8, 2009, at appmximately 6:56 p.m., Respondent removed '2 mgs of kflromorphone from t e Aclsdose h machine for patient TC.
17. On w about June 8,2009, deipondent failed to document

administering or wasting the 2 rng of hydromorphone that he removed from the Amdose machine at 6:56 p.m, for patient T.C..
Patient C.E.F.
18. On-or'about May 26, 2009, at.approxirnately 3:20 p.m.,
Respondent removed 2 mgs of hydromorphone fimm the Acudose rnachfne for patient C.E.F.
19. On or about May 26, 2009, Respondent failed to

document administering or wasting the 2 mg of hydromorphone that he removed from the Acudose machine at 6:56 p.m. for patient T.C.
DOH v Tyler SpmIlin, R.k. tzw Numbs: 200923617 J : \ p s ~ N u f i i n g \ T ~ U n p ~ n a n d u W p d h , Tylrs, RN, imccurek rearr6mg.d~ Co l
Pat'Bnt G.5,
20.
On or about lune 5, 2009, at appraxirnstely 457 p.m.,
Respondent removed 2 rngs hydromorphone from the h d o s e machine for patient G.D.
21.
On or about June 5, 2009, Respondent failed to document
administering or wasting the 2 mg of hydromorphone that he remwecl from the Acudose machine at 4:57 p.m, for patient G.D.
22. . On or about M a y 13, 2009,:at approximate!y 12t45 p.m., . . ~espondent'removed .2 mgs .hydromorphone from' the Acudose
machlne for patient R.M.

23. 'On or 'about May 13, 2009,. Respondent failed
to
document administering or wasting the 2 mg of hydromorphone that he rernwkl from the Acudose machine at 12:45 p.m. for patient R M .
24.
On or about May 13, 2009, at approximately 4:26 p.m.,
Rkspondent removed 2 mgs hydromotphone from the Acudose
machine for patient RM.
DOH v T y k SpipradRn, RN. Cess NU*K 2ED3-23517
k\RWusing\TrevWC\Unpmk&mal tondu45piadlin, Tyier, RN, inarmrate re3~;ding.d~~
25.
On or about May 13, 2509, ReSpondent failed to
iI
!
document a d m i n i ~ ~ n gwasting the 2 mg of hydromorphone that or he repwed from the Acudose machine at 4:26 p.m, for patient RM. 26,' section 464;518(1)(h Rorida. Statutes (2008), makes
'
unprofessional conduct an. act that constitutes grounds for dixipiinary action. 27:
Rule 6489-8.005(1), Florida Administrative W e , defines

'.
unprofessional anduct to indude inamrate recording. . . . . 28. On or about June 8, 2 0 ~ 9 at B:04 am, 8:13 am, 3:53 pm, . , . ..
' '
andlor' 6:56 pm, Respondent removed hydrocodone from the Acudose machine for patient T.C., adminiskring or wasting the medications. 29,
On or a b u t June 8, 2009, at 2 4 3 prn, Respondent
but failed to document
~emoved oxymdone from h e Acudcse machine -for pauent T.C., but
failed to document administering or wasting the md~cations.

30. On or about May 26, 2009, at 6:56 prn, Respondent removed hydrocodone from the Acudose machine for patient C.E.F.,
but faikd to document adminiering or wasting the medications.
DOH v T y k Spiadbn, LN.

CCE Number: 2W9-D617
7
Tyier, RN, i w r a t e mrdinqdo;
I : ~ N m i n g \ T r e v W U n p ~ n Condu&\sp&, aI
31. On or about June 5, 2059, a t 4 5 7 pm, Respondent
removed hydrocodone from the Acudose machine for patient G.D., but faled to documerit administering or wasting the medications.
32.
On or about Nsy 13, 2009, at 12:45 pm, and/or 4:26 pm,
Respondent removed hydrocodone from the Acudose machine for patient R.M., but failed b document administering or wasting the medications.
33.
Bad
on the foregoing Respondent violated Section
464.018(l)(h), Florida Statutes (205&),by engaging in unproWlonal conduct as defined by Rule 64B9-8.00S(l)(a), Florida Administrative Code, by inaccurateiy recording.
DOH v Tyler 5pra66n, LN. Number: 2009-23617 J:\PSu\Nlhsing\Trem~Unp~ml Conduc?Spradiln, Tyis, RN, iwccutate remrding.doc
WHEREFORE, the. Petitioner resp&uliy
requests that the
Board of Nursing enter an order imposing one or more of the following penalties: permanent revocation . or suspension of .: Respondent3 liknse, resMaion of practice, imposition' of an administrative fine,. issuance of a reprimand, placement of the Respondent on probation, corrective action, refund af fees billed or
!
c o I W d , remedial education andfor any other .relief that the Board

deems appropriate.
j 1
SEGWEB this
')
/.
day OF
D-QG.
,2010.
DEPU~~ cLERK c ~ E R KAngel S ~ 1 ) d e ~ PATE D E C l 6 rotP
u ,, , n ,
nLED OF H W T W
M i n t General Counsel DOHPms&on Servics Unit 4052 Bald Cypress Way, Bin C-65 Tallahassee, Florida 32394-3265 floricfa Bar Number 0017617 (850) 245 - 4640 Telepbne (850) 245 - 46B3 Facsimile
DOH v Tyler Spradlin, RN, Czse Numbs! 2004-23617 S:\psv\Nursing\T~e~~Unp~~na] tondudSpradiin, Tykr, RN, inamrmte remrding.doc
Respondent has the right fzo request a hearing ka be mducteel in aaordance with Section 120.569 and 120.57, Florida S&tb&sr to be ~epressrrted counsel or ather qtialified by representative, b p r e ~ n evidence and argument, tn &all and t moss-&mine witnesses and to have subpeeria and subpoena duces kcurn issued on his or her behalf if a hearing is requested.
Respondent is p i a d si notice that PeMoaw has l incurred costs related tQ &e Znvestigation and pmsecbstispr a f this wr , Pursuant a ection 456.D72!(4), Florida Statutes, the B o d shall a m s s m i eelat& to t h e . ss investigation and p m & i o n of a ddlscip8nay matter, which may inclyde attorney brers end casts, on the Respecedent in adfition to any other Bi&pline.impsed.
W v Tyier SpraJlln, RN. H k s e Number. 20D4-23617

3:\PN\Nurdng~Tlwlx\ngUnpMnalConductWradiin, Tyler, RN, inaccurate remrdin$.dDc
Case# 12-001949
July 27, 2012

Shawn Eric Stafford, L.P.N. 4603 Cleveland Avenue South Canton, Ohio 44707 Dear Mr. Stafford: 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 two (2) years. A. Item 7. of the January 2012 Consent Agreement states, Within forty-five (45) days of the effective date of this Consent Agreement and continuing throughout the probationary period, MR. STAFFORD shall submit, at his 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 MR. STAFFORDs 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. STAFFORD shall be negative, except for substances prescribed, administered, or dispensed to him by another so authorized by law who has received a complete copy of this Consent Agreement prior to prescribing for MR. STAFFORD. Despite this provision, as of July 2, 2012, you have failed to register with Firstlab, the Boards random drug/alcohol screen program administrator, to determine if you had been selected to provide a urine specimen. B. Item 9. of the January 2012 Consent Agreement states, Within three (3) months of the effective date of this Consent Agreement, MR. STAFFORD 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. STAFFORD shall provide the chemical dependency professional with a copy of this Consent Agreement and assessments, evaluations, and treatment
Shawn Eric Stafford, L.P.N. Page 2 records from Glenbeigh at Rock Creek, Ohio. Further, MR. STAFFORD 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 MR. STAFFORDs license to practice, and stating whether MR. STAFFORD is capable of practicing nursing according to acceptable and prevailing standards of safe nursing care. Despite this provision, as of July 2, 2012, you have failed to submit to the Board documentation of 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. 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. and 9. of the January 2012 Consent Agreement. YOU ARE FURTHER NOTIFIED THAT YOUR LICENSE TO PRACTICE NURSING AS A LICENSED PRACTICAL NURSE, PN-119412, 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 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 upon meeting the requirements for licensure, 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 two (2) years. 2. Item 7. of the January 2012 Consent Agreement states, Within forty-five (45) days of the effective date of this Consent Agreement and continuing throughout the probationary period, MR. STAFFORD shall submit, at his 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 MR. STAFFORDs initiation
Shawn Eric Stafford, L.P.N. Page 3 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. STAFFORD shall be negative, except for substances prescribed, administered, or dispensed to him by another so authorized by law who has received a complete copy of this Consent Agreement prior to prescribing for MR. STAFFORD. Despite this provision, as of July 2, 2012, you have failed to register with Firstlab, the Boards random drug/alcohol screen program administrator, to determine if you had been selected to provide a urine specimen. 3. Item 9. of the January 2012 Consent Agreement states, Within three (3) months of the effective date of this Consent Agreement, MR. STAFFORD 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. STAFFORD shall provide the chemical dependency professional with a copy of this Consent Agreement and assessments, evaluations, and treatment records from Glenbeigh at Rock Creek, Ohio. Further, MR. STAFFORD 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 MR. STAFFORDs license to practice, and stating whether MR. STAFFORD is capable of practicing nursing according to acceptable and prevailing standards of safe nursing care. Despite this provision, as of July 2, 2012, you have failed to submit to the Board documentation of 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. 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
Shawn Eric Stafford, L.P.N. Page 4 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,
Case # 10-5452
CONSENT AGREEMENT BETWEEN SHAWN ERIC STAFFORD, L.P.N. AND OHIO BOARD OF NURSING
This Consent Agreement is entered into by and between SHAWN ERIC STAFFORD, L.P.N. (MR. STAFFORD) 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.
MR. STAFFORD voluntarily enters into this Consent Agreement being fully informed of his 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.
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. Specifically, 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.
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MR. STAFFORD was initially licensed to practice nursing as a licensed practical nurse in the State of Ohio, PN-119412, in August 2005. MR. STAFFORD'S license to practice as a licensed practical nurse is active. MR. STAFFORD knowingly and voluntarily admits to the following:
1. On June 7, 201 1, MR. STAFFORD was convicted in the Ashland Municipal Court in Ashland, Ohio, Case No.
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Shawn Eric Stafford, L.P.N. Page 2
10CRB01352, of Drug Paraphernalia, a third-degree Misdemeanor. 2. In 2010, MR. STAFFORD entered treatment for alcohol dependency at Glenbeigh Hospital in Rock Creek, Ohio. MR. STAFFORD relapsed after his initial treatment and he returned to Glenbeigh Hospital in 2011 for an additional forty-eight (48) days of treatment. 3. On or about December 1,2010 or December 2,2010, while sitting in a parked vehicle with a female occupant in Ashland, Ohio, MR. STAFFORD witnessed the female occupant inject herself with methamphetamine. Police officers from the Ashland Police Department approached the vehicle and intervened. During a phone call with a Board Investigator, MR. STAFFORD stated that he had met the female while MR. STAFFORD was in treatment for alcohol addiction at Glenbeigh in Rock Creek, Ohio. MR. STAFFORD ceased the practice of nursing after his relapse and return to Glenbeigh Hospital in 201 1.
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. STAFFORD knowingly and voluntarily agrees with the Board to the following terms, conditions, and limitations: MR. STAFFORD'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 two (2) years: 1.
MR. STAFFORD shall obey all federal, state, and local laws, and all laws and rules governing the practice of nursing in Ohio. MR. STAFFORD shall appear in person for interviews before the full Board or its designated representative as requested by the Board or its designee. MR. STAFFORD agrees that he will submit a request to the Bureau of Criminal Identification and Investigation (BCII) to conduct a criminal records check of MR. STAFFORD, including a check of Federal Bureau of Investigation (FBI) records, and shall request BCII to submit MR. STAFFORD's criminal records check reports to the Board. MR. STAFFORD'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.
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Within six (6) months of the effective idate of this Consent Agreement, MR. STAFFORD 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 Cmsent Agreement: ten (10) hours of Chemical DependencyiSubstance Abuse; ten (10) hours of Ethics; and one (1) hour of the Scope of Practice For Ohio RNs & LPNs.
Monitoring
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MR. STAFFORD shall abstain completely from the personal use or possession of drugs, except those prescribed, administered, or dispensed to him by mother so authorized by law who has received a complete copy of this Consent Agreement prior to prescribiqg for MR. STAFFORD. MR. STAFFORD shall self-administer the prescribed drugs only in the manner prescribed. MR. STAFFORD 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, MR. STAFFORD shall submit, at his expense and on the cLay selected, blood, breath, hair, or urine specimens for drug andor alcohol analysis at a collection site specified by the Board at such times as the Board may request. Upon and after MR. STAFFORD'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 oonstitute 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. STAFFORD shall be negative, except for substances prescribed, administered, or dispensed to him by another so authorized by law who has received a complete copy of this Consent Agreement prior to prescribing for MR. STAFFORD.
a. Prior to MR. STAFFORD initiating drug screening, MR. STAFFORD 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 MR. STAFFORD.
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b. After initiating drug screening, MR. STAFFORD 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, MR. STAFFORD 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. 8.
Within thirty (30) days of the effective date of this Consent Agreement and continuing throughout the probationary period, MR. STAFFORD 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 MR. STAFFORD 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. Within three (3) months of the effective date of this Consent Agreement, MR. STAFFORD 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. STAFFORD shall provide the chemical dependency professional with a copy of this Consent Agreement and assessments, evaluations, and treatment records from Glenbeigh at Rock Creek, Ohio. Further, MR. STAFFORD 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 MR. STAFFORD'S license to practice, and stating whether MR. STAFFORD is capable of practicing nursing according to acceptable and prevailing standards of safe nursing care. MR. STAFFORD 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. STAFFORD 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 MR. STAFFORD7s license and that the terms, conditions, and limitations may be incorporated in an addendum to this Consent Agreement.
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MR. STAFFORD 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 nursing employment. MR. STAFFORD, within fifteen (15) day of the effective date of the Consent Agreement, if working in a position in which a nursing license is required, shall provide his employer(s) with a copy of this Consent Agreement. Further,MR. STAFFORD is under a continuing duty to provide a copy of this Consent Agreement to any new employer prior to accepting nursing employment. MR. STAFFORD shall have his 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. MR. STAFFORD 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 dilte Consent Agreement was received.
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MR. STAFFORD shall report to the Board, in writing, any violation of this Consent Agreement within thirty (30) days of the occurrence of the violation. MR. STAFFORD shall sign release of information forms allowing health professionals and other organizations to submit the requested documentation directly to the Board. MR. STAFFORD shall submit any and ail information that the Board may request regarding his ability to practice according to acceptable and prevailing standards of safe nursing practice. MR. STAFFORD 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. STAFFORD 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. MR. STAFFORD shall submit the reports and documentation required by this Consent Agreement or any other documents required by the Board to the
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Shawn Eric Stafford, L.P.N Page 6 attention of the Compliance Unit, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, OH 43215-7410. 19. MR. STAFFORD shall verify that the reports and documentation required by this Consent Agreement are received in the Board office. MR. STAFFORD 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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Temuorarv Practice Restriction Unless otherwise approved in advance, in writing, by the Board o r its designee, MR. STAFFORD 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 MR. STAFFORD to provide nursing services for fees, compensation, or other consideration or who engage MR. STAFFORD as a volunteer. Unless otherwise approved in advance, in writing, by the Board o r its designee, MR. STAFFORD 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 T O COMPLY MR. STAFFORD agrees that his license to practice nursing as a licensed practical nurse will be automatically suspended if it appears to the Board that MR. STAFFORD has violated or breached any terms or conditions of the Consent ~greement. Following the automatic suspension, the Board shall notify MR. STAFFORD via certified mail of the specific nature of the charges and automatic suspension of his license. MR. STAFFORD 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, MR. STAFFORD 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.

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. STAFFORD and the Board. The Board may only alter the probationary period imposed by this Consent Agreement if: (1) the Board determines that MR. STAFFORD has complied with all aspects of this Consent Agreement; and (2) the Board determines that MR. STAFFORD is able to practice according to acceptable and prevailing standards of safe nursing care without Board monitoring, based upon an interview with MR. STAFFORD and review of the reports as required herein. Any period during which MR. STAFFORD 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.
ACKNOWLEDGMENTSLIABILITY RELEASE MR. STAFFORD 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. STAFFORD waives all of his rights under Chapter 119, ORC, as they relate to matters that are the subject of this Consent Agreement. MR. STAFFORD waives any and all claims or causes of action he may have against the Board, and its members, officers, employees andlor agents arising out of matters, which are the subject of this Consent Agreement.
EFFECTIVE DATE MR. STAFFORD 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.
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SHAWN ERIC STAFFORD, L.P.N.
DATE
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Case #11-004967
July 27, 2012

Donald C. Staggers, R.N. 3744 Main St. Apt 717 Weirton, WV 26062 Dear Mr. Staggers: 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. In August 2011, you entered into a Proposed Consent Agreement (West Virginia 2011 Agreement) with the West Virginia Board of Examiners for Registered Professional Nurses that placed your West Virginia nursing license on probation for two (2) years. A copy of the West Virginia 2011 Agreement is attached hereto and incorporated herein. Section 4723.28(B)(1), ORC, authorizes the Board to deny a license or otherwise 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. 2. In October 2011, you entered into a Consent Agreement and Order (Pennsylvania 2011 Order) that became effective on or about December 2, 2011. The Pennsylvania 2011 Order placed probationary terms and conditions on your license to practice nursing in Pennsylvania. A copy of the Pennsylvania 2011 Order, with attachments, is attached hereto and incorporated herein. Section 4723.28(B)(1), ORC, authorizes the Board to deny a license or otherwise 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. 3. After self-reporting chemical dependency issues to the Board, you provided a written statement dated July 25, 2008, in which you described relapsing on alcohol beginning in February 2008 and indicated being sober and drug free since the end of June 2008. However, on or about July 16, 2008, in Belmont
Donald C. Staggers, R.N. Page 2 County Court, Northern Division, Court Case Number 08 TR C 00905, you pled no contest to and were subsequently found guilty of one (1) count of OVI, a firstdegree misdemeanor, in violation of Section 4511.19(A)(1)(H), ORC. The event underlying this conviction occurred in Belmont County, Ohio on or about July 9, 2008. 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)(1), states that a licensed nurse shall not submit or cause to be submitted any false, misleading or deceptive information, or documentation to the board or any representative of the board. 4. On or about May 19, 2009, you submitted an on-line application to the Board for the renewal of your registered nursing license (2009 Application). Under the Compliance section of the 2009 Application, you were asked: Have you been convicted of, found guilty of, pled guilty, pled no contest to, pled not guilty by reason of insanity to, entered an Alford plea, received treatment or intervention in lieu of conviction or received diversion for . . . A misdemeanor in Ohio, another state, commonwealth, territory, province, or country? This does not include non- DUI/OVI traffic violations. You answered No. to this question. However, on or about July 16, 2008, in Belmont County Court, Northern Division, Court Case Number 08 TR C 00905, you pled no contest to and were subsequently found guilty of one (1) count of OVI, a first-degree misdemeanor, in violation of Section 4511.19(A)(1)(H), 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, Rule 4723-4-06(P)(1), OAC, states that a licensed nurse shall not submit or cause to be submitted any false, misleading or deceptive information, or documentation to the board or any representative of the board. 5. On or about June 6, 2011, you submitted an application to the Board for the renewal of your registered nursing license (2011 Application). Under the Compliance section of the 2011 Application, you were asked: Have you entered into an agreement of any kind, whether oral or written, with respect to a professional license/certificate, or registration in lieu of or in order to avoid formal disciplinary action, with any board, bureau, department, agency, or other body, including those in Ohio other than this Board? You answered No to this question. However, as referenced on Page 2, Paragraph e., of the Pennsylvania 2011 Order, on June 3, 2009, you entered into a
Donald C. Staggers, R.N. Page 3 Voluntary Recovery Program (VRP), Professional Health Monitoring Program (PHMP) Agreement with the Commonwealth of Pennsylvania. 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)(1), OAC, states that a licensed nurse shall not submit or cause to be submitted any false, misleading or deceptive information, or documentation to 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. 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@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 the 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,
WEST VIRGINIA STATE BOARD OF EXAMINERS FOR REGISTERED PROFESSIONAL NURSES IN THE MATTER OF DONALD STAGGERS PROPOSED CONSENT AGREEMENT
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Comes now DONALD STAGGERS (STAGGERS), and the West Virginia Board of Examiners for Registered Professional Nurses ("Board"), for the purpose of determining what disciplinary action should be taken against STAGGERS by the Board (1993). As reflected in this document, pursuant to West Virginia Code $30-7-1 STAGGERS 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 76714, STAGGERS 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 1. STAGGERS submitted an Endorsement Application to the Board on May 20, 2009. 2. On the application appears the following question, "Have you EVER been convicted of a felony or a misdemeanor or pled nolo contendere to any crime, had records expunged or been pardoned? (List speeding tickets only if you have received three (3) speeding tickets in the last two (2) years)" 3. 2009. Staggers began employment at Northwood Health Services, Wheeling, West 4. Virginia on April 26, 2010. By letter dated April 30, 2010 Staggers reported he was instructed by his case 5. manager at the Pennsylvania Peer Assistance Program (PNAP) to inform the Board he was being monitored by PNAP as result of alcohol abuse. The Board sent Staggers an official Notice of Complaint along with information 6. related to the Boards Impaired Nurse Treatment Program. During the complaint/investigation process, which included review of Staggers' 7. employment records from Northwood Health Services, the Board learned Staggers was STAGGERS was subsequently issued license number 76714 on October 2,
was convicted of "Public Intoxication" in Hancock County, West Virginia in 1985 and convicted of "DUI" in Belmont County, Ohio in 2008. Staggers signed a Suspension Consent Agreement as a result of falsification 8. of the Endorsement Application. 9. 10. 11. Staggers petitioned the Board for reinstatement of his license. Staggers admits the above stipulations are true. Staggers license is reinstated pursuant to the terms of this agreement.
12. STAGGERS acknowledges that his conduct violated West Virginia Code 30-7-11 (c),(d) and (f), which state that the licensee may be disciplined if he or she (c)[i]s unfit or incompetent by reason of negligence, habits or other causes; or ... (d)[i]s habitually intemperate or is addicted to the use of habit-forming drugs; or ... (f)[i]s 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 a g q . pertaining to the practice of registered professional nursing. Specifically, the stipulations support sanctions under the following sections of the West Virginia Code: West Virginia Code 30-7-11 (c), which states that a licensee may be disciplined a. upon proof that he or she [i]s unfit or incompetent by reason of negligence, habits or other causes; West Virginia Code 30-7-11 (d), which states that a licensee may be disciplined b. upon proof that he or she [i]s habitually intemperate or is addicted to the use of habit-forming drugs; and, West Virginia Code $30-7-1 1 (f), which states that a licensee may be disciplined c. upon proof that he or she [i]s guilty of conduct derogatory to the morals or standing of the profession of registered nursing.
CONSENT
STAGGERS, by affixing his signature hereon, agrees to the following:

1. He acknowledges that he is aware of his option to retain legal counsel and to be represented by legal counsel at a formal hearing before the Board.
He intelligently and voluntarily waives his right to a formal hearing before 2. the Board in this matter, if the Board accepts the terms and conditions set forth herein and joins with him in executing this agreement. He acknowledges that he is fully aware that without his consent, no legal action can be taken against him by this Board, except pursuant to West Virginia Code 30-7-1 w. relevant rules. and
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He submits this proposed agreement freely and voluntarily and not under 4. duress, restraint or compulsion. He agrees that the Board may investigate his background at any time during the terrn of this agreement.
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He consents to the entry of the following order affecting his license to 6. practice registered professional nursing in the State of West Virginia. He understands that the Board may accept or reject the facts and terms set 7. forth 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 76714, issued to STAGGERS, be suspended for the period of one (1) year. Such suspension is hereby stayed contingent upon STAGGERS complying with the terms set forth below, and license number 76714 is placed on probation for a period of 2 years 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 STAGGERS is employed as a registered professional nurse and shall run only during such time that he is employed as a registered professional nurse on at least a permanent part-time l basis (forty hours every two weeks) or f l ~ ltime basis in the State of West Virginia. The Board also ORDERS STAGGERS pay a fine and administrative costs in the amount of Two Thousand Dollar(s) ($2,000.00). To receive and maintain a probationary license, regardless of employment status, STAGGERS shall meet the following conditions:
General:
1. 30-7-1
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STAGGERS shall not violate the provisions of West Virginia Code
2. STAGGERS shall, immediately upon notification of the entry of this Order, submit his current registered professional nurse license to the office of the Board.
STAGGERS shall not commit any act which would be a crime under West 3. Virginia or federal law. If STAGGERS is charged by any law enforcement agency with committing any such criminal act, he shall notify the Board in writing of the formal charge(s) against him, and resolution of same. STAGGERS shall maintain a current and active license in the State of 4. West Virginia. He shall not allow his license to lapse or be placed on an inactive status. STAGGERS shall not, under any circumstances, misrepresent his licensure status.
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6. ST,4GGERS shall not be employed by a nursing registry, temporary nursing agency, home health care agency, or as a private duty nurse.
STAGGERS shall not work in an autonomous nursing position. He shall 7. work only under the direct supervision of a registered professional nurse in a structured registered professional setting throughout the term of his probation. Such supe~ising nurse must, at the time of said supervision, hold an active, unencumbered West Virginia license. STAGGERS shall inform the Board in writing within ten (10) days of the 8. date he 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 his employer. He shall provide in writing the name of his immediate registered professional nurse supervisor. STAGGERS shall inform the Board of any interruption in nursing practice or change in employment within ten (10) days of such interruption or change.
9. STAGGERS shall immediately inform his nursing employer, any prospective nursing employer, and the director of any nursing education program in which he enrolls or teaches, that the Board has placed his license on probation, and shall provide a complete copy of this agreement to his employer(s). The Board may provide his employerjs) with a copy of this agreemeilt and may communicate with his employer(s).
10. STAGGERS shall, within ten (10) days of employment or continuation of practice, cause his 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. STAGGERS shall further cause his employer or supervisor to submit monthly reports to the Board describing STAGGERS'S job performance, attendance, attitude, and other work behaviors during the first year of probation and if his progress is satisfactory to the Board, quarterly thereafter. 11. STAGGERS shall submit documentation of fifteen (15) contact hours of continuing education in substance abuse each year during the time his license is on probation, in addition to the those required by law.
12. STAGGERS shall report in person for appointment with the Board staff upon request. Rehabilitative: 13. STAGGERS shall participate in a structured aftercare program, with a certified addictions counselor approved by the Board. The treating certified addictions counselor shall make a monthly report to the Board about STAGGERS'S progress and his compliance with the aftercare program. STAGGERS shall visit his approved treatment provider at least one (1) time per month during the term of this agreement. This requirement may be modified upon request to the Board by STAGGERS'S certified addictions counselor. 14. STAGGERS shall submit or have submitted to the Board evidsnce of his participation in 12-Step meetings. STAGGERS shall attend at least three (3) 12-Step meetings per week. Written evidence of participation in meetings shall be submitted to the Board on or before the fifth day of each month. 15. STAGGERS shall not handle nor administer narcotic or psychotropic medications, nor have access to locked or other storage areas in which such medications are kept. STAGGERS shall notify his employer of this restriction on his practice. 16. STAGGERS shall submit to unannounced, witnessed drug-screening tests. Said tests shall be on demand and to ihe specifications of the Board and at licensee's expense. STAGGERS shall call the Board's drug screening company DAILY between the hours of 5:00 a.m. through 2:30 p.m. t o see if he is selected to test. Receipt of a positive drug screen andlor not calling the drug screening program daily within the specified time frame is deemed to be a violation of this Consent Agreement, and shall result in immediate suspension of STAGGER'S license. Eating products containing poppy seeds will not constitute as an accepted reason for having a positive screen for opioids. Licensee shall not consume tonic water, quinine water, hemp tea or other products containing substances that trigger a positive drug screen. 17. STAGGERS shall abstain from the use of alcohol and limit his use of drugs to those prescribed for a legitimate purpose by a physician, dentist or nurse practitioner duly licensed in the State of West Virginia. STAGGERS shall provide a copy of this agreement to any prescribing physician, dentist or nurse practitioner. STAGGERS shall cause his physician, dentist, or nurse practitioner to notify the Board in writing of any medications/drugs prescribed and the condition for which said drug(s) has been prescribed. STAGGERS agrees that, if he accepts a prescription for narcotic or psychotropic drugs, the Board may impose additional probationary terms. 18. STAGGERS shall coordinate any health care services he requires with one physician or registered nurse practitioner, who shall be informed of any services or prescriptions sought or obtained by STAGGERS from any physician, dentist or nurse
practitioner. STAGGERS shall provide this individual, who serves as his point of contact for health care needs, with a copy of this agreement. 19. STAGGERS shall execute a release to permit the Board to obtain medical or other health care records, which may be requested at any time while his license is on probation, regarding his physical or mental health and any treatment rendered. 20. STAGGERS shall annually submit to the Board a written personal statement regarding progress in recovery. 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:
Any deviation from these requirements without prior written consent of the 21. Board shall constitute a violation of this Order, and result in immediate suspension of STAGGERS's probationary license. 22. The Board shall immediately notify STAGGERS via certified mail of the specific nature of the charges, and the suspension of his license. a. STAGGERS may request reinstatement of his probationary license through 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, STAGGERS shall be b. notified in writing. STAGGERS may request a hearing to seek reinstatement of his probationary license. If STAGGERS 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 STAGGERS. If STAGGERS 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 ths hearing, and shall not include any legal or other fees incurred by the Board or STAGGERS in bringing the matter to hearing. c. The Board may schedule a hearing on its own initiative for the purpose of allowing the Board opportunity for considering further suspension or revocation of STAGGERS'S license. Said hearing shall be scheduled in accordance with the provisions of West Virginia Code 30-1-8 and 30-1-7 e .The Board shall bear the t. cost if it should seek a hearing following suspension of STAGGERS'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 STAGGERS in bringing the matter to hearing.
Modification of Terms:
If STAGGERS is proceeding successfully in meeting the terms of his 23. probation, he may petition the Board after no less than one (1) year from the execution of this agreement for a modification of the terms of the agreement. In the event that the Board finds that STAGGERS has made significant progress, based upon all information available, the Board may, at its discretion, alter or amend certain provisions of this agreement.
Petition for Reinstatement:
Following the two (2) year probationary period, STAGGEXS may petition 24. to appear before the Board and submit satisfactory evidence that he is presently able to safely engage in the practice of registered professional nursing. Evidence in support of this request shall include: a. Letter of reference from a physicianltherapist involved in STAGGERS aftercare (if applicable); b.
c.
Letter of reference from STAGGERS'S employer, if employed; Letter from STAGGERS outlining his future plans; and Payment of all fines and administrative costs
d.
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 STAGGERS'S license is fully reinstated by the Board. WHEREFORE, STAGGERS hereby requests that the Board accept the stipulations and impose sanctions in accordance with West Virginia Code s30-7-1 g t
sea.
DONALD STAGGERS
&dL!-%
J~Y(/
Date
Agreed to:
8 - IS-//
Date Discialinarv Review Committee Member
Teresa Ritchie. RN. MSN. FNP Disciplinary ~ i v i e w committee Member
QjJi. g &
Ad
Date
aura'^. Rhodes, RN, MSN
a\
&d'
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g,'&jJ. L /
Date
Executive Director West Virginia Board of Examiners for Registered Professional Nurses ENTERED: This the &-/ day
2011.
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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF STATE" ' 1 BEFORE.THE STATE BOARD OF NURSING commonwealth of Pennsylvania Bureau of Professional and Occupational Affairs vs
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: Docltet No, : File No.
01 37-51-1 1 10-51-09376
Donald C, staggers, R.,N., Respondetlt CONSENT AGREEMENT AND ORDER The Commonwealth and Respondent stipulate as follows in settlement of the above-captioned case:
I This matter is before the State Board of Nursing ("Board") pursuant to the
~rofessional Nursing Law, Act of May 22, 1951, P.L. 317, 3 amended, (Act), 63 P.S.
9s 211-25.5
2. At all relevant and material times, Donald C. Staggers, R.N. (Respondent) held a license to practice as a registered nurse in the Commonwealth of Pennsylvania,
. license no. ~N546'727, which was origina[iy.issued on July 15, 2003.

3. The Respondent admits that the following facts are true: a. Respondent's license expired on October 31,201.0, and may be renewed, reactivated or reinstated thereafter upon the filing of the appropriate documentation and payment of the necessary febs.
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b, ~espondeni's address on file with the Board,is 84b Pyramus.

Street, Apt. I, Chester, W2.6034, but his current address is 3744 Main
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Street, Apt. 717, weirton,
w 26062-5351.
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c. ~ e ~ ~ o n dlast pradticed in W6st Virginia. ' . ent

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d. Respondent has suffered from chemical abuse or dependency, specifically alcohol, since December 2007.
e. o n June 3, 2009, the Board issued its Order adopting the

~ ~ r e e m e n t the Voluntary Recovery .Program (VRP), Professional for Health Monitoring Program (PHMP), . Bureau of Professional. and Occupational Affairs (VRP Agreement) entered into between Respondent and the Commonwealth, File No. 09-51-00775, and, among other things, found Respondent to have violated the Act at Section 14(a)(2) of the Act, 63 P.S. 224(a)(2) in that Respondent was unable to practice the'
profession withTeasonabie skill and safety to patients by reason of illriess, addiction to drugs or alcohol.
f. On or about March I, 2010, Respondent's participation in the
VRP was extended until at least three (3) years fr'bm the aforementioned date as the result of a January 2010 relapse. g. ~espondent-hasbeen in compliance with the VRP and, the Pennsylvania Nurse Peer Assistance Program since the extension of his VRP Agreement. h. On or aboit September 28, 2010, Responderit's nursing' license in West Virginia was suspended by the.:~est'VirginiaState Board of Examiners for Registered Professional.Nurses. i.. A true and correct copy of the ~eptember28, 2010' consent;'.:. Agreement and order of the West Virginia State ~ o a r d Ex&niners:f6r df . .
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Registered Professional Nurses is attached and incorporated as Exhibit
j.
On or about August 24,201 Iby Consent Agreement and Order

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Nurses,. Respondent's nursing license in West Virginia was suspended for one (1) year, which was stayed and placed' on two (2) years of probation subject to terms and"conditions, and despondent agreed to pay a two thousand dollars ($2,000.00) in fines and administrative costs.
k. A true and correct copy of the August 24, 2011 Consent

Agreement and Order of the West Virginia state Board of Examiners for Registered Professional Nurses is attached and incorporated as Exhibit
B.
4. Based upon the factual allegations in paragraph 3 'above, the Board is authorized to suspend or revoke,.or otherwise restrict Respondent's license', or impose a civil penalty under Section 13 (b), 63 P.S.
3 223(b), 63 P.S. 2205(b), and 14(a)(2)
of the Act, 63 P.S. 224(a)(2), in that Respondent is unable to practice the profession with reasonable skill and safety to patients by reason of mental or'physical illness or .. condition or physiological or psychological dependence upon alcohol, hallucinogenic or narcotic drugs or other'drugs which tend to impair judgment or coordination and 14(a)(@)of the Act, 63 P.S. 224(a)(6), in that Respondent's license to practice nursing
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&s disciplined by the proper licensing
of anotherdate. .
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5. The parties consent to the issuance of the following Order in settlement of this
matter: a. The Board is authorized to suspend'or revoke, or otherwise restrict Respondent's license, or impose a civil penalty under 14(a)(2) of the Act, 63 P.S. 224(a)(2) in that Respondent is unable to practice the profession with reasonable skill and. safety to patients by reason of mental . or physical illness or condiipn or physiological or psychological dependence upon alcohol, hallucinogenic or narcotic.drugs or other drugs which tend to impair judgmient or coordination (h6reinafter "impairment") and and 14(a)(6) of the Act, 63 P.S. 224(a)(6), in that Respondent's license to practice nursing .wai authority of'another state. b. Respondent's license, No. RN546727, is INDEFINITELY disciplined by t h e proper licensing
SUSPENDED for no less than three (3) years retroactive to March 1, ,2010 and shall cantinue thereafter until his license in West Virginia is' reinstated to unrestricted status, and such suspension is STAYED' IMMEDIATELY in favor of no less than three- (3) years of PROBATION
. . retroactive to March 1, 2010 and shall continue thereafter until his license
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in West Virginia is reinstated to unrestricted status subject to the following terms and conditions:
GENERAL
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(1)
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Within 10 days of the approval of this Agreement
by the hoard, Respbndent. shall . contact ,the Bureau. 'of .
~rbfessional and Occupational Affairs, Professional Health ~onitoring programs ~ P H M P ~ ,i s c i ~ l i n a r Monitoring Unit ~ y ("DMU") in writing at P.O. Box 10569, Harrisburg, PA 17105-0569 and by telephone at (717) 783-4857 or (800) 554-3428 to begin monitoring.
. (2)
Respondent shall fully and completely comply and
'cooperate with the Bureau of Professional and Occupational Affairs, Professional Health Monitoring Program ("PHMP"), Disciplinary Monitoring Unit ("DMU") and. its agents and employees in their monitoring of Respondent's impairment under this Consent~~reernent Order ("Agreement"). and (3) Respondent shall abide by and obey all laws of the
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United States, the Commonwealth of Pennsylvania and its p'olitical siibdivisions and all rules and regulations and laws pertaining to the practice of the profession in this Commonwealth
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or any other 'state or jurisdiction in which Respondent holds a license to practice the profession. Summary traffic violations shall
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not constitute a violation of this ~greement. l-jowever, a' violation of any conditions of a criminal probation andlo'r
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parole is' a violation'of this Agreement;
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(4)
Respondent shall at all times cooperate with the
PHMP and its agents and employees in the monitoring, supervision and investigation of Respondent's compliance with the terms and conditions of this Agreement. Respondent shall ..
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cooperate with any requests for .written reporfs, records or verifications of actions that may be required by the PHMP; the' requested shall be obtained and submitfed at Respondent's expense.
(5)
Respondent's failure to fully cooperate with the
PHMP shall be deemed a violation of this Agreement. (6) Upon request of the PHMP case manager,
Respondent shall enroll in a peer assistance program, when available, including, but not limited to, Physician's Health Program (PHP), ~ecunbum Artem Reaching Pharmacists with . Help (SARPH), and Pennsylvania Nurse Peer Assistance Program (PNAP), and shall fully and completely comply with all of the
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terms and conditions of Respondent's agreement with 'the peer assistance program. Respondent's failure to fully and completely comply with Respondent's cfgreement with the peer assistance program shall co~stitute violation of this Agreement. . a .
(7)
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Responde?t'shall not falsify, misrepresent or make ..

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material omission of any information submitted pursuant to. this

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Agreement: .
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(8)
Respondent may
not
be
absent
from
the
~ommonwealth ~enns~lvania any period exceeding twenty of for (20) days unless Respondent seeks and receives prior written perhission from the PHMP subject to any additional terms.and .. conditions r6quired by the PHMP.
(9)
Respondent may not engage in,,the practice of ...

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nursing in any other state' or jurisdiction without first obtaining written permission from PHMP. Once written permission is granted by PHMP, Respondent shall notify the licensing board of
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the other state or jurisdiction that Respondent suffers from an impairment and is enrolled in PHMP prior to engaging in the practice of nursing in the other state or jurisdiction. (10) In the event Respondent relocates to another
jurisdiction, within five days (5) days of relocating Respondent shall either enroll in the other jurisdiction's impaired professional program and have the reports required under this Agreement sent to the PHMP, or if the other jurisdiction does not have an impaired professional program, Respondent shall notify the licensing board of the other jurisdiction that Resppnderit is impaired and enrolled in this Program,
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in the event .~espond,ent fails to do so, in of
addition- to being in violation bf this . Agreement, the .

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suspension and 'probation shall be tolled.'It is a violation of this

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'Ai&ement if the ~ e s ~ o n .d e.violates andlot fails to. fully and nt

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completely
damply
with the impaired professional program .in
another jurisdiction. (11) Respondent shall notify the PHMP in writing within
five (5). days of the filing of any criminal charges against Respondent; the final disposition of any criminal charges against Respondent; the initiation o f ' any, legal action pertaining to Respondent's privileges to practice the prof6ssion; the initiation of charges, action, restriction or limitation related to Respondent's privileges to practice the profession by a professional licensing authority of any state or jurisdiction or the Drug Enforcement Agency of the United States Department of Justice; or any investigation, action, restriction or limitation related to
Respondent's privilegesto practice the profession at any health care facility.
(12)
Respondent shall notify the PHMP by telephone
within 48 hours and in writing within five (5) days of any change of ~ e s ~ o n d e n thome address, phone number, employment status, 's employer andlor change in practice' at a health care facility.
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Failure to timely advise the P H M P . L I this subsection due to ~~~~

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the PHMP office being closed is not an excuse'for not leaving a voice inail message with this information.
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(13)
Respondent shall cease or limit her practice of the
profession if the PHMP case manager directs that Respondent do

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EVALUATION TREA.TMENT (14) If an assessment/treatment evaluation' has not been
done by a provider approved by PHMP ("approved provider") within thirty (30) days prior to the effective date of this Agreement, or within thirty (30) days subsequent to the effective date of this Agreement and at any other time as requested by PHMP, ~ ~ s p o n d e shall' have forwarded to the PHMP-DMU, P.O. Box nt '10569, Harrisburg, PA 17105-0569, (717) 783-4857 o r (000) 5543428, a written mental and/or physical evaluation by an approved provider assessing Respondent's fitness to actively practice the profession. If the approved provider determines that Respondent
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is not fit to practice, Respondent shall immediately cease practicing the profession and not practice until an approved provider and the 'PHMP case manager determine that
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~ e s ~ o n d e n t fit to resume practice with reasonable skill'and is safety to patients. (15) The evaluation, described in the previous paragraph
is in addition to any other evaiuation already provided.
(16)
Respondent shall provide copies of any -prior
evaluations and counseling records and a copy of this Agreement to the approved provider. (17)
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Respondent shall authorize, in writing, the PHMP to
have a copy of any written evaluation rePo& of the approved provider.

(18)
If
an
approved
provider
recommends
that
Respondent obtain treatment, Respondent must fully comply with those recommendations as part .of these probationary
requirements.
(19)
Respondent shall arrange and ensure that written
treatment reports from all approved providers are'submitted to the

PHMP upon request or at least every ninety (90) days after the
effective date of this. Agreement. -The reports shall contain at least the following iriiormation: (i) Verification that the provider has
received a copy of this Agreement and understands the conditions of this probation; (ii) (iii)
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A treatment plan, ifd6velobeh;

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progress reports, ' including infdimation

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regarding complianie with the treatment plan; . . . .
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(iv)
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Physjcal evaluations; if applicable; :

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(v)
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The results of any testing.inciuding any therapeutic levels of prescribed
testing 'for
medications when deemed appropriate by the provider; (vi) applicable; (v) Administration ' or prescription of any Modifications :in treatment plan, if
drugs to Respondent; and (viii) Discharge summary and continuing care
plan at discharge. (ix)
.Any .
change
in
the
provider's
assessment of the Licensee's fitness to actively practice the profession.

(20)
Respondent shall identify a primary care' physician

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who &all send written notification to the ~ e s ~ o h d k n t 'PHMP s case manager certifying. Respondent's .health status as
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SUPPORT GROUP ATTENDANCE
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Respondent shall attend and actively participate in
any support group programs recommended by the provider or the P[rlMP case manager at the frequency recommended by the
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provider, but no less than twice a week.
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(22)
Respondent shall
writtenverification of all
supPort group attendance to the PHMP on at least a monthly basis or as otherwise directed by the PHMP. ABSTENTION
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(23) Respondent shall completely abstain from the use of

controlled substinces, caution legend .(p;escription) drugs, mood altering drugs or drugs of abuse includinn alcohol in anv form, except under the following conditions: (i) Respondent, is a bona fide patient of a .
licensed health care practitioner who is aware of Respondent's impairment and . participation in the . PHMP; (ii). such medications are lawfully
prescribed by Respondent's treating practitioner and

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approved by the PHMP case manager; and (iii) Upon receiving

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the
medication,
Respondent must provide to the PHMP within 48 hours'bv telephone and within 5 days in writing:
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the 'name of the 'medication: the name of the

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practitioner prescribing thk drug, the illness or medical condition diagnosed; the type,, strength, amount and dosage of the medication; and a-signed statement
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consenting t'cthe release of medical information from
the prescribing practitioner to the PHMP or its

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designated representative for .. verification.
the
purpose of
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(iv)
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Upon
refilling
medication,
~es~ondent' must'provide to the PHMP within 48 hours by telephone A d within 5 days in wrifinq: the name, of the medication: the name of the practitioner prescribing the drug, the illness or medical condition diagnosed; the type, strength, amount and dosage of the medication; and a signed statement consenting to the release of medical information from the prescribing practitioner to the PHMP or its designated representative for verification.
DRUG TESTING
the
purpose . of
(24)
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Respondent shall submit to random unannounced
and observed drug and Alcohol tests, inclusive of bodily fluid, breath analysis,, hair analysis or another procedure as may be
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directed by the PHMP for the detection of substances prohibited

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under this ~ ~ i e e m e as directed by the PHMP. A positive,. nt

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adulterated qr. substituted resuit on a drug test shall'constitute an . irrefutable violatibn of this: Agreement unless Respondent has. complied with the provisioni of this ~ ~ r e e m e pertaining to the' nt
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use of drugs. , Failure to provide a specimen or a specimen of sufficient quantity for testing when requested will be considered a violation of this Agreement.
(25)
Respondent,shall avoicl all foods that contain poppy
seeds.' Ingestion of poppy seeds will not bB accepted as a valid explanation for a positive screen.
(26)
In addition to abstaining from the use of alcohol in
beverages, medication and food, Respondent shall avoid all substances containing alcohol including 'alcohol in chemical solutions, cleaning solutisns, gasoline, hand sanitizers, or other skin preparations.
incidental use of alcohol will not be accepted
as a yalid explanation for a positive drug test unless Respondent has complied with the provisions of this ~ ~ r e e m e pertaining to nt the use of drugs as set forth in the Abstention Section above. MONITORED PRACTICE
(27)
"Practice" includes employment in any position
requiring a current license to practice nursing or attendance at any 'educational programlcourse that includes a clinicai practice
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component with. patients and/or requires a current license to practice. nursing. .

(28)
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Respondent .shall not practice unless 'a treatment
. provider approved by. PHMP recommends that practice in writing
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and the PHMP case manager
written permission to practice.
(29)
When permitted to return to practice, Respondent
shall not do any of the following unless Respondent first obtains specific written approval from the PHMP case manager to do so:
(i)
Practice in any capacity that involves
the administration of.controiled substances; (ii) (iii) Function as a supervisor; Practice in a private practice setting or
without direct supervision; (iv) Work in an emergency room, operating

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room, intensive care unit, cardiac catheterization laboratory, or coronary care unit.
(v)
(30)
Practice as an agency nurse
Respondent may not work in any practice setting including attendance at any
without
direct' supervision,
educational programlcourse that includes a clinical practice

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component with patients andlor requires a current license, to practice nursing. (31) .Direct supervision is the physical presehce of the
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supervisor on the, premises"so that the supervisor Is immediately . . available to the licensee being superviskd when needed. ' (32)
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If Respondent. is practicing or attending 'any
educational . program/course that, includes a clinical practice
component with patients andlor requires a current license to

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practice, Respondent shall give any employ'er, supervisor, preceptor, or instructor (hereinafter referred to collectively as .
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"supervisor") a copy' of this ~gieement within fi"e (5) days of the effective dgte of this ~greement: (33) ~espokdent shall give a copy of-this Agreement to
any prospective employer and supervisor when applying for employment in the practice of the professiqn and to any prospective schoollprogram, when applying for any educational programlcourse that includes a clinical practice component with patients and/or requires a current license to practice nursing.
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(34)
Respondent shall
the PHMP by telephone
within 48 hours, and in writing within fke (5) days of the effective
date of this Agreement or obtaining employment or beginning any educational programlcourse that includes a clinical practice component with patients andlor requires a current license to
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practice nursiig, notification of the followitig:
(i)
~ame(s)
and
,address(es)'
of
supervisor(s) who' will be responsible for evaluating Respondent's practice if required by PHMP; (ii) 'The name(s)' and address(es). ,df the .
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place(s). .at. which Respondent will practice the
profession and a description of Respondent's duties and responsibilities at such places of practice; and (iii). Any practice.
(35)
restrictions
on
Respondent's
Respondent
shall
ensure
that
~es~onient's
supervisor submits to ihe PHMP the followhg informadon in writing:

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(i)
Verification, at the time . Respondent
obtains or changes a supervisor, that the .employer and slrpervisor have received a copy of this Agreement and undbstand the conditions of this probation; (ii) An evaluation of Respondent's work
performance on a 90-day or more frequent basis as requested'by the PHMP; and (iii) Immediate notification of any suspected
violation of this probation by Respondent. . .
(36)
Respondent, Respondent's treatment providers,
supervisor(s), employers or other persons required, to submit

. reports under,this Agreemeiit shall .cause, such reports, data. or
other information.to be filed with the PHMP, unless otherwise.

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,PHMP-DMU' Bm 10569 Harrisburg, PA 17105-0569 (37) Respondentconsents to the release by the PHMP
of any information or data produced'& a resuii'of this piobation, including written treatment provider evaluations, to any treatment. provider, supervisor, ~ommonwealth'sattorney, hearing examiner or Board. members in the administration and enforcement of this
(38)
Respondent shall sign any required waivers or
release forms requested by the PWMP for any and ail records,, including medical or other health-related and psychological records, pertaining to treatment and 'monitoring rendered to . . Respondent during this probation and any corresponding criminal probation, as well as any employment, personnel, peer review or review records pertaining fo Respondent's practice of the profession during this probation,'fo be released to the PHMP, the ~ommonwealth's attorney, hearing examiner or Board members in the administration and enforcementof this Agreement,
COSTS
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d'&spondent shail be responsible fo; a l l costs

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incurred in complying with the terms of .this Agreement, including . but not limited to psychiatric or psychotherapy treatments, and . . ..
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reproduction of.treatment or other records. Respondent ihall.bay
the costs for any drug testing and any subsequent reanalysis of
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,.specimens required by PHMP. Failure of Respondent to pay any of these costs in a timely manner shall constitute a violation of this Agreement.
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BUREAUIPHMP EVALUATIONS
(40)
Upon request of the PHMP, the Respondent shall
submit to mental or physical evaluations, examinations or interviews by a treatment provider approved by thePHMP or the PHMP. ' ~ e i ~ o n d e n tfailure to submit to such an examination, 's evaluation or interview, shall constitute a violation of this Agreement.
VIOLATION THIS AGREEMENT OF
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c. Notification of a violation of the terms or conditions of probation contained in this Agreement shail result in the IMMEDIATE VACATING of the stay order, the IMMEDIATE TERMINATION of the period of probation, and
ACTIVATION
of the SUSPENSION in paragraph 5(b) above of
. . Respondent's license to practice the profession in the Commonwealth of
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Pennsylvania as follows:
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(I) prosecuting attdrney for the Commonwealth shall The
present to the Board's probable Cause sb?enihg cointiittee

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(~othmittee)a Petition that indicates that Respondent has violated .. any terms or conditions of this Agreement.
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(2) Upon a probable cause determination by the Commifiee that Respondent has violated any of the terms or conditions of this Agreement, the Committee shall, without holding a formal hearing, issue a preliminary order vacating the stay of the'within suspension, terminating this probation and activating the suspension of Respondent's license.
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(3) Respondent shall be notified. of the Committee's preliminary order within three (3) business days of its issuance by certified mail and first class mail, postage prepaid, sent to the Respondent's last registered address on file with the Board, or by
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personal service if necessary.

(4) Within twenty (20) days of mailirig of the preliminary
order, Respondent may submit a written answer to the Commonwealth's Petition and request that a formal hearing be held concerning Respondent's violation of probation, in which
Respondent m'ay seek relief from the preliminary order activating the suspension. The answer shall be set forth in numbered : paraaraphs correspotding to the numbered para~l'aphsof the Petition.
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Respondent shall admit or deny each of the

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Blleclations ' s ~ tforth in the paraaraahs in ,the 'petition.
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~ e s ~ o n d eshall mail the' originai.inswer and request for hearing nt t to the ~ e ~ a r t m ' e nof State, Bureau of ~rofessional and
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Occupational ~ffairs,' office of Prothonotary, . . North . Third 2601 . .
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Street, P.O. .BOX 2649, Harrisburg, PA 17105-2649, and a copy to . . the prosecuting attorney for the Commonwealth, as well as all subsequent filings in the matter. (5) If ~e'spondent submits a timely answer and request for a formal hearing, the Board or a designated hearing examiner shali convene a formal hearing within forty-five (45) days from the date of, the Prothonotary's receipt of Respondent's request for a formal hearing...
(6) Respondent's submission of a timely answer and request
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for a hearing shall not stay the suspension of Respondent's license under the preliminary order. The suspension shall remain in effect unless the Board or the hearing examiner issues an order afler the formal hearing staying the suspension again and reactivating the probation. (7) The facts and averments in this Agreement shall be deemed admitted and uncontested at this hearing.
(8) If the Board.or hearing examiner afler the formal hearing
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makes a determination against Respondent, a final order will be issued sustaining the suspension of Respondent's license and.
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imposing any additional disciplinary measures'deemed appropriate.

(9) If Re~~ondent'fails timely file an answer and request . to
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for a hearing, the Board shall 'issue a final 'order affirming the
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suspension of Respondent's license.

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(10) If Respondent does not make a timely answer and

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request for a formal hearing and
..a final
order affirming, the
suspension is issued, or the Board or the hearing examiner makes a determination against Respondent sustaining the suspension of Respondent's license, after at least three (3) years of active suspension and any , adbitionai . imposed discipline, Respondent may petition the Board for reinstatement based upon an affirmative showing that Respondent has at least thirty-six (36) months of sustained documented recovery, Respondent has undergone an evaluation by a treatment provider approved by PHMP and is fit to safely practice the profession, and Respondent has abided by and obeyed all. laws of the United States, the Commonwealth of Pennsylvania and its political subdivisions, and ,all rules and regulations pertaining to the practice of the profession in this Commonwealth. (11) If the ~ o a r dissues a Preliminary Order terminating the, '
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stay of the suspension and actively suspending, Respondent's license to paitice the profession in accordance with the procedure nt set forth above, ~ e s ~ o n d e shall immediately cease the practice of the prof?ssion., ~ e s ~ o n d eshall continue to.cbmply with all of nt
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the".terms and conditions. of . probation in thisConsent Agreement and order during theactive suspension until the Board issues
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~ i n aOrder. Continued failure by Respondent to comply:with the i
unaffected terms and conditions of 'probation while awaiting the issuance of a . Final 0'rder by the Board may result in further
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disciplinary action against Respondent.
d, Respondent's failure to fully .comply with any terms of this

Agreement may also constitute grounds for additional disciplinary action. e. ~ o t h i nin this ~greement'shall preclude' the prosecuting ~ attorney for ttie Commonwealth from filing charges or the Board. from imposing disciplinary action or corrective measures for violations or facts
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COMPLETION OF PROBATION
f. After successful completion of a minimum of three (3) years of
probation retroactive to March 1, 2010 and upon providing a certified copy
of the Order from the West Virginia State Board of Examiners for Registered Professional Nurse to the Board showing the reinstatement of his West Virginia registered nursing license to unrestricted status, Respondent may petition the Board, upon a form provided by PHMP, to reinstate Respondenf's license to unrestricted, non-probationary status upon an affirmative showing that ~ e s ~ o n d ehas complied with all terms nt
and conditions of this Agreement and that Respondent 's resumption of unsupervised practioe does not present
a threat to the public health and

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safety. Resporident shall be required to remain in compliance with all terms and conditions of this Agreement until the Board issues the,
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order terminating,~es~ondent's probati,otiary status.
ADMISSIBILITY OF CONSENT AGREEMENT IN FUTURE PROCEEDINGS

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6. Respondent agrees that if Respondent is charged with a violation of an Act
enforced by this Board in. the future, this Consent Agreement and' Order shall admitted into evidence without objection'in that proceeding.
ACKNOWLEDGMENT OF NOTICE AND WAIVER OF HEARING
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7 , despondent waives the filing and receipt of an order to show Cause in this
matter. Respondent knowingly and voluntarily waives the right to an administrative hearing in this matter, and to the following rights related to that hearing: to be represented by counsel at the hearing; to present witnesses and testimony in defense or in mitigation of any sanction that may be imposedfor a violation; to cross-examine witnesses and to challenge evidence presented.by the Commonwealth; to present legal arguments by means of a brief; and to take an appeal from'any final adverse decision. WAIVER OF CLAIM OF COMMINGLING AND OTHER CONSTITUTIONAL CLAIMS
8. Respondent expressly waives any constitutional rights and issues, such as
commingling of prosecutorial and adjudicative functions by the Board or its counsel, which may arise or have arisen during the negotiation, preparation and/or presentation of this.Consent Agreement. Respondent specifically agrees that if the Board rejects this agreement, it may assume that the facts and averments as alleged in this Consent .. . Agreement are true and correct for the 'limited purpose of recommending a sanction, based on those assumed facts, that would. be acceptable. to the.6oard before hearing .
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'the case. 'ln the event that the Boarddoks assume the facts and averments as ..
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iti this consent ~greement true for purposes of'making a recommendation as to an are
acceptable sanction, such' actionshall not constitute commingling of prosecutorial and
adjudicative functions by the Board or its counsel, and the Respondent expreSsly waives any constitutional rights and issues .relqted to alleged conimirigling, bias, or violation of due process rights30 have an unbiased and impartial adjudicator in any
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subsequent hearing. If a hearing is subsequently held, neither this Consent Agreement nor the proposed'terms of settlement may not be admitted into evidence and any facts, averments, and allegations contained in the Consent Agreement must be proven at hearing unless otherwise separately stipulated. This paragraph is binding on the participants even if the Board does not approve this Consent Agreement. NO MODIFICATION OF ORDER
9. Respondent agrees, as a condition of entering into this Agreement, not to
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seek modification of it at a later date without first obtaining the .express written concurrence of the Prosecution bivision of the Department of State. AGREEMENT NOT BINDING ON OTHER PARTIES 10.The Office of General Counsel has approved this Consent Agreement as to form and legality; however, this Consent Agreement shall have no legal effect unless and until the Board issues the stipulated order:
EFFECT OF BOARD'S REJECTION OF CONSENT AGREEMENT
11..Should the Board not approve this ' Agreement, presentation to and consideration of it by the Board shall not prejudice ihe Board or any of its members from further participation in the adjudication of this matter. 'This
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participants even if the ~oard,does app;ove this Agreement. . not . .
ACKNOWLEDGMENT OF RIGHT TO ATTORNEY 12.Respondent acknowledges that Respondent is aware that Respondent has the right to consult with, and/or be represented by, private legal counsel of Respondent's choosing and at Respondent's expense when reviewing, considering and accepting the terms of this Consent Agreement. To the extent that Respondent is not represented by legal'counsel, Respondent has knowingiy, voluntarily, intelligently and freely 'waives the right to be represented by an attorney in the negotiation and settlement of this matter by this Agreement.'
ENTIRE AGREEMENT
13.This agreement contains the whole agreement between the participants; provided however, that the captions printed in the various provisions of this agreement are for ease of reading only and are not to be interpreted as forming any part of this agreement, There are no other terms, obligations, covenants, representations,
statements or conditions, or otherwise, of any kind whatsoever concerning this
AGREEMENT DOES NOT PRECLUDE DISCIPLINE FOR OTHER VIOLATIONS 14.Nothing in this Order shall preclude the Prosecution Division for the ~ommonwealth from filing charges or the Board from imposing disciplinary or corrective
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measures for violations or facts not contained i n this Consent Agreement; EFFECTIVE UPON BOARD APPROVAL
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15,~hi's Agreement shalltake effeq immediately upon its approval and adoption . . . . by the Board.
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16. Respondent verifies that the facts and statements set forth in this Agreement
are true and correct to the best of Respondent's knowledge, information and belief. 'Respondent understands that statements in this Agreement are made subject to the criminal penalties of 1-8 Pa.C.S. $4904 relating to ilnsworn falsification to 'authorities. .
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Department of State
a J md
Donald C. Staggers Respondent
COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF STATE BEFORE THE STATE BOARD OF NURSING Commonwealth of Pennsylvania Bureau of,Professional and Occupational Affairs
VS.
Docket,No, : File No.
O'l37-61-14 10-51-09376
Donald C, Staggers, R.N,, Respondent
AND NOW, this
PRDER,
day of December 201Ithe approves and adopts
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the foregoing Consent ~greementand incorpor.ates the terms of para&aph 5, which shall consttute the Board's Order and is now Issued in resolution of this matter. This Order shall take effect immediately.
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BUREAU OF PROFESSIONAL AND OCCUPATIONAL AFFAIRS
STATE BOARD OF NURSING
itano, Ph.D, M.P.H., C.R.N.P. Cotnmissloner For the Commonwealth: Chair Margaret A, Sheaffer P.O. Box 264g Harrlsburg, PA 17105-2649 Donald C. Staggers 3744 Main Street, Apt. 717 Weirton, WV 26062-5351
For the Respondent:
Date of Mailing:
201 1
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WEST VlRGlNlA STATE BOARD OF EXAMI&ERS FOR REGISTERED PROFESSIONAL NURSES
IN THE MATTER OF DONALD STAGGERS PROPOSED CONSENT AGREEMENT Comes now DONALD STAGGERS (STAGGERS), and the.West ,Virginia Board of Examiners for Registered Professional Nurses ("Board"), for the purpose- of .determining what disciplinary action should be taken a g a i n s t ' S T A ~ ~ ~thesBoard by ~ (1993). As reflected'in this document, pursuant to West Virginia Code $30-7-1 STAGGERS has admitted to the stipulations set forth herein, and moves the Board consid'&"lhese stipulations and the terms of the accompanying prpposed agreement, and enter an ORDER accepting the proposed terms set forth below.
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In offering this proposal for settlement of the complaint against license number
76714,. STAGGERS 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 appropr,iate:
I, STAGGERS submitted an Endorsement' Application to the Board on about May 20,2009.

On the application appears the following question; "Have you EVER been 2. convicted of a felony or a misdemeanor or pled nolo contendere to any crime, had records expunged or been pardoned? (List speeding tickets only if you have received three (3) speeding tickets in the last two (2) years)" '3. 2,2009.
STAGGERS was subsequently 'issued license number.76714 on 0ctober
staggers began employment at Northwood Health services, Wheeling,. West Virginia on Apri1.26, 2010.
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5, . By letter dated April 30, 2010 Staggers reported he was instructed by his case manager at the Pennsylvania Peer Assistance Program (PNAP) to inform the. . Board he was belng monitored by PNAP as result of alcohol abuse. . . .
The Board sent .stag;ers an official Notice.. of Complaint ,along with 6.' inforniation related to, the '~oardslm~aired' Treatment Program. Nurse .. . '7.. . .i3uing complaint/investiga;ion . prpcGss, which included re"iew. of staggers' empioyment reco(dsfrom North--od Health Services, the Board learned I ,. . .. ... . .. . . \
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Staggers was convicted of "Public intoxication" in Hancock Couniy, Wesi Virginia in 1985 and convicted of "DUi" in Belmont County, Ohio in 2008.
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Staggers admits the above.stipulations to be true,
STAGGERS acknowledges that his conduct violated West Vii'ginia Code g30-7-31 (a),(c) and (d), which state.that the, licensee may be disciplined if he or she (a)[i]s or was guilty of fraud or deceit in procuring or attempting.to procure a license topractice registered professional nursing; o r ... (c)[i]s unfit or incompetent by reason of negligence, habits or other causes; or ... (d)[i]s habitually intemperate or is addicted to the use of habit-forming drugs;".
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CONCLUSIONS OF LAW The West Virginia Board of ~xaminersfor Registered Professional Nurses concludes'that the stipulations support the sanction of disciplinary action pursuant to West Virginia Code 530-7-1 etseq, pertaining to the practice of registered professional nursing. Specifically, the stipulations support sanctions under the following sections of the West Virginia Code: West Virginia code $30-7-1 1 (a), which states that a licensee may be discipli!led a. upbn proof that he or she [i]s or was guiity,of fraudor deceit in procuring or attempting to procure a license to practice'registered professional nursing; West Virginia Code. 30-7-11 (c), which states that a licensee may be disciplined b. upon proof that he or she [i]s unfit or incompetent by reason of negligence, habits or .,. other causes; and West Virginia Code 30-7-11 (d), which states that a licensee may be disciplined c. upon 'proof that he or she [ils habitually intemperate. or is addicted to the use of habit-forming drugs. . .
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CONSENT
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STAGGERS, by affiing his signature hereon, agrees to the following: . . . . ..

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He icknowledges that he is aware of his option to'retain legai.counsel and ; 1. 'to, be represented by legal counsel at a formal hearing before the Board. ; . . 2. , He intelligently and voluntarily waives. his right to a formal hearing befdre the Board in this matter, if the Board accepts the terms and conditions set forth herein and joins with him in executing this agreeinent. : .. .
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He acknohledges that he is fully aware that without his~onsent, legal no 3. action can be taken'against .him by this Board, except pursuant to West Virginia Code $30-7-1 and relevant rules. . .
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He submits this proposed agreement freely and voluntarily and not under 4. duress, restraint or compulsion. He agrees that the, Board may investigate his,background at any time 5. during the term of this Order. He consents to the entry of the following Order affecting his license to practice registered professional nursing in the State of West Virginia.
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He understands that the Board may accept or reject the,facts and terms set 7. forth in this proposed agreement, and may impose revocaiion or.other conditions of a I disciplinary nature as are deemed appropriate.
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On the basis of the foregoing, the Board hereby.SUSPENDS license number 76714, and ORDERS that STAGGERS is granted leave to petition for reinstatement of year license number 76714 after a period of one (I). from the date this agreement is entered. The board also ORDERS STAGGERS pay a fine and administrative costs.in' the amount of One Thousand Dollar(s) ($1,000.00). ,. Violation of any of the following terms shall constitute grounds for denial of the leave granted to DONALD STAGGERS to petition for reinstatement: 8. 30:7-1
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STAGGERS shall not violate the provisions of West Virginia Code

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STAGGERS shall n.ot commit any act which would be a crime under West . 9. Virginia or federal law. . I f STAGGERS is charged bjf any law enforcement agency with committing .any such criminal act, h e shall notify the Board in writing of the formal charge(sj againsthim, and resolution of same.
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10. STAGGERS shall 'not, under .any circumstances, misrepresent 'his . licensure status.
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I f . STAGGERS shall 'report in person for appointment with the Board staff .. upon request. Petition for Reinstatement: ,'.
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S& (6) months after this agreement 'is entered, STAGGERS may betition to .
appear before the Board and submit satisfactory evidence that heis presently able to . .
safely engage in the practice of registered ~rofessio~~al nursing. Evidence in supporf of this request shall include: Evidence of successful completion of a treatment program 'for the treatment of .. substance abuse;
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Letter from ]a lidensed physician specializing in the treatment of addictions, or 'b. : from a certified addictions counselor, .indicating STAGGERS'S status .in recovery and tiis ability to safely practice as a registered professional nurse; Evidence of monthly random drug scr~ens.throughout term of suspension; the c. such drug screen shall be coordinated by STAGGERS'S treatment. provider; the Board aiso request STAGGERS to submit 'to random drug s.creens throughout the suspension period; d. Evidence of attendance at not less than three'(3) 12-Step meetings per week throughout the term of this agreement; . . At least three (3) 'letters of personal reference, one of which shali be 'from STAGGERS' employer, if STAGGERS is employed. These letters should attest to the , . adequacy of STAGGERS' judgement;
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STAGGERS shali cause a celtified copy of all documents relative to STAGGERS' criminal history be sent directly to the Board's office from the Court(s) containing such documents. '
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Letter from STAGGERS outliving his future plans; and Payment of all fines and administrative costs.
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WHEREFORE, STAGGERS hereby requests that the ~ o a r daccept -the stipulations and impose sanctions in accordance with West Virginia Code 330-7-1
However, the terms of this agreement's Order shall remain in effect until such time as his license is reinstated by the Board. .. . .
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Witness
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Agreed to:
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Date Disciplinary Review committee Member
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~ e r e s a i t c h i e : ~ ~ ~ , FNP R RN, Committee Disciplinary ~&\iiew
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Date
64 Laura $. ~hode's,'~N,. MSN

Executive Director West Virginia Board of Examiners Professional Nurses . for ~egistered ENTERED: This the
4.agI./D.'
Date
o~g& of day
-+
2.030.
WEST VIRGINIA STATE BOARD OF EXAMINERS FORREGISTERED PROFES.SI0NAL NURSES.
Comes now DONALD STAGGERS (STAGGERS), and the West (nrginla'66ard of Exalnlnets for Registered Professional Nurses rBqard'j, 'for the purpose of determining what discipllnary action should be taken against STAGGERS by the Board' (1903). As reflected in this document, pursuant to Wesl Virginla Code S30-7-1 STAGGERS has admtted lo the stiqblallons 8et f%h hereln, and moves the Board consider these sUpulations and the. tqms '06 d!e accompanying propwed :agre,ement, and enter an ORDER accepting the prbposed tenns set forth belov~,
In offering lhls proposal for setllement ofthe complaint age1nst.llcensenumber

70714. STAGGERS acknowledges fhat !he Board may reject ihls proposal, and may hold a heating lo impose revacation or other condiflons of a. dlsclplinary nature as it deems appropriate.
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2009.
STAGGERS submitled an Endorsement Applicalion to !he Board on ~ a 20, y

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On the opp ic;ll!on appoars Itlo fol!owlng qrlofitinn, "Ht~vc EVER been you 2. convicted of a fclolly or a misdomoanor or pled nolo contender0 to any crime, hnd records expunged or been pardoned? (list 'speeding tickets only if you have received three (3) speeding tickets In the lastlwo (2) yearsr . .
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STAGGERS was subsequenUyIssued licunse number76714 on Oclobet 2.
2009.
~tsggkrs beDan employment at Northwood Health Services, Wheel1ng;Wesi. 4. Virginla on Apdl26,2010. . .

5. By lotlor dated April 30,2010 Staggers reported ho was lnnlruclcd by tilo c;iso manager at the Perinsyivania Peer Asslslanco Progranl (PNt\P) lo lnforrn the lloard he was being moflitofed by PNAP as result of alcohol abuse..
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related to the Boards lmpalred NurseTrealment Program.
The Board sent Sfapgers an official Nalica qlcomplalnt along vdlh inforn!alion
7. During fhe.complalnvinvestigatlon whlc)ilncludedrevlewof Stqgbsrs' employment records from NorUlwo6d health SenriceG, the Board leained Staggers was
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vrasmnvlctei of 'Public IntoxicatiOn" in ~ a " & c k County, West Virginia in 1986 and convicted olaOUl"ln Belmont County,'Ohlo In.2008. .Staggers s1gned.a Suspenslon'Conselit Agreement as a resalt of falslffcallon 8. of the EndorsemefitAppilc2tl0n:
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~ t , a ~ g kpelltioned B rs
I Board . reinstalemenl df his licanse ~ for .

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Staggers admits the,above stipulatlona-arai ~ e . .
Staggers license is reinstated pursuant to thotems of this agreement.
STAGGERS ackno~vfcdges that his coilduct violated West Virginia Code, j2. $30-7-71 (c).(d) and (f), vrhlch stat6 illat the llconsec !nay be disciplined if he o she ; (cj(ilo unfit or incon~pelnnt reas011of ncgligoisu, l~abiis otllor causes: or (d)[l]s by or habit11;rlly. Intempcrato or ki addicted to tho uso of habit-for~nlng ~ a s or !.. (8013 gullly d : of conduct dorogatory to tho morals or slnndlng of. the profession of rcgkfered nurslng;'.
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The West Vlrglnla Board of Examlners lor Registered Professional Nurses coriciudes that 81s stlpuiatlons support the sancuon of disciplinary action pursuant to West Virginia M e $30.7-1 &sq. pertaining to the pradlce of registered professional nursing.' Specifically, the stipulatFons support sanclions under ihe following sections of the West Vlrglnla Coda:
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We~est Virginla'Coda $ 3 0 - ~ - l(c),whlch states that a license6'may be disdplined i upon proof that 11sor she (iJs unfi, or Incompetent by reason of negligence, habits or ' other causes;
West Virginia Code $30-7-11(d), whlch slates-bat a.iicensee may be dlsclplined b. upon proaf that he or she ills habltuany intemperate or is addicted to the use of hablbfoning drugs;.and, o. West Virginia Code $30-7-11 (9,whlch stalev that a llcensee may be dlsclplined upon proof that he or she iJsguilty of conduct derogatoiy fo(he m6rais or standlng of Ihe profession of reglstere nurslng.
STAGGERS, by affiring his sfgnature hereon, agrees to the fallovdng: 1. He acknowledgesthat he is aware of his option to retain tegal cguneel and . l o be representedby legal counsel at a formal hearing hefore the Board.
He infelllgerltly and .vdluintarilywaives h!s right to'a formal hearing before the board th!? vatter, N the Board aocapts the terms and conditions set fodh hereln 11) a n d ~ o l ~ ? hlm In executing this agreement. vdlh Ulat heis fully aware that without his co"seht, no legal 3. .He iction can be taken againsf him by ihls Board, except pursuant to West Vrglnla Code . 3&7-1 mseq. and fetevent rules. He submits ihls proposed agreement free& and voluntarily and not under 4. duress, reslralnt'oi compulsion. He agrees Uiat Ihe Board may lnvestlgate his backgfsund at'any llme .5, during the t e n ofthis agreement. He consents to the entry of the, fo~lodng order affecung 111slicense to 6. pracliw reglktered professional nuislng in the Slate of West Wrginla.
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He understands bat Ule Board may acceptor reject the facts aiid terms set 7. forth i this proposed agreement, and maylmpose revomtion ar otherOndltions of a n ' dlsclplinar/ nature as are deemed appropriate.
On the basis of the foregoing, the Board hereby ORDERS that l l ~ n s e number
76714, Issued to STAGGERS, b e suspended for Vle perlod of one. ( ) I year. Such
sudpenslon Is hereby stayed cantlngent upon STAGGERS complying wilh the tenns set forih below, and llcen,se number 76714 Is placed otiprobatlon for a period of 2 years .employment a%a reglstered professlonal nurse. The computation of such period.Isto begin on Ule date on whfch notice Is received h t h e ofliceof the Board that STAGGERS k employed.as a reglstered professionalnurseand shall run only duriing such,lime !hat he is employed.as a reglstered profosslonal nvrse on at least a permanent part-!me bssls (forty hours every tu~oweeks)or full time basis 1 Ule,State of West Vlrglnia. The 0 ' Board slso ORDERS STAGOERS pay a flnwand adminlstrativacosts In-the amount of Two Thousand Dollar(s) ($2,000.00). To rsceive and meintaln a probatlonely license, regardless of employment status, STAGGERS,shallmeet the following condllons: General:
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STAGGERS shall not Vlolate the provi+lons o f we& Vrglnia Code 2. $30-7-1gkQQ..
S~AGGERS shall,.lmmedlalely upon noMcatlon of the entw of'thls Order> 2; submR hls wrrent reglstered professlonal nurse ilcansejo the oftlcs of the Board.
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STAGGERS s l i d notcontmii any acthhich \riouia be $ gime unqei West % yrginia pr federal law. If STAGGERS is charged by any law enforcement dgency'with commRtlng any such criminal act, he shall n o r i the Board in Vnlting of the formal, charge(s1 against him, and resolution of same;
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STAGGERS shall malntain a current and aclive license in ihe-State of' 4. West Virgln!a. He shall not allow his license to lapse or be placed on an inacfive status. . .
STAGGERS shall not. Uhder .any clrcumslances, ~ ~ r e p r e s e i Ills lt 5: llcensure sfatus. ,.
STAGGERS siiali not be employed b y a nurslng regislw, temporarl 6 . nurslng agency, home heallh care agency, or as a private duty nurse.
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STAGGERS shall "ot wo;k in an avtonomous nursing posiuon. He shall 7 . work only under 1h.q direct supervbion of a registered grofess/onai nurse in a stiuciured setting ihroughod the lerm of hls probailon. Such supelvising registered professional nurse must, at the time of said supervision, hold an active, unencumbered WestVlrginia .IIc%nse. . STA&GERS shall Inform the Board b cvriUng wilhin ten (10) days of the 8. date he assumes the pradice of registered professional nurslng, or any employment in Ihe health care field, in the Stale of West Vlrginia and shall include the name, address. and telephone number of hls embloyer. He shall provlde in virRing the name af his STAGGERS shall lnform the Board Immediate registered professional nurse supe~lsor. of anyinterruptlon In nursing pracllco-or change in employment vrithin ten (10) days of suchinter~plion change. or
9. STAGGERS shall imnledialeiy Inform his nursing. employer, any prospkctive nursing employer, and the direcfor of any nursing edqcatlon program in whlch he enrolls or teaches, that the Board has placed his. llcense on probation, and . shall provide a complete copy of this agreement to his employer(s). The Board may provide his employor(s) with a copy of Ws agreement and may wmn~unicatewithhis enipioyer(s).
10. STAGGERS shall,. withln tell (10) days of emp1,oyment orcon8nuation of. practice, cause hls employer orlmmediate reglstqred. professlonal nurse supervisor, to notify the Board. in writing, of lhe employer or supervisor's receipt 0 a copy of this T agreement. STAGGERS shall further cause hls employer or supedsor lo submil monthly reporls to the Board descrlblng STAGGERS's.job performance, attendance, attiiude, and otller work bohaviots.rfudng \he Orst yearof probalion and ifhis progress Is satk;f+cto~joShe Board, quarleriy lhereailer.
I:<. .STAGGERS shall submit documenktlon of fiiteen (16)mntaot hours of. continuing educatiort In substan& &use.each year dtlring the Ume hls 1lcense.l~ on . probaiion, In addition to the Ulose required by law
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12. 'STAGGERS shall report In person for appoinbnent v h we Board slaH dupon request. .
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RqhabilitBtI'dB:
$3. STAGGERS shall participate ilr a struclllted aftercare program, wilI1.a. coflflad addlctlons counselor approved bythe Board. 7he treatitig cqrtifled.addictjons counselor shall make a monthly repod to theBoardqbout STAGGERS's,progres$ and his comptiance with the .aftercare program. STAGGERS shall vkit hls approved treatment provider at least one (1) Ume per month durlng the tern1 of thls agreement. ; This ie~uirement may be modied upon request to the Board by STAGGERS'S cetiied addicli.ong counsel^(:
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.IS. STAGGERS shall not handle nor admlnlsler narcotic or psychotropic. medlcatlbns; nor have access to. locked 01 other storage areas In whlch such medications a? Kept. STAGGERS sball notify hts employer of Ulis reslrlcllon on hls practice. .
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16. STAGGERS shall submit to unannounced, witnessed d~g-screening tesls. Said tests sshall.be on demand and 14 the speciflcatlotis of IhaBoard and at licensee's expense. STAGGERS sliall call the Board's drug screening company. DAILY behveen the hours of 6:OO a.m. through 2:30 p.m. fo see if he is selecfed to tesL Recelpt o f a posltlve drug screen 6n610r not Calling' the, drug sereenlng program dally wlthln the speclfled time ffanle.16 deemed to be a violation ofthls Consent Agreement, and shall result In' Immediate suspension of'STAGGER'S license. Eating produds cotitainlng poppy see& wlll not constitute as an. accepted reason for having a posnive screen for oplolds. Licensee shall not consume tonic water, quinine water, lienip tea ot other products confalnltlgsubstances that [rigger a poslihre drug screen.
17. STAGGERS shall abstain from the use of alcohol and limH his use of drtigs to those prescribed for a IegHimafe purpose 6y a physlcian, dentist or nursa practitloner duly llcenssd In the Slits .of West Virginia. STAGGERS .shall provide a eopy of this agreement lo any prescciblng physl~lan,d.entist or nurse practitioner. STAGGERS shall cause hls physlbian, denbst, or nufqe'practltionerto notify ihs Board in wiiting of any medlcatlons/dmgs prescribed and She condllion for which sald clrug(s) lias been prescdbed. STAGOERS agrees that, t h e ah?pls.a.prescripU9nfor ~larcotlo or psychotropic drugs, the Board niay Impose addlilonal probatlonary terms.
.IS. STAGQERS shall coordinate any hee!\h ca;e services he tequi;es with one physlcian or registered fiu~sepractnioner, who shall be informed of any secvices or prescrlptlons :sought or obtained by STAGGERS from any physlclart, denlist or nurse
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'praclilioner. STAGGERS shall piovlde Wis lndlljidual, who serve: contact for healtli q r q needs; with a copy of'this agreement.
as hls point of
ixecuiea release to permit the Board to sbtalhmedical is. STAGGERS or other health care records, vlhlcli nlay berequested at any flmewhlie his license is on probatlon,(egardlnghls physlcal or mental heakh anti any treafment rendered.
20. . STAGGERS $hall innually subnilt fo the .BoiiriJ .a Wrilletl personal In statement regarding progr@ss recovery. The statement shall be due at the end of !he flrst year and In %oh subsequent year during (he month In which thls agreemerit is accepted by the'Board. '
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21, Any deviation from'haSe reQuir&mentsvhlhout prior written consent of Ule Board shall ~ 0 h ~ l I la violallon of this Order, and resvit 1 ImtIIedldte suspension of ~te n . STAGQERS'sprobailonary license.
22 Tho Board shall ln~nxedlalely nol~fy STAGGERS via coctifled inall of tho of 1 s specific nature of lho cliargcs, ond Ole susponslor~ 1 1 llcense.
'STAGGERS may request relnslatement of his probdllonary license Ulrough a. renewal of thls agreement, or exec!Aion.bf a new agreement, which may contain different.ar addlllonal terms. The.$oaN Is not bound to comply wilh lhls requesl. b. If Ihe Board does not accept arenewed or newagreement, STAGGERS shall be notied In wtilng. STAGGERS may request a hearlng lo seek reinstatement of hrs proballondry license. If STAGGERS requesls a hearlng following suspension for vlolallon of Ulls agreemenl and' does not prevail, h e .wst lncurred In holdlng such hearing shall be borne by STAGGERS. If STAGGERS prevails, the cost of such heating shall be borne by ihe Board. Cost shall refer only to ihe expenseof employing a court reporter and hearing examlner for the purpose of tha hearing, and shall not Incluck any legal .or olher fees .Incuned'by the Bcilrd' or STAGGERS.In bringlng the matter to hearing. o. The Board may 'schedu1e.a hearing. on Its own'inl~aflv$ lha purpose .for allowing Uie Board opporlunlty for cunslderJng further suspension -or revocation .of STAGGERS'S license. Said .l~earlngshall be scheduled In acwrdanw with tho provisions of West VIrglnla Code $30-1-8 and $30-1-7 t . Board shall bear the e .The cost K %should seek a hearlng following suspension of STAGGERS'! pr.o%allonary license for violation of 1hIs agreement. Cost shall refer .only to the expense of employing a cOurt reporter and hearlng examiner for the purpose of the hearlng, and shall not Include any legal of other fees Incurred by STAGGERS In bdnglng the maller to hearlng. , .
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Nlodlncatlon of Terms:
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23. IF STAGGERS .is proceeding successfully in meeling (Re lenns of hls probation, he may petilion the Board afler no less than one (1) year from Ulectxecution b f this a$eement for'e modllication of O terms of lhe agreement. Jn the event thatihe l e Board finds that STAGGERS has made slgnllicsnt progress, based upon all infwmatlon a'~hliablo,the Board may, at ifs dl'scretion, aiter or amend certain provisions of this agreement. .
PaUUon for Rainstaternant:
24. Following the b e (2)yeaiprobstionary period, STAGGERS may petition to appear before the Board and subnlit satisfactoly evidence that he is presently able to -safelyengage in the practice of registered professionalmlrsing. Evidence In support of thisrequest shall include:
a. Letter of refererlca from a physlclan/Ulerapist involved In STAGGERS,aftercam (Kappllcabte); .
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LeRer of rafererice from STAGGERS'S employer; if emjjloyed; , . Letter froan-STAGGERSoutlining his future plans; and ~ a ~ m e n t 'allf iines and adminislral(ve.costs. o
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~owbter, terms of this Order shall remain in effect and subject to yearly re$i&v arid the appropriate revision by lhe Board until such tlme as STAGGERS'S license 1s iirliy ' reinstated by the Board. ' WHEREFORE, STAGGERS hereby requests that the Board accept the. stipulations and impose sanclidns in accordance with West Virginia dod,e $30-7-9 & sBe.
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Agreed to:
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Teresa Rllchle. RN, MSN, FNP Disciplinary Review CommiHee Member
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Laura S. Rhodes. RN, MSN Executive Director West Virgin$ Board of Examlners for Registered Profe$sionalNurses
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Froni: Subject: Date: To: b
"ST, Prothonotary" <RA-Prothonotary@pa.gov> RE: disciplinary/corrective action for Donald C. Staggers April 10, 2012 3:06:18 PM EDT 'Jodi Crowe'<jcrowe@nursing.ohio.gov> 1 Attachment, 1.8 MB
Dear Ms. Crowe, Attached you should find the documentation for Donald Staggers. Thank you, Peter R. Jones Legal Assistant 1 Hearing Examiners Office
From: Jodi Crowe [ma~lto:jcrowe@nursing.oh~o.govl Sent: Tuesday, April 10,2012 10:18 AM To: ST, Prothonotary Subject: dtsciplinary/correct~ve actlon for Donald C. Staggers
D e a r S i r o r Madam; Per the P e n n s y l v a ~ l i a Department o f State's on-line license verification, D o t i a i d C. Staggers, R N 546727, lias h a d disciplinary o r corrective action taken o n h i s licellse t o practice ~ ~ u r s i as a registered nurse in Penosylvailia. ng Please consider this message as a w r i t t e n request f r o m the Ohio B o a r d o f N u r s i n g f o r a certified c o p y of ail)^ and a l l disciplinary or corrective action docunletlts taken on Mr. Staggers license. Please f o r w a r d the certified document(s) v i a einail
(ifpossible) or
v i a regular U.S. M a i l , to:
T h e Ohio B o a r d o f N u r s i n g Attention Jodi C r o w e 17 S. High Street, Suite 400 Columbus, OH 4321 5-741 0
Iappreciate your assistance in this matter.

Kind Regards,
Jodi Crowwe
Supervising Attorney Compliance Unit Ohio Board of Nursing (614) 466-7958 jcroweQnursinq.ohio.aov
I h ~ ~ 0 m m ~ n i ~ a tis 0 n s 1 intended only for Lse by llie indtvtduai or entity to vrnom it 1 addressed It may contall1 .nforma[ionIllat is s
prlv.leged,confider~tial, exempt lrom disclosure under tho Srate andlor federal law If ihc reader of thts mossaqe is not the inlended and recipient you are notified that anydissemination, distribution, or copying of this communication is strictly prohibited. -11you receive this communication in error, please notify the sender immediately by telephone, and return the original message to the above address.
,a g g e r s , Do. odf
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Case # 11-000668
July 27, 2012

Tracy Lynn Steck, L.P.N. 9 North Mulberry St. Troy, Ohio 45373 Dear Ms. Steck: 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 August 22, 2007, in Miami County Municipal Court Case No. 2007 TRC 07079, you were convicted of the amended charge of Reckless Operation, following an initial charge of OMVI. 2. On or about September 15, 2010, in Miami County Municipal Court Case No. 2010 TRC 00110, you were found guilty of OMVI. 3. On or about September 28, 2011, the Board ordered you to submit to an examination pursuant to Section 4723.28(G) ORC, to determine if you suffered from a physical or mental impairment that may affect your ability to provide safe nursing care. On or about December 21, 2011, the examining physician issued findings which included the following: a. You denied ever being told you were diagnosed with Alcohol Abuse or Dependence. Despite this, a review of your records from the Miami County Recovery Council showed that you were involved in chemical dependency treatment from March 30, 2010 until August 27, 2010, with a final diagnosis of Alcohol Dependence. You were recommended to abstain from alcohol use. b. You reported to the examining physician that you continue to use alcohol intermittently, including drinking six to eight beers while cleaning your house, as well as drinking outside of your home. You also reported your last use of alcohol was the day prior to the examination. c. The drug screen specimen you provided for the examination was positive for alcohol metabolites at a significantly elevated level.
Tracy Lynn Steck, L.P.N. Page 2 d. You were diagnosed with Alcohol Dependence. The examining physician recommended you be admitted to a formal treatment program at the intensive outpatient level of 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. 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,
Judith A. Church, R.N., C.N.P. Supervising Member Certified Mail Receipt No. 7012 1010 0002 4225 1466 Attorney Certified Mail Receipt No. 7012 1010 0002 4225 1473
Tracy Lynn Steck, L.P.N. Page 3 cc: Henry G. Appel, Assistant Attorney General Paul R.F. Princi, Esq.
Case# 12-001272
July 27, 2012

Kimberlee Yasmin Stephenson 3950 East 153rd Street Cleveland, Ohio 44128 Dear Ms. Stephenson: 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. Under the January 2012 Consent Agreement, your license to practice as a registered nurse was suspended, with the suspension stayed subject to probationary terms, conditions, and limitations for a minimum period of two (2) years. A. Item 6. of the January 2012 Consent Agreement states, MS. STEPHENSON shall abstain completely from the use of alcohol and any products containing alcohol. Item 7. of the January 2012 Consent Agreement states, Beginning within sixty (60) days following the effective date of this Consent Agreement and continuing throughout the probationary period, MS. STEPHENSON 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. STEPHENSON shall be negative, except for substances prescribed, administered, or dispensed to her by another so authorized by law who has full knowledge of MS. STEPHENSONs history of chemical dependency and recovery status. Despite these provisions, on March 16, 2012 and March 23, 2012, you submitted urine specimens to FirstLab, the Boards drug screen program administrator, which tested positive for Ethyl Glucuronide Despite the above language prohibiting you from consuming any products containing alcohol, you reported to a Medical Review Officer, regarding both positive screens, that you had been consuming walgreens allergy liquid, CVS flu relief, xyrtec elixir.
Kimberlee Yasmin Stephenson, R.N. Page 2 On the following dates, you failed to call Firstlab to determine if you had been selected to provide a specimen: May 10-13, 2012. On the following dates, you were selected to provide a urine specimen and failed to do so: May 3-4, 2012. During telephone conversation on or about May 14, 2012, you stated to the Monitoring Agent that you had relapsed and were in treatment. On or about June 3, 2012, you submitted a statement to the Monitoring Agent stating you had relapsed, had been admitted to the Cleveland Clinic Behavioral Health Unit from May 10-14, 2012, and had started IOP treatment at Glenbeigh on May 21, 2012. 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 12. of the January 2012 Consent Agreement states, Prior to initiating drug screening and continuing throughout the probationary period, MS. STEPHENSON 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. STEPHENSON. Item 13. of the January 2012 Consent Agreement states, After initiating drug screening and within twenty-four hours of release from hospitalization or medical treatment, MS. STEPHENSON shall notify the Board of any and all medication(s) or prescription(s) received. Despite these provisions, you reported to the MRO on or about March 27, 2012, that you were prescribed Phenergan and Zofran, and on or about April 10, 2012 reported to the MRO that you were prescribed Phenergan and Zofran. You had not reported and/or had your treating practitioners report these prescriptions to the Board. On or about April 20, 2012, you submitted a report of your prescribed medications to the Board indicating you were prescribed Promethazine and Zofran. A copy of the report signed by your prescriber was sent to the Board on or about April 23, 2012. 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 January 2012 Consent Agreement, you are hereby notified that it appears to the Board that you have violated Items 6., 7., 12., and 13. of the January 2012 Consent Agreement. YOU ARE FURTHER NOTIFIED THAT YOUR LICENSE TO PRACTICE NURSING AS A REGISTERED NURSE, RN #277061 IS HEREBY 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.
Kimberlee Yasmin Stephenson, R.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 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 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. Under the January 2012 Consent Agreement, your license to practice as a registered nurse was suspended, with the suspension stayed subject to probationary terms, conditions, and limitations for a minimum period of two (2) years. 2. Item 6. of the January 2012 Consent Agreement states, MS. STEPHENSON shall abstain completely from the use of alcohol and any products containing alcohol. Item 7. of the January 2012 Consent Agreement states, Beginning within sixty (60) days following the effective date of this Consent Agreement and continuing throughout the probationary period, MS. STEPHENSON 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. STEPHENSON shall be negative, except for substances prescribed, administered, or dispensed to her by another so authorized by law who has full knowledge of MS. STEPHENSONs history of chemical dependency and recovery status. Despite these provisions, on March 16, 2012 and March 23, 2012, you submitted urine specimens to FirstLab, the Boards drug screen program administrator, which tested positive for Ethyl Glucuronide. Despite the above language prohibiting you from consuming any products containing alcohol, you reported to a Medical Review Officer, regarding both positive screens, that you had been consuming walgreens allergy liquid, CVS flu relief, xyrtec elixir. On the following dates, you failed to call Firstlab to determine if you had been selected to provide a specimen: May 10-13, 2012. On the following dates, you were selected to provide a urine specimen and failed to do so: May 3-4, 2012. During telephone conversation on or about May 14, 2012, you stated to the Monitoring Agent that you had relapsed and were in treatment. On or about June 3, 2012, you submitted a statement to the Monitoring Agent stating you had relapsed, had been admitted to the Cleveland Clinic Behavioral Health Unit from May 10-14, 2012, and had started IOP treatment at Glenbeigh on May 21, 2012.
Kimberlee Yasmin Stephenson, R.N. Page 4 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 12. of the January 2012 Consent Agreement states, Prior to initiating drug screening and continuing throughout the probationary period, MS. STEPHENSON 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. STEPHENSON. Item 13. of the January 2012 Consent Agreement states, After initiating drug screening and within twenty-four hours of release from hospitalization or medical treatment, MS. STEPHENSON shall notify the Board of any and all medication(s) or prescription(s) received. Despite these provisions, you reported to the MRO on or about March 27, 2012, that you were prescribed Phenergan and Zofran, and on or about April 10, 2012 reported to the MRO that you were prescribed Phenergan and Zofran. You had not reported and/or had your treating practitioners report these prescriptions to the Board. On or about April 20, 2012, you submitted a report of your prescribed medications to the Board indicating you were prescribed Promethazine and Zofran. A copy of the report signed by your prescriber was sent to the Board on or about April 23, 2012. 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 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
Kimberlee Yasmin Stephenson, R.N. Page 5 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 ($500.00) per violation. Sincerely,
Case # 10-2776
(6 t4) 466-3947
17 Soutll$ligh Street, Suite 400 * Columbus, Ohio 43215-7410
CONSENT AGREEMENT BETWEEN KIMBERLEE YASMIN STEPHENSON, R.N. AND OHIO BOARD OF NURSING
This Consent Agreement is entered into by and between KIMBERLEE YASMIN STEPHENSON, R.N. (MS. STEPHENSON) 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)(lO), 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(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 this chapter or any rules adopted under it. Specifically, Rule 47234-06(H), Ohio Administrative Code, states that a licensed nurse shall implement measures to promote a safe environment for each client. MS. STEPHENSON has an active license to practice nursing as a registered nurse, RN-277061, in the State of Ohio. MS. STEPHENSON was initially licensed as a registered nurse in February 1998. MS. STEPHENSON knowingly and voluntarily admits to the following:
B.
C.
Kimberlee Yasmin Stephenson, R.N. Page 2 1. On or about June 15, 2010, while working as a registered nurse in the Pediatric ICU at the Metro Health Medical Center, MS. STEPHENSON was sent for a 'for cause' drug screen after appearing impaired and tested positive for alcohol. MS. STEPHENSON was subsequently placed on leave. On or about June 27,2010, MS. STEPHENSON underwent a Chemical Dependency evaluation at Glenbeigb Hospital in Rocky River, Ohio and entered Inpatient Treatment for Alcohol Dependency. On July 22,2010, MS. STEPHENSON completed Inpatient Treatment and subsequently entered and completed Intensive Outpatient Treatment and the Aftercare Program at Glenbeigh. On or about August 1,2010, MS. STEPHENSON returned to work at Metro Health Medical Center on an eighteen (18) month Last Chance Agreement. On December 22,201 1, MS. STEPHENSON completed the terms and conditions of the agreement including submitting random drug screens with negative results.
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MS. STEPHENSON continues to work hard on her recovery and has submitted documentation of weekly 12-Step meetings attendance and has a sponsor. MS. STEPHENSON is willing to cooperate with the Board in order to maintain her nursing license. AGREED CONDITIONS
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Wherefore, in consideration of the foregoing and mutual promises hereinafter set forth, and in lieu of any formal proceedings at this time, MS. STEPHENSON knowingly and voluntarily agrees with the Board to the following terms, conditions, and limitations: MS. STEPHENSON'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. STEPHENSON shall obey all federal, state, and local laws, and all laws and rules governing the practice of nursing in Ohio. MS. STEPHENSON shall appear in person for an interview before the full Board or its designated representative, as requested by the Board or its designee. MS. STEPHENSON agrees that she will submit a request to the Bureau of Criminal Identification and Investigation (BCII) to conduct a criminal records check of MS. STEPHENSON, including a check of Federal Bureau of Investigation (FBI) records, and shall cause BCII to submit MS.
3.
Kimberlee Yasmin Stephenson, R.N. Page 3
STEPHENSON'S criminal records check reports to the Board. MS. STEPHENSON'Scompleted 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. 4. By July 1, 2012, in addition to the requirements for licensure renewal, MS. STEPHENSON 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 Chemical Dependency; and three (3) hours of Critical Thinking.
5.
MS. STEPHENSON 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. STEPHENSON's history of chemical dependency and recovery status. MS. STEPHENSON shall self-administer prescribed drugs only in the manner prescribed. MS. STEPHENSON shall abstain completely from the use of alcohol and any products containing alcohol. Beginning within sixty (60) days of the effective date of this Consent Agreement and continuing throughout the probationary period, MS. STEPHENSON shall submit, at her expense and on the day selected, blood or urine specimens for drug andlor 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. STEPHENSON shall be negative, except for substances prescribed, administered, or dispensed to her by another so authorized by law who has full knowledge of MS. STEPHENSON'S history of chemical dependency and recovery status. Upon request by the Board or its designee and within sixty (60) days of such a request, MS. STEPHENSON 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. STEPHENSON shall provide the professional with a copy of this Consent Agreement and treatment records from Glenbeigh. Further, MS. STEPHENSON 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
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Kimberlee Yasmin Stephenson, R.N. Page 4 to the Board that includes diagnoses, recommendations for treatment and monitoring, any additional restrictions that should be placed on MS. STEPHENSON'S license to practice, and stating whether MS. STEPHENSON is capable of practicing nursing according to acceptable and prevailing standards of safe nursing care.
9.
If a chemical dependency evaluation is requested, MS. STEPHENSON 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. STEPHENSON 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. STEPHENSON'S license and that the terms, conditions, and limitations shall be incorporated in an addendum to this Consent Agreement. Beginning within thirty (30) days of the effective date of this Consent Agreement and continuing throughout the probationary period, MS. STEPHENSON 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. MS. STEPHENSON 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.
10.

11.
Within thirty (30) days of the effective date of this Consent Agreement, MS. STEPHENSON 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. STEPHENSON 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. Prior to initiating drug screening and continuing throughout the probationary period, MS. STEPHENSON 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. STEPHENSON. After initiating drug screening and within twenty-four (24) hours of release from hospitalization or medical treatment, MS. STEPHENSON shall notify the Board of any and all medication(s) or prescription(s) received.
12.
13.
Kimberlee Yasmin Stephenson, R.N. Page 5
14.
If working in a position in which a nursing license is required, M S . STEPHENSON 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.
15.
M S . STEPHENSON, 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, M S . STEPHENSON 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. M S . STEPHENSON 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 within thirty (30) days of accepting nursing employment. M S . STEPHENSON 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.
Reporting Requirements of Licensee 16.

17.
M S . STEPHENSON shall report to the Board, in writing, any violation of this Consent Agreement within thirty (30) days of the occurrence of the violation. M S . STEPHENSON 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. M S . STEPHENSON 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. M S . STEPHENSON 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. M S . STEPHENSON 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.
18.
19.
20.
Kimberlee Yasmin Stephenson, R.N. Page 6 21. 22.
MS. STEPHENSON shall verify that the reports and documentation required by this Consent Agreement are received in the Board office. MS. STEPHENSON 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.
Temporarv Practice Restrictions MS. STEPHENSON 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. STEPHENSON to provide nursing services for fees, compensation, or other consideration or as a volunteer. MS. STEPHENSON 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. STEPHENSON agrees that her license to practice nursing as a registered nurse will be automatically suspended if it appears to the Board that MS. STEPHENSON has violated or breached any terms or conditions of the Consent Agreement. Following the automatic suspension, the Board shall notify MS. STEPHENSON via certified mail of the specific nature of the charges and automatic suspension of her license. Upon receipt of this notice, MS. STEPHENSON 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. STEPHENSON 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.
DURATIONlMODIFICATIONOF 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. STEPHENSON and the Board.
Kimbcrlco Yaslnin Stephenson, R.N. Page 7 Tho Board shall only alter the probationaiy period irnposcd by this Consent Agreement if: (1) MS. STEPHENSON has complietl with a11 aspects of this Consent Agreement; and (2) the Board determines that MS. STEPHENSON is ablc to practice according to acceptable and prevailing standards of safe nursing care wirhout Boxd monitoring bascd upon an interview with MS. STEPHENSON and review o the reports required hcrein. Any period during which MS. Y STEPBENSON does not work in ;1 position for which a nursing license is required shall not count toward fulfilling the probationary pel-iod imposed by this Consent Agreelnent.
MS. STEPHENSON acknowledges that she has had an opportunity to ask questions concerning the terms of this Consent Agrecment and that all questions askcd have been answered in a
satisfactory manner.
MS. STEPHENSON waivcs all of hcr rights undcr Chapter 119, ORC as they rclatc lo matters that are thc subject of this Consent Atgreement.
MS. STEPHENSON waives any nnd all claims or causes of action she may have against the
Board, and members, officers, cmpl13yeesandlor agents of eithcr, arising out of matters that are tho sUb,ject crf this Consent Agrcemer~l:. This Consent Agreement is not arl adjudication order as discussed in Chapter 119, ORC. Howcvor, any action iniliated by the Board based on alleged violati.ons of this Consent Agueement shall conlply wjch the Administrative Procedures Act, Chapter 119, ORC. This Consent Agreement shall be considered a public rccord as that teim is used in Section 149.43, ORC.The information contained herein may be reported to appropriate organizations, data banks and governmental bodies.
MS. STEPHENSON understands that this Consent Agreement is subject to ratification by tho
Boosd prior to 3ignatuiul-eby the Board President and shall become effective upon the last date of signature below.
/./l/Z
DATE
IR d
Ohio Board ~f Nursing
I ;Xd.aola
DATE
Case# 12-001614
July 27, 2012

Joshua A. Stewart, R.N. 12590 Deer Creek Drive, #101 North Royalton, Ohio 44133 And 23 Brookins Olmsted Twp, Ohio 44138 Dear Mr. Stewart: 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 renewal, 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 at least three (3) years. Attached to and incorporated within the May 2011 Consent Agreement is a July 2008 Consent Agreement (July 2008 Consent Agreement) and a March 14, 2008 Notice of Immediate Suspension and Opportunity for Hearing (March 2008 Notice). [Information redacted, pursuant to Section 2953.52 of the Ohio Revised Code.] A. Item 1. of the May 2011 Consent Agreement states, MR. STEWART 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. 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)(1), 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 the board. Item 4. of the May 2011 Consent Agreement states, MR. STEWART 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 who has full knowledge of MR. STEWARTs history of chemical use. MR. STEWART shall self-administer prescribed drugs only in the manner
Joshua A. Stewart, R.N. Page 2 prescribed. Item 6. of the May 2011 Consent Agreement states, MR. STEWART shall continue submitting, at his 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 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. STEWART shall be negative, except for substances prescribed, administered, or dispensed to him by another so authorized by law who has full knowledge of MR. STEWARTs history of chemical use. Item 18. of the May 2011 Consent Agreement states, MR. STEWART 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 these provisions, on or about January 24, 2012, you provided a urine specimen for analysis to Firstlab, the Boards random drug/alcohol screen program administrator, that tested positive for Tramadol, without a legal, valid prescription. On or about February 2, 2012, you submitted a statement to the Board reporting that on January 23, 2012, you had asked a co-worker for Motrin or Tylenol and the co-worker unknowingly gave you Ultracet (Tramadol). On or about February 27, 2012, you told your Board Monitoring Agent that the Tramadol was not from a co-worker but from your childrens babysitter. You submitted a statement to the Board dated April 17, 2012, admitting that your February 2, 2012 statement was untruthful and misleading. 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. 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)(1), 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 the board. B. In addition, you failed to call Firstlab to determine if you had been selected to provide a urine specimen: July 14, 2011; July 17, 2011; September 10, 2011; May 5, 2012; and June 10, 2012. 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.
Joshua A. Stewart, R.N. Page 3 C. Item 10. of the May 2011 Consent Agreement states, Within sixty (60) days of the effective date of this Consent Agreement, MR. STEWART shall provide a copy of this Consent Agreement, with the redacted copies of the attached July 2008 Consent Agreement, the attached March 2008 Notice, and the attached letter explaining the redactions to all treating practitioners and shall provide to the Board a list of all treating practitioners, including addresses and telephone numbers. Further, MR. STEWART shall be under a continuing duty to provide a copy of this Consent Agreement and the 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. Item 11. of the May 2011 Consent Agreement states, MR. STEWART 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. STEWART throughout the duration of this Consent Agreement. Despite these provisions, you received treatment and prescriptions from a Dentist in August 2011, but failed to provide updated treatment information or have your Dentist submit a prescription medication report to the Board until April 2012. 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 Items 1., 4., 6., 10., 11. and 18. of the May 2011 Consent Agreement. YOU ARE FURTHER NOTIFIED THAT YOUR LICENSE TO PRACTICE NURSING AS A REGISTERED NURSE, RN-327845, 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 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 renewal, your license to practice nursing as a registered nurse in the State of Ohio would be reinstated
Joshua A. Stewart, R.N. Page 4 and suspended indefinitely and that such suspension would be stayed subject to probationary terms, conditions, and limitations for a minimum period of at least three (3) years. Attached to and incorporated within the May 2011 Consent Agreement is a July 2008 Consent Agreement (July 2008 Consent Agreement) and a March 14, 2008 Notice of Immediate Suspension and Opportunity for Hearing (March 2008 Notice). [Information redacted, pursuant to Section 2953.52 of the Ohio Revised Code.] 2. Item 1. of the May 2011 Consent Agreement states, MR. STEWART 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. 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)(1), 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 the board. Item 4. of the May 2011 Consent Agreement states, MR. STEWART 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 who has full knowledge of MR. STEWARTs history of chemical use. MR. STEWART shall selfadminister prescribed drugs only in the manner prescribed. Item 6. of the May 2011 Consent Agreement states, MR. STEWART shall continue submitting, at his 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 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. STEWART shall be negative, except for substances prescribed, administered, or dispensed to him by another so authorized by law who has full knowledge of MR. STEWARTs history of chemical use. Item 18. of the May 2011 Consent Agreement states, MR. STEWART 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 these provisions, on or about January 24, 2012, you provided a urine specimen for analysis to Firstlab, the Boards random drug/alcohol screen program administrator, that tested positive for Tramadol, without a legal, valid prescription.
Joshua A. Stewart, R.N. Page 5 On or about February 2, 2012, you submitted a statement to the Board reporting that on January 23, 2012, you had asked a co-worker for Motrin or Tylenol and the co-worker unknowingly gave you Ultracet (Tramadol). On or about February 27, 2012, you told your Board Monitoring Agent that the Tramadol was not from a co-worker but from your childrens babysitter. You submitted a statement to the Board dated April 17, 2012, admitting that your February 2, 2012 statement was untruthful and misleading. 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. 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)(1), 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 the board. 3. In addition, you failed to call Firstlab to determine if you had been selected to provide a urine specimen: July 14, 2011; July 17, 2011; September 10, 2011; May 5, 2012; and June 10, 2012. 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 10. of the May 2011 Consent Agreement states, Within sixty (60) days of the effective date of this Consent Agreement, MR. STEWART shall provide a copy of this Consent Agreement, with the redacted copies of the attached July 2008 Consent Agreement, the attached March 2008 Notice, and the attached letter explaining the redactions to all treating practitioners and shall provide to the Board a list of all treating practitioners, including addresses and telephone numbers. Further, MR. STEWART shall be under a continuing duty to provide a copy of this Consent Agreement and the 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. Item 11. of the May 2011 Consent Agreement states, MR. STEWART 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. STEWART throughout the duration of this Consent Agreement. Despite these provisions, you received treatment and prescriptions from a Dentist in August 2011, but failed to provide updated treatment information or have your Dentist submit a prescription medication report to the Board until April 2012.
Joshua A. Stewart, R.N. Page 6 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 ($500.00) per violation. Sincerely,
Judith A. Church, R.N., C.N.P. Supervising Member Certified Mail Receipt No. 7012 1010 0002 4225 4986 Second Address Certified Mail Receipt No. 7012 1010 0002 4225 2166 cc: Henry G. Appel, Assistant Attorney General
rsing
.. .
..,..
17 South High Street. ~uile'400
. www.nursing.ohio.gov . .. . . Columbus, Ohio 43215-7410 * (614) 466-3947 . .

.,
.. .
To Whom It May Concern: You recently requested records regarding Joshua A. Stewart, R.N. Enclosed are records in response to your request. Information has been redacted, per Section 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 #2011-001567

17 South High Slrcet, Suite 400
0
www.~~ursi~~g.ohio.gov
(614) 466-3947
Colmx1bus, Ohio 43215-7410
REINSTATEMENT CONSENT AGREEMENT BETWEEN JOSHUA A. STEWART, R.N. AND OHIO BOARD OF NURSING
This Consent Agreement is entered into by and between JOSHUA A. STEWART, R.N. (MR. STEWART) 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. MR. STEWART voluntarily enters into this Consent Agreement being fully informed of his rights under Chapter 119, ORC, including the right to representation by legal counsel and the right to a fonnal adjudicative hearing on the issues considered herein. Agreement contains the entire agreement between the parties, there being This Consei~t 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. MR. STEWART admits to violating Section 4723.28, ORC, as set forth in his July 18, 2008 Consent Agreement (July 2008 Consent Agreement) and in his March 14, 2008 Notice of Immediate Suspension and Opportunity for Hearing (March 2008 Notice). Redacted copies of the July 2008 Consent Agreement and the March 2008 Notice and a letter explaining the redactions are attached hereto and incorporated herein. MR. STEWART was initially issued a license to practice nursing in Ohio as a registered nurse, RN-327845, in August 2006. MR. STEWART'S license was immediately suspended by his
B.
Joshua A. Stewart, R.N. Page 2
November 2008 Notice and MR. STEWART'S license was then indefinitely suspended by his July 2008 Consent Agreement. C. Under the terms of his July 2008 Consent Agreement, MR. STEWART is now eligible to request reinstatement of his license and submitted such a request in writing. D.
MR. STEWART provided the Board with his February 2011

addiction psychiatric evaluation that was performed by David W. Streem, M.D. and by Susan M. Daum, CS, LICDC. MR. STEWART was diagnosed with Conduct Defect as Adjustment Reaction, Insomnia and with a brief (episodic) history of Narcotic Abuse and a chemical dependency diagnosis was not found. During evaluation, MR. STEWART reported that his overdose referenced in Paragraph E. of MR, STEWART'S July 2008 Consent Agreement was not accidental, as MR. STEWART has previously reported to the Board. MR. STEWART further reported that he has obtained counseling for depression and is currently in counseling with Jeffrey Kolson, LISW-S. Dr. Streem and Ms. Daum opined that MR. STEWART is safe to return to the practice of nursing and they recommended that MR. STEWART continue counseling with Mr. Kolson.
E.
In Mr. Kolson's May 2011 statement to the Board, he reported that MR. STEWART has remained compliant with treatment and that at this time, MR. STEWART does not have any serious mental health issues. Mr. Kolson recommended that MR. STEWART continue seeing him on a monthly basis for stress management.
F.
MR. STEWART is currently prescribed an antidepressant and

migraine medication by his primary treating physician.
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. STEWART knowingly and voluntarily agrees with the Board to the following terms, conditions, and limitations: Upon meeting the requirements for renewal, MR. STEWART'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 period of at least three (3)years:
1.
MR. STEWART shall obey all federal, state, and local laws, and all
laws and rules governing the practice of nursing in Ohio.
2.
MR. STEWART shall appear in person for interviews before the full Board or its designated representative as requested by the Board or its designee.

3.
Within ninety (90) days prior to submitting a request for release from the probationary terms, conditions and limitations of this Consent Agreement, MR. STEWART agrees that he will submit a request to the Bureau of Criminal Identification and Investigation (BCII) to conduct a criminal records check of MR. STEWART, including a check of Federal Bureau of Investigation (FBI) records, and shall cause BCII to submit MR. STEWART'S criminal records check reports to the Board. MR. STEWART agrees that a request for release from the probationary 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
4.
MR. STEWART 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 who has full knowledge of MR. STEWART'S history of chemical use. MR. STEWART shall self-administer prescribed drugs only in the manner prescribed. MR. STEWART shall abstain completely from the use of alcohol andlor substances containing alcohol. MR. STEWART shall continue submitting, at his expense and on the day selected, blood or urine specimens for drug andlor 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 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. STEWART shall be negative, except for substances prescribed, administered, or dispensed to him by another so authorized by law who has full knowledge of MR. STEWART'S history of chemical use. MR. STEWART shall participate in continuing individual counseling at intervals deemed appropriate by Mr. Koison, or another mental health professional approved in advance by the Board or its designee
Joshua A. Stewart, R.N. Page 4 until released. MR. STEWART shall have the mental health professional submit written reports regarding MR. STEWART'S progress, status, and compliance with his treatment plan to the Board on a quarterly basis beginning July 1,2011. MR. STEWART shall provide the mental health professional with a copy of this Consent Agreement, with the redacted copies of the attached July 2008 Consent Agreement, the attached March 2008 Notice, and the attached letter explaining the redactions prior to June 17, 2011. MR. STEWART shall inform the Board, in writing, within five (5) business days of discontinuing participation in individual counseling, and prior to said discontinuation, shall inform the Board, in writing, of the name(s) of another mental health treating professional(s) and intervals of treatment for approval by the Board or its designee.
If the Board or its designee requests a chemical dependency evaluation and/or a psychiatric evaluation, MR. STEWART shall, f within ninety (90) days o such request(s), and at his own expense,
obtain the evaluation(s) and shall provide the Board with complete documentation of the evaluation(s) from professional(s) approved in advance by the Board. Prior to the evaluation(s), MR. STEWART shall provide the professional(s) with a copy of this Consent Agreement, with the redacted copies of the attached July 2008 Consent Agreement, the attached March 2008 Notice, and the attached letter explaining the redactions. MR. STEWART shall execute releases to permit the professionai(s) to obtain any information deemed appropriate and necessary for the evaluation(s). The evaluating professional(s) 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. STEWART'S license to practice, and statemeilt(s) as to whether MR. STEWART is capable of practicing nursing according to acceptable and prevailing standards of safe nursing care.
MR. STEWART shall provide the Board with satisfactory documentation of compliance with all aspects of the treatment plan(s) developed by the professional(s) described above until released. Further, MR. STEWART agrees that the Board may utilize the professional(s)'s recommendations and conclusions from the evaluation(s) as a basis for additional terms, conditions, and limitations on MR. STEWART'S license and that the terms, conditions, and limitations may be incorporated in an addendum to this Consent Agreement.
Joshua A. Stewart, R.N Page 5

10.
Within sixty (60) days of the effective date of this Consent Agreement, MR. STEWART shall provide a copy of this Consent Agreement, with the redacted copies of the attached July 2008 Consent Agreement, the attached March 2008 Notice, and the attached letter explaining the redactions to all treating practitioners and shall provide to the Board a list of all treating practitioners, including addresses and telephone numbers. Further, MR. STEWART shall be under a continuing duty to provide a copy of this Consent Agreement and the 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. MR. STEWART 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. STEWART throughout the duration of this Consent Agreement.
Within twenty-four (24) hours of release from hospitalization or medical treatment, MR. STEWART shall notify the Board of any and all medication(s) or prescription(s) received.
11.
12.
13.
Prior to accepting employment as a nurse, each time with every employer, MR. STEWART shall notify the Board in writing. MR. STEWART is under a continuing duty to provide a copy of this Consent Agreement, with the redacted copies of the attached July 2008 Consent Agreement, the attached March 2008 Notice, and the attached letter explaining the redactions to any new employer prior to accepting employment as a nurse. MR. STEWART shall have her employer(s) submit written reports regarding job performance on a quarterly basis beginning within thirty (30) days of accepting nursing employment. Further, MR. STEWART 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 and the attachments, including the date they were received.
14.

15.
MR. STEWART shall report to the Board, in writing, any violation of this Consent Agreement within thirty (30) days of the occurrence of the violation. MR. STEWART shall sign release of information forms allowing health professionals and other organizations to submit the requested documentation directly to the Board. MR. STEWART shall submit any and all information that the Board may request regarding his ability to practice according to acceptable and prevailing standards of safe nursing practice. MR. STEWART 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. STEWART 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. MR. STEWART shall submit the reports and documentation required by Kis 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. STEWART shall verify that the reports and documentation required by this Consent Agreement are received in the Board office. MR. STEWART 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.
Nursing Refresher Course or Orientation Prior to working in a position where a nursing license is required, MR. STEWART shall complete and submit satisfactory documentation of completion of a nursing refresher course or an extensive orientation to be approved in advance by the Board or its designee.
Temporarv Narcotic Restriction MR. STEWART shall not administer, have access to, or possess (except as prescribed for MR. STEWART'S use by another so authorized by law who has full knowledge of MR. STEWART'S history of chemical use) any narcotics, other controlled substances, or mood altering drugs for a minimum period of one (1) year in which MR. STEWART is working in a position that requires a nursing license. At any time after the one-year period of time previously described, MR. STEWART may submit a written request to the Board to have this restriction re-evaluated. In addition, MR. STEWART shall not count narcotics or possess or carry any work keys for locked medication carts, cabinets, drawers, or containers. MR. STEWART shall not call in or order prescriptions or prescription refills. Permanent Practice Restrictions MR. STEWART 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, MR. STEWART 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 MR. STEWART 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, MR. STEWART 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, VicePresident of Nursing. FAILURE TO COMPLY MR. STEWART agrees that his license to practice nursing as a registered nurse will be automatically suspended if it appears to the Board that MR. STEWART has violated or breached any terms or conditions of the Consent Agreement. Following the automatic suspension, the Board shall notify MR. STEWART via certified mail of the specific nature of the charges and automatic suspension of his license. Upon receipt of this notice, MR. STEWART 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, MR. STEWART appears to have violated or breached any terms or conditions of this
Joshua A. Stewaa, R.N. Page 8
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.

The terms, limitations, and conditions, of this Consent Agreement, other than the permanent practice restrictions, may be modified or terminated, in writing, at any time upon the agreement of both MR. STEWART and the Board. The Board may only alter the probationary period imposed by this Consent Agreement if: (1) the Board determines that MR. STEWART has complied with all aspects of this Consent Agreement; and (2) the Board determines that MR. STEWART is able to practice according to acceptable and prevailing standards of safe nursing care without Board monitoring, based upon an interview with MR. STEWART and review of the reports as required herein. Any period during which MR. STEWART 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.
ACKNOWLEDGMENTSILIABILITY RELEASE MR. STEWART ackllowledges 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. STEWART waives all of his rights under Chapter 119, ORC, as they relate to
matters that are the subject of this Consent Agreement.
MR. STEWART waives any and all claims or causes of action he may have against the
Board, and its members, officers, employees andlor 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 reporred 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.
Joshua A. Stewart, R N . Page 9
MR. STEWART understands thnt this Consent Agreement is subject to ratification by

the Board prior to signanue by the Board President and shall become effective upon the
last date of signature below.
6 '
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CONSENT AGREEMENT BETWEEN JOSHUA A. STEWART, R.N. AND OHIO BOARD OF NURSING
This Consent Agreement is entered into by and between JOSHUA A. STEWART, R.N. (MR. STEWART) 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. MR. STEWART voluntarily enters into this Consent Agreement being fully informed of his 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, wliich 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(8)(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@)(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(8)(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.
.., .
......
"
.. ..........
Joshua A. Stewart, R.N. Page 2 B.
MR. STEWART'S license to practice nursing as a registered nurse in the

State of Ohio, RN-327845, was immediately suspended by the Board on or about March 14, 2008. MR. STEWART'S Ohio nursing license was initially issued in August 2006.
C.
MR. STEWART knowingly and voluntarily admits to the factual and lezal
allegations set forth in the Notice of Immediate Suspension and Opportunity for Hearing issued to him by the Board on or about March 14, 2008 (March 2008 Notice), a copy of which is attached hereto and incorporated herein.
MR. STEWART admits that, when he was admitted to the Parma Hospital
Emergency Room, three (3) Methadone tablets belonging to the hospital were found on his person. MR. STEWART states that he had the tablets
MR. STEWART states that he was admitted to. the emergency room
because he accidentally overdosed on his Xanax prescription and Vicodin, which was prescribed to him for an ankle injury. MR. STEWART explains that a professional evaluated him for chemical dependency subsequent to this incident and did not diagnose him with chemical dependency.
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. STEWART knowingly and voluntarily agrees with the Board to the following terms, conditions, and limitations:
1.
MR. STEWART'S license to practice nursing as a registered nurse is hereby suspended for an indefinite period of time, but not less than one ( I ) year. MR. STEWART may submit a written request for reinstatement anytime after the
conditions for reinstatement have been satisfied.
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Josl~ua Stewart, R.N. A. Page 3 CONDITIONS FOR REINSTATEMENT
3.
MR. STEWART shall appear in person for interviews before the full Board or its designated representative as requested by the Board or its designee. Within three (3) months prior to requesting reinstatement. MR. STEWART agrees that he will submit a request to the Bureau of Criminal Identification and lnvestigation (BCII) to conduct a criminal records check of MR. STEWART, including a check of Federal Bureau of Investigation records, and shall cause BCII to submit MR. STEWART's completed criminal records check reports to the Board. Prior to reinstatement, MR. STEWART 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.
MR. STEWART shall abstain completely from the personal use or possession of
drugs, except those prescribed, administer.ed, or dispensed to him by another so authorized by law who has full knowledge of MR. STEWART'S history of chemical use. MR. STEWART shall self-administer the prescribed drugs only in the manner prescribed.
7.
MR. STEWART shall abstain completely from the use of alcohol

Within three (3) months prior to seeking reinstatement by the Board, MR. STEWART shall, at his own expense, seek a comprehensive evaluation from Edna Marie Jones, M.D. or another physician, approved in advance by the Board or its designee, who specializes in Addiction Medicine. MR. STEWART shall provide the Board with compIete documentation of such evaluation. Prior to the evaluation, MR. STEWART shall provide the evaluating physician with a copy of this Consent Agreement, the attached March 2008 Notice, and-summaries from his treating physicians for the past two (2) years, including the types and frequency of all drugs MR. STEWART has been prescribed for that period. Further, MR. STEWART shall execute releases to permit the physician to obtain any information deemed appropriate and necessary for the evaluation. The 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 MR. STEWART's license, and. a statement as to whether MR. STEWART is capable of practicing nursing according to acceptable and prevailing standards of safe nursing care.
8.
.Joshua A. Stewart, R.N. Page 4

9.
MR. STEWART shall provide the Board with satisfactory documentation of compliance with all aspects of the treatment plan developed by the physician described above until released. Further; MR. STEWART 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 MR. STEWART'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 one (1) year immediately prior to requesting reinstatement, MR. STEWART shall submit, at his expense and on the day selected, blood or urine specimens for drug andlor alcohol analysis at a collection site specified by the Board at such times as the Board may request. Upon and after MR. STEWART'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. STEWART shall be negative, except for substances prescribed, administered, or dispensed to him by another so authorized by law who has full knowledge of MR. STEWART'S history of chemical use. a. Within thirty (30) days prior to MR. STEWART initiating drug screening, MR. STEWART shall provide a copy of this Consent Agreement and the attached 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 MR. STEWART. b. After initiating drug screening, MR. STEWART shall be under a continuing duty to provide a copy of this Consent Agreement and the attached March 2008 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, MR. STEWART 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.
11.
Upon request by the Board or its designee, and within fourteen (14) days of that request, MR. STEWART shall attend a minimt~mof one (1) meeting per week of a support or peer group meeting approved in advance by the Board, or a Twelve Step program, and MR. STEWART shall provide satisfactory documentation of such attendance to the Board prior to reinstatement.
Joshua A. Stewart. R.N, Page 5
Psychiatric Evaluation and Treatment

12.
Upon request by the Board or its designee and prior to reinstatement, MR. STEWART shall, at his own expense, seek a psychiatric evaluation from a Board
approved psychiatrist and shall provide the Board with complete documentation of such evaluation. Prior to the evaluation, MR. STEWART shall provide the psychiatrist with a copy of this Consent Agreement and the attached March 2008 Notice 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 o n MR. STEWART'S license, and a statement as to whether MR. STEWART is capable of practicing nursing according to acceptable and prevailing standards of safe nursing care.
13.
MR. STEWART shall provide the Board with satisfactory documentation of

professional until compliance with all aspects of the treatment plan developed by tl~e released. Further, MR. STEWART agrees that the Board may use the professional recommendations and conclusions from the evaluation as a basis for additional terms, conditions, limitations on MR. STEWART'S license and that the terms, conditions, and limitations shall be incorporated in an addendum to this Consent Agreement.

14.
MR. STEWART shall report to the Board, in writing, any violation of this Consent
15.
MR. STEWART shall sign release of information forms allowing health

professionals and other organizations to submit requested documentation or information directly to the Board.
16.
MR. STEWART shall submit any and all information that the Board may request regarding his ability to practice according to acceptable and prevailing standards of safe nursing practice. MR. STEWART shall not submit or cause to be submitted any false, misleading, or
17.
18.
MR. STEWART 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 sl~alibe made to the Compliance Unit of the Board.
Joshua A. Stewart, R.N. Page 6 19. MR. STEWART 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. MR. STEWART shall verify that the reports and documentation required by this Consent Agreement are received in the Board office. MR. STEWART shall inform the Board within five (5) business days, in writing, of any change in address andlor telephone number.
20..
21.
Nursin? Refresher Course o r Orientation Upon request by the Board or its designee, MR. STEWART 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. Tem~orarv Narcotic Restrictions Upon reinstatement of his license, MR. STEWART shall not administer, have access to, or possess (except as prescribed for MR. STEWART'S use by another so authorized by law who has full knowledge of MR. STEWART'S history of chemical use) any narcotics, otlrer controlled substances, or mood altering drugs for a minimum period of ONE (1)YEAR in which MR. STEWART is working in a position that requires a nursing license. At any time after the one-year period previously described, MR. STEWART may submit a written request to the Board to have this restriction reevaluated. In addition, MR. STEWART shall not count narcotics or possess or cany any work keys for locked medication carts, cabinets, drawers, or containers. MR. STEWART shall not call in or order prescriptions or prescription refills. Permanent Practice Restrictions MR. STEWART further knowingly and voluntarily agrees to the following PERMANENT PRACTICE RESTRICIONS: Unless otherwise approved in advance by the Board or its designee, MR. STEWART shall not practice nursing as a registered nurse (1) for agencies providing home care in tlre 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 enFage MR. STEWART to provide nursing services for fees, compensation, or other consideration or as a volunteer. Unless otllerwise approved i n advance by the Board or its designee, MR. STEWART shall not function in a position or employment wlrere 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
Joshua A. Stewart, R.N Page 7 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 "r.estrictions placed on a license" for purposes of Section 4723..28(B), O R C If, in the discretion of the Board, MR. STEWART 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 practice restrictions, may be modified or terminated, in writing, at any time upon the agreement of both MR. STEWART and the Board. The Board may only alter the indefinite suspension imposed if: (1) MR. STEWART submits a written request for reinstatement; (2) the Board determines that MR. STEWART has complied with all conditions of reinstatement; (3) the Board determines that MR. STEWART is able to practice according to acceptable and prevailing standards of safe nursing care based upon an interview with MR. STEWART and review of the documentation specified in this Consent Agreement; and (4) MR. STEWART 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..
MR. STEWART acknowledges that he has had an opportunity to ask questions concerning the
MR. STEWART waives all of his rights under Chapter 119, ORC, as they relate to matters that
MR. STEWART waives any and all claims or causes of action he may have against the Board,
and its members, officers, employees andlor 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 shalt comply with the Administrative Procedures Act, Chapter 119, ORC.
Joshua A. Stewart, R.N Page 8 This Consent Agreement shall be considered a public record as that tern is used in Section 149.43, ORC. The information contained herein may be reported to appropriate organizations, data banks and governmental bodies.
EFFECTIVE DATE
MR.STEWART understands that this Consent Agreement is subject to ratification by the Board
prior to signature by the Board President and sllall become effective upon the last date of signature below.
LISA K L E N ~President , Ohio Board of Nursing
DATE
11 - 8 - 0C
Case # 07-2941 and 07-3004
d of Nursing
,,w,nu~sing.o~io.gov
. . .
17 South High Street: Suite 400 * Columbus, Ohio 43215-7410 * (614) 466-3947
March 14,2008

Joshua A. Stewart, R.N. 17833 Whitney Road #315 Strongsville, OH 44136 AND Joshua A. Stewart, R.N. 5800 Laurent Drive #210 Parma, OH 44129 Dear Mr. Stewart:
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 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 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 licensed practical nurse, RN-327845, 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:
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. Section 4723.28(B)(13), ORC, authorizes the Board to discipline a licensee for obtaining or attempting to obtain money or a n y h u g of value by intentional misrepresentation or material deception in the course of practice. 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.
Joshua A. Stewart, 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 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, Disciplinary Unit 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 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,
Debra A. Broadnax, M.S.N., R.N., C.N.S. Supervising Member Address #1 Certified Mail Receipt No. 7007 3020 0000 7377 5291 Address #2 Certified Mail Receipt No. 7007 3020 0000 7377 5307 cc: Matthew A. Palnik, Attorney for Mr. Stewart 425 Western Reserve Building 1468 West Ninth Street Cleveland, OH 44113
Attorney Certified Mail Receipt No. 7007 3020 0000 7377 53 14

CC:
Leah O'Carroll, Assistant Attorney General
Case # 12-003509
July 27, 2012

Tammy Annette Stone, L.P.N. PO Box 41 Lucasville, Ohio 45648 Dear Ms. Stone: 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 July 19, 2012 in Scioto County Court of Common Pleas Case No. 11CR000750, you were found guilty of Theft by Deception/Elderly Person or Disabled Adult, in violation of Section 2913.02(A)(3)/(B)(3), ORC, being a felony of the fourth degree. 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. 2. On or about April 19, 2012, in Scioto County Court of Common Pleas Case No. 11CR000750, the Court determined that you submitted a drug screen specimen that was positive 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. 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
Tammy Annette Stone, 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, 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,
Cases# 11-005062 & 12-001394
July 27, 2012

Carol Ann Stricklan (A.K.A. Carol Ann Caso-Stricklan), R.N. 32443 Lake Road Avon Lake, Ohio 44012 Dear Ms. Stricklan: You are hereby notified that, 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 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 2011 Consent Agreement states, MS. CASOSTRICKLAN 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 4. of the September 2011 Consent Agreement states, MS. CASO-STRICKLAN 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. CASO-STRICKLANs history. MS. CASOSTRICKLAN shall self-administer prescribed drugs only in the manner prescribed. Item 5. of the September 2011 Consent Agreement states, Within forty-five (45) days of the effective date of this Consent Agreement and continuing throughout the probationary period, MS. CASO-STRICKLAN 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. CASO-STRICKLAN shall be negative, except for substances prescribed, administered, or dispensed to her by another so authorized by law who has full knowledge of MS. CASO-STRICKLANs history.
Carol Ann Stricklan (A.K.A. Carol Ann Caso-Stricklan), R.N. Page 2 Despite these provisions, on December 5, 2011, you provided a urine specimen for analysis to Firstlab, the Boards random drug/alcohol screen program administrator, that tested positive for Lorezepam (Ativan), without a legal, valid prescription. You submitted a statement to the Board dated December 13, 2011, admitting that you consumed an Ativan tablet from an old prescription. You also admitted to consuming two Vicodin tablets from an old prescription (August 2011), and state that since this pre-dated the September 2011 Consent Agreement, the prescriber was not aware of the Consent Agreement. 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), ORC, authorizes the Board to discipline a licensee for violation of any restrictions placed on a nursing license by the Board. C. Also, you failed to call Firstlab to determine if you had been selected to provide a urine specimen: March 12, 2012; April 17, 2012; and April 22, 2012. D. Furthermore, on April 9, 2012, you were selected to provide a urine specimen for analysis and failed to do so. 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 1. of the September 2011 Consent Agreement states, MS. CASOSTRICKLAN 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 4. of the September 2011 Consent Agreement states, MS. CASO-STRICKLAN 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. CASO-STRICKLANs history. MS. CASOSTRICKLAN shall self-administer prescribed drugs only in the manner prescribed. Despite this provision, you submitted a written statement to the Board dated April 27, 2012, admitting that you had consumed a Nucynta tablet on April 7, 2012 without a prescription. You further admitted that you did not have a prescription for the drug and had obtained the drug from another individual.
Carol Ann Stricklan (A.K.A. Carol Ann Caso-Stricklan), R.N. Page 3 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), 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 2011 Consent Agreement, you are hereby notified that it appears to the Board that you have violated Items 1., 4., and 5. of the September 2011 Consent Agreement. YOU ARE FURTHER NOTIFIED THAT YOUR LICENSE TO PRACTICE NURSING AS A REGISTERED NURSE, RN-316656, 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 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 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 2011 Consent Agreement states, MS. CASOSTRICKLAN 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 4. of the September 2011 Consent Agreement states, MS. CASO-STRICKLAN 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. CASO-STRICKLANs history. MS. CASOSTRICKLAN shall self-administer prescribed drugs only in the manner prescribed. Item 5. of the September 2011 Consent Agreement states, Within forty-five (45) days of the effective date of this Consent Agreement and continuing throughout the probationary period, MS. CASO-STRICKLAN shall submit, at her expense and on the day selected,
Carol Ann Stricklan (A.K.A. Carol Ann Caso-Stricklan), R.N. Page 4 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. CASO-STRICKLAN shall be negative, except for substances prescribed, administered, or dispensed to her by another so authorized by law who has full knowledge of MS. CASO-STRICKLANs history. Despite these provisions, on December 5, 2011, you provided a urine specimen for analysis to Firstlab, the Boards random drug/alcohol screen program administrator, that tested positive for Lorezepam (Ativan), without a legal, valid prescription. You submitted a statement to the Board dated December 13, 2011, admitting that you consumed an Ativan tablet from an old prescription. You also admitted to consuming two Vicodin tablets from an old prescription (August 2011), and state that since this pre-dated the September 2011 Consent Agreement, the prescriber was not aware of the Consent Agreement. 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), ORC, authorizes the Board to discipline a licensee for violation of any restrictions placed on a nursing license by the Board. 3. Also, you failed to call Firstlab to determine if you had been selected to provide a urine specimen: March 12, 2012; April 17, 2012; and April 22, 2012. 4. Furthermore, on April 9, 2012, you were selected to provide a urine specimen for analysis and failed to do so. 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 1. of the September 2011 Consent Agreement states, MS. CASOSTRICKLAN 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 4. of the September 2011 Consent Agreement states, MS. CASO-STRICKLAN 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
Carol Ann Stricklan (A.K.A. Carol Ann Caso-Stricklan), R.N. Page 5 who has full knowledge of MS. CASO-STRICKLANs history. MS. CASOSTRICKLAN shall self-administer prescribed drugs only in the manner prescribed. Despite this provision, you submitted a written statement to the Board dated April 27, 2012, admitting that you had consumed a Nucynta tablet on April 7, 2012 without a prescription. You further admitted that you did not have a prescription for the drug and had obtained the drug from another individual. 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), 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 ($500.00) per violation. Sincerely,
Carol Ann Stricklan (A.K.A. Carol Ann Caso-Stricklan), R.N. Page 6 Certified Mail Receipt No. 7012 1010 0002 4225 4887 cc: Henry G. Appel, Assistant Attorney General
Case #lo-2535
17 Soulh lligh Stleet, Suilc 400 * Columnbus, Ohio 43215-7410 * (614) 466-3947
CONSENT AGREEMENT BETWEEN CAROL ANN CASO-STRICKLAN, R.N. AND OHIO BOARD OF NURSING
This Consent Agreement is entered into by and between CAROL ANN CASO-STRICKLAN, R.N. (MS. CASO-STRICKLAN) 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. CASO-STRICKLAN 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.
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 othenvise 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. CASO-STRICKLAN has ail active license to practice nursing as a registered nurse, RN-316656, in the State of Ohio. MS. CASO-STRICKLAN was initially licensed as a registered nurse in March 2005. MS. CASO-STRICKLAN knowingly and voluntarily admits to the following:
1)
C.
MS. CASO-STRICKLAN self-reported that on or about May 29, 2010, while working as a registered nurse at St. John West Shore Hospital (St. John's Hospital) in Westlake, Ohio, she was randomly
Carol Ann Caso-Stricklan, R.N. Page 2 drug screened and tested positive for Darvocet, without a current, valid prescription. 2)
MS. CASO-STRICKLAN denied diversion, but admitted to selfadministering a family member's Darvocet the previous day, due to a migraine headache. MS. CASO-STRICKLAN subsequently returned to nursing employment at St. John's Hospital and was required to submit random drug screens and review her migraine therapy with her physician. MS. CASO-STRICKLAN apologizes for her action and is willing to cooperate with the Board in order to maintain her nursing license. AGREED CONDITIONS
3)
4)
Wherefore, in consideration of the foregoing and mutual promises hereinafter set forth, and in lieu of any formal proceedings at this time, MS. CASO-STRICKLAN knowingly and voluntarily agrees with the Board to the following terms, conditions, and limitations: MS. CASO-STRICKLAN'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 one (1) year:
1.
2.
MS. CASO-STRICKLAN shall obey all federal, state, and local laws, and ail laws and rules governing the practice of nursing in Ohio. MS. CASO-STRICKLAN shall appear in person for an interview before the full Board or its designated representative, as requested by the Board or its designee. MS. CASO-STRICKLAN agrees that she will submit a request to the Bureau of Criminal Identification and Investigation (BCII) to conduct a criminal records check of MS. CASO-STRICKLAN, including a check of Federal Bureau of Investigation (FBI) records, and shall cause BCII to submit MS. CASO-STRICKLAN's criminaI records check reports to the Board. MS. CASO-STRICKLAN's completed criminal records check, including the FBI check, must be received by the Board within six (6) months folIowing the effective date of this Consent Agreement.
3.

4.
MS. CASO-STRICKLAN 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 fulI knowledge of MS. CASOSTRICKLAN's history. MS. CASO-STRICKLAN shall self-administer prescribed drugs only in the manner prescribed.
Carol Ann Caso-Stricklan, R.N. Page 3

5.
Within forty-five (45) days of the effective date of this Consent Agreement and continuing throughout the probationary period, MS. CASOSTRICKLAN shall submit, at her expense and on the day selected, blood or urine specimens for drug andlor 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. CASO-STRICKLAN shall be negative, except for substances prescribed, administered, or dispensed to her by another so authorized by law who has full knowledge of MS. CASO-STRICKLAN's history. Upon request by the Board or its designee and within sixty (60) days of such request, MS. CASO-STRICKLAN 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. CASO-STRICKLAN shall provide the professional with a copy of this Consent Agreement. Further, MS. CASOSTRICKLAN 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 olaced on MS. CASO-STRICKLAN's license to practice, and stating wh&her MS. CASO-STRICKLAN is capable of practicing nursing according to acceptable and prevailing standards of safe nursing care. If a chemical dependency evaluation is requested, MS. CASOSTRICKLAN 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. CASOSTRICKLAN 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. CASO-STRICKLAN's license and that the terms, conditions, and limitations shall be incorporated in an addendum to this Consent Agreement.
6.
7.

8.
Prior to initiating drug screening and continuing throughout the probationary period, MS. CASO-STRICKLAN 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
Carol Ann Caso-Stricklan, R.N. Page 4
MS. CASO-STRICKLAN after initiating drug screening and throughout the duration of this Consent Agreement. Employment Conditions 9. If working in a position in which a nursing license is required, MS. CASOSTRICKLAN 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. CASO-STRICKLAN, 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. CASO-STRICKLAN 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. CASOSTRICKLAN 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 within thirty (30) days of accepting nursing employment. MS. CASO-STRICKLAN 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.

11.
MS. CASO-STRICKLAN shall report to the Board, in writing, any violation of this Consent Agreement within thirty (30) days of the occurrence of the violation. MS. CASO-STRICKLAN 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. CASO-STRICKLAN 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. CASO-STRICKLAN 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.
12.
13.
14.
Carol Ann Caso-Stricklan, R.N. Page 5 15.
MS. CASO-STRICKLAN 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. MS. CASO-STRICKLAN shall verify that the reports and documentation required by this Consent Agreement are received in the Board office. MS. CASO-STRICKLAN 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.
Temporarv Practice Restrictions Unless otherwise approved in advanced, in writing, by the Board or its designee, MS. CASO-STRICKLAN 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. CASO-STRICKLAN to provide nursing services for fees, compensation, or other consideration or as a volunteer. Unless otherwise approved in advanced, in writing, by the Board or its designee, MS. CASO-STRICKLAN 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. CASO-STRICKLAN agrees that her license to practice nursing as a registered nurse will be automatically suspended if it appears to the Board that MS. CASO-STRICKLAN has violated or breached any terms or conditions of the Consent Agreement. Following the automatic suspension, the Board shall notify MS. CASO-STRICKLAN via certified mail of the specific nature of the charges and automatic suspel~sionof her license. Upon receipt of this notice, MS. CASO-STRICKLAN 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. CASOSTRICKLAN 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
Carol Ann Caso-Stricklan, R.N. Page 6 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.
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. CASO-STRICKLAN and the Board. The Board shall only alter the probationary period imposed by this Consent Agreement if: (1) MS. CASO-STRICKLAN has complied with ail aspects of this Consent Agreement; and (2) the Board determines that MS. CASO-STRICKLAN is able to practice according to acceptable and prevailing standards of safe nursing care without Board monitoring based upon an interview with MS. CASO-STRICKLAN and review of the reports required herein. Any period during which MS. CASO-STRICKLAN 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.
MS. CASO-STRICKLAN 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. CASO-STRICKLAN waives all of her rights under Chapter 119, ORC as they relate to
matters that are the subject of this Consent Agreement.
MS. CASO-STRICKLAN waives any and all claims or causes of action she may have against
the Board, and members, officers, employees and/or agents of either, arising out of inatters that are the subject of this Consent Agreement. This Consent Agreement is not an adjudication order as discussed in Chapter 119, ORC. However, 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.
Carol Ann Caso-Stricldan, R.N Page 7
EWECTIVE DATE
MS. CASO-STRICKLAN understands that this Cansent Agreement is subject to ratification by the Board prior to signature by the Board President and shall become effective upon the lasr date
of signature below
CAROL ANN CASO-STRICKLAN, R.N.
ho n y - k l h
w
DATE
DATE
Case #12-000274
July 27, 2012

Pamela Sue Swisher, L.P.N. 72 Woolery Ln. #B Dayton, Ohio 45415 Dear Ms. Swisher: 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: While working as a nurse at The Sanctuary at Wilmington Place in Dayton, Ohio (Sanctuary), you committed several medication errors, including the following: 1. On or about October 30, 2011, you removed two (2) tablets of Ativan (Lorazepam) and documented administration to Patient #1 at 8:00 A.M. The physician order called for one (1) tablet of Ativan. You did not document any Ativan waste. 2. The physician orders for Patient #2 prescribed a Clonidine 0.1 mg. Patch to be removed and replaced every seven (7) days. On or about November 4, 2011, you failed to remove and replace the Clonidine 0.1 mg. Patch given to Patient #2 on October 28, 2011. 3. On or about November 12, 2011 at 2:00 P.M., you failed to administer Patient #1s prescribed dose of Tramadol. 4. On or about November 12, 2011, a physician issued an order to you to increase Patient #3s Coumadin dose from 3 mg. to 5 mg. You incorrectly documented the order as increasing Patient #3s Coumadin dose by 5 mg., from 3 mg. to 8 mg. This resulted in Patient #3 receiving one (1) 8 mg. dose of Coumadin. 5. On or about January 7, 2012 at 2 P.M., you withdrew one (1) Tramadol tablet outside of the physician order, and administered it to Patient #4. You failed to document administering the Tramadol to Patient #4, and you did not document any waste. You incorrectly determined that Patient #4 had been prescribed Tramdol as needed, when the order called for one (1) tablet, two (2) times daily.
Pamela Sue Swisher, L.P.N. Page 2 6. On or about January 16, 2012, you failed to administer the 2 P.M. dose of Morphine Sulfate (Roxanol) to Patient #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 4723-4-04(B), Ohio Administrative Code (OAC), states that a licensed practical nurse shall maintain current knowledge of the duties, responsibilities, and accountabilities for safe nursing practice. 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 4723-4-04(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. 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.
Pamela Sue Swisher, L.P.N. Page 3 Sincerely,
Case #11-004687
July 27, 2012

Regina Anne Sword, L.P.N. 253 S. Eckard Road Dalton, Ohio 44618 Dear Ms. Sword: 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 May 22, 2012, in Wayne County Court of Common Pleas Case Number 12-CR-0013, you pled guilty to four (4) counts of Illegal Processing of Drug Documents, felonies of the fourth degree, in violation of Section 2925.23(B)(1), ORC; and four (4) counts of Deception to Obtain a Dangerous Drug, felonies of the fourth degree, in violation of Section 2925.22(A), 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. Illegal Processing of Drug Documents, felonies of the fourth degree, in violation of Section 2925.23(B)(1), ORC; and Deception to Obtain a Dangerous Drug, felonies of the fourth degree, in violation of Section 2925.22(A), 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
Regina Anne Sword, L.P.N. Page 2 PRACTICAL NURSE, PN-091431, 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 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 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 22, 2012, in Wayne County Court of Common Pleas Case Number 12-CR-0013, you pled guilty to four (4) counts of Illegal Processing of Drug Documents, felonies of the fourth degree, in violation of Section 2925.23(B)(1), ORC; and four (4) counts of Deception to Obtain a Dangerous Drug, felonies of the fourth degree, in violation of Section 2925.22(A), ORC, and were found eligible for Intervention in Lieu of Conviction. The acts underlying this case occurred in or about October and November 2011 and involve you making, uttering, selling, or possessing a false or forged prescription involving a Schedule I or II drug, not Marihuana. Further acts underlying this case involve you using deception to procure the administration of, a prescription for, or the dispensing of a dangerous drug included in Schedule I or II, not Marihuana. 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. 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
Regina Anne Sword, L.P.N. Page 3 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 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,
Case# 12-002559
July 27, 2012

Benita M. Thomas, (F.K.A. Benita M. Smith), L.P.N. 15912 Springs Village Blvd. Taylor, Michigan, 48180 And 31727 Hoover Rd. Apt. 24 Warren, MI, 48093 Dear Ms. Thomas: 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 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 for a minimum period of at least one (1) year. A. You were issued a license to practice nursing as a licensed practical nurse in the State of Ohio on May 24, 2011. B. Item 3. of the May 2011 Consent Agreement states, By September 1, 2011, MS. THOMAS shall, in addition to the requirements of licensure renewal, 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 Professional Accountability and Legal Liability for Nurses and ten (10) hours of Anger Kills (How to Overcome the Boiling Point). Despite this provision, as of June 15, 2012, you have failed to submit to the Board satisfactory documentation of successful completion of five (5) hours of Professional Accountability and Legal Liability for Nurses and ten (10) hours of Anger Kills (How to Overcome the Boiling Point). 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.
Benita M. Thomas (F.K.A. Benita M. Smith), L.P.N. Page 2 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 3. of the May 2011 Consent Agreement. YOU ARE FURTHER NOTIFIED THAT YOUR LICENSE TO PRACTICE NURSING AS A LICENSED PRACTICAL NURSE, PN-144850, 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 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 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 for a minimum period of at least one (1) year. 2. You were issued a license to practice nursing as a licensed practical nurse in the State of Ohio on May 24, 2011. 3. Item 3. of the May 2011 Consent Agreement states, By September 1, 2011, MS. THOMAS shall, in addition to the requirements of licensure renewal, 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 Professional Accountability and Legal Liability for Nurses and ten (10) hours of Anger Kills (How to Overcome the Boiling Point). Despite this provision, as of June 15, 2012, you have failed to submit to the Board satisfactory documentation of successful completion of five (5) hours of Professional Accountability and Legal Liability for Nurses and ten (10) hours of Anger Kills (How to Overcome the Boiling Point). 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.
Benita M. Thomas (F.K.A. Benita M. Smith), L.P.N. Page 3 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,
Judith A. Church, R.N., C.N.P. Supervising Member Certified Mail Receipt No. 7012 1010 0002 4225 4863 Second Address Certified Mail Receipt No. 7012 1010 0002 4225 4870 cc: Henry G. Appel, Assistant Attorney General
Case #lo-5784

17 South H ~ g h Street, Suite 400
www.nursi~~g.ohio.gw
Colulnbus, Ohlo 43215-7410 * (614) 466-3947
CONSENT AGREEMENT BETWEEN BENITA M. (SMITH) THOMAS, L.P.N. APPLICANT AND OHIO BOARD OF NURSING
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This Consent Agreement is entered into by and between BENITA M. ( S M I m ) 5 THOMAS, L.P.N. APPLICANT (MS. THOMAS) and the Ohio Board of ~ u r $ $ ~ (Board), the state agency charged with enforcing Chapter 4723. of the Ohio Revised Code (ORC), and all administrative rules promulgated thereunder.
:2
MS. THOMAS 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)(6), ORC, authorizes the Board to deny a license or othenuise 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, an act in another jurisdiction that would constitute a felony or a crime of moral turpitude in Ohio.
Benita M. (Smith) Thomas, L.P.N. Applicant Page 2 In December 2010, MS. THOMAS submitted to the Board an Application for Licensure by Examination to Practice in Ohio as a Licensed Practical Nurse.
B.
C.
MS. THOMAS knowingly and voluntarily admits that in December 2008, in Wayne County (Michigan), MS. THOMAS was convicted of one (1) amended misdemeanor count of Aggravated Domestic Violence. After completing the terms of the case, MS. THOMAS was released from probation in June 2009.
In her statement to the Board, MS. THOMAS indicated that her conviction stemmed from a physical altercation with her now former husband. MS. THOMAS further reported that the husband was the aggressor and that he assaulted her. MS. THOMAS indicated that she grabbed a knife and defended herself. MS. THOMAS also indicated that she has worked in the healthcare fieId for 17 years.
D.
E.
MS. THOMAS was permitted to take the NCLEX-PN, and on or about March 14,2011, MS. THOMAS 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. THOMAS knowingly and voluntarily agrees with the Board to the following terms, conditions, and limitations: Upon meeting the requirements for licensure, MS. THOMAS shall be granted a license to practice nursing as a licensed practical nurse in the State of Ohio. MS. THOMAS'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 at least one (1) year: 1.
MS. THOMAS shall obey all federal, state, and locaI laws, and all laws and rules governing the practice of nursing in Ohio. MS. THOMAS shall appear in person for interviews before the full Board or its designated representative as requested by the Board or its designee.
2.

3.
By September 1, 2011, MS. THOMAS shall, in addition to the requirements of licensure renewal, submit satisfactory documentation of successful completion of the following continuing education taken subsequent to the effective date of this Consent Agreement: five (5)
Benita M. (Smith) Thomas, L.P.N. Applicant Page 3
hours of Professional Accountability and Legal Liability for Nurses and ten (10) hours of Anger Kills (How to Overcome the Boiling Point).
Mental Health Evaluation

4.
Upon request by the Board or its designee and within ninety (90) days of such a request, MS. THOMAS shall, at her expense, obtain a
mental health evaluation that includes an anger management assessment from a mental health professional approved in advance by the Board or its designee. Further, MS. THOMAS shall provide the Board with complete documentation of this evaluation. Prior to the evaluation, MS. THOMAS shall provide the mental health professional with a copy of this Consent Agreement and shall execute releases to permit the mental health professional to obtain any information deemed appropriate and necessary for the evaluation. The mental health proiessional 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. THOMAS'S license, and a statement as to whether MS. THOMAS is capable of practicing nursing according to acceptable and prevailing standards of safe nursing care.
If an evaluation is requested, MS. THOMAS shall provide the Board

with satisfactory documentation of compliance with all aspects of the treatment plan developed by the mental health professional until released. Further, MS. THOMAS agrees that the Board may use the mental health professional's recommendations and conclusions from the evaluation as a basis for additional terms, conditions, and limitations on MS. THOMAS's license and that the terms, conditions, and limitations may be incorporated in an addendum to this Consent Agreement.
Empioyment Conditions 6.
7.
Prior to accepting employment as a nurse, each time with every employer, MS. THOMAS shall notify the Board. MS. THOMAS 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. THOMAS 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 July 1, 2011 or within thirty (30) days of accepting nursing employment. MS. THOMAS shall have her employer(s) send documentation to the Board, along with
Benita M. (Smith) Thomas, L.P.N. Applicant Page 4 the first employer report, of receipt of a copy of this Consent Agreement, including the date the Consent Agreement was received.

8.
MS. THOMAS shall report to the Board, in writing, any violation of

this Consent Agreement within thirty (30) days of the occurrence of the violation.
9.
MS. THOMAS shall sign release of information forms allowing health professionals and other organizations to submit the requested documentation directly to the Board. MS. THOMAS 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.
11.
MS. THOMAS shall not submit or cause to be submitted any false,

12.
MS. THOMAS 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.
13.
MS. THOMAS 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.
14.
MS. THOMAS shall verify that the reports and documentation

required by this Consent Agreement are received in the Board office.
15.
MS. THOMAS shall inform the Board within five (5) business days, in
Temporarv Practice Restrictions MS. THOMAS 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
Benita M. (Smith) Thomas, L.P.N. Applicant Page 5 individual or group of individuals who directly engage M S . T H O M A S to provide nursing services for fees, compensation, or other consideration or as a volunteer.
M S . T H O M A S 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 T O C O M P L Y M S . T H O M A S agrees that her license to practice nursing as a licensed practical nurse will be automatically suspended if it appears to the Board that M S . T H O M A S has violated or breached any terms or conditions of the Consent Agreement. Following the automatic suspension, the Board shall notify M S . T H O M A S via certified mail of the specific nature of the charges and automatic suspension of her license. Upon receipt of this notice, M S . T H O M A S 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, M S . T H O M A S 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.
DURATION1 MODIFICATION OF T E R M S
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. T H O M A S and the Board. The Board nlay only alter the probationary period imposed by this Consent Agrecment if: (1) the Board determines that MS. T H O M A S has complied with all aspects of this Consent Agreement; and (2) the Board determines that MS. T H O M A S is able to practice according to acceptable and prevailing standards of safe nursing care without Board monitoring, based upon an interview with M S . T H O M A S and review of the reports as required herein. Any period during which M S . T H O M A S 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.
Benita M. (Smith) Thomas, L.P.N. Applicant Page 6
MS. THOMAS 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. THOMAS waives all of her rights under Chapter 119, ORC, as they relate to matters that are the subject of this Consent Agreement. MS. THOMAS waives any and all claims or causes of action she may have against the Board, and its members, officers, employees andlor agents arising out of matters, which are the subject of this Consent Agreement.
EFFECTIVE DATE MS. THOMAS 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 sienature below.
DATE
I-
DATE
Case# 12-001741
July 27, 2012

Esther Torres, L.P.N. 6502 Haltnorth Walk #C Cleveland, Ohio 44104 Dear Ms. Torres: You are hereby notified that, on or about July 30, 2010, you entered into a Consent Agreement (July 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 May 2012. A. You were issued a license to practice nursing as a licensed practical nurse in the State of Ohio on August 2, 2010. B. Item 2. of the July 2010 Consent Agreement states, MS. TORRES 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, January 12, 2012, you failed to appear at the Boards office for your scheduled personal interview with your Board Monitoring Agent. You were sent a letter dated December 9, 2011, to your address of record notifying you of this scheduled personal interview. C. Item 3. of the July 2010 Consent Agreement states, By July 1, 2010, MS. TORRES 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 Ethics. Despite this provision, as of June 15, 2012, you have failed to submit to the Board satisfactory documentation of successful completion of ten (10) hours of ethics. 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.
Esther Torres, L.P.N. Page 2 In accordance with the paragraph under FAILURE TO COMPLY of the July 2010 Consent Agreement, you are hereby notified that it appears to the Board that you have violated Items 2. and 3. of the July 2010 Consent Agreement. YOU ARE FURTHER NOTIFIED THAT YOUR LICENSE TO PRACTICE NURSING AS A LICENSED PRACTICAL NURSE, PN-140697, 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 July 30, 2010, you entered into a Consent Agreement (July 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 May 2012. 2. You were issued a license to practice nursing as a licensed practical nurse in the State of Ohio on August 2, 2010. 3. Item 2. of the July 2010 Consent Agreement states, MS. TORRES 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, January 12, 2012, you failed to appear at the Boards office for your scheduled personal interview with your Board Monitoring Agent. You were sent a letter dated December 9, 2011, to your address of record notifying you of this scheduled personal interview. 4. Item 3. of the July 2010 Consent Agreement states, By July 1, 2010, MS. TORRES 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 Ethics. Despite this provision, as of June 15, 2012, you have failed to submit to the Board satisfactory documentation of successful completion of ten (10) hours of ethics.
Esther Torres, 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. 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,
Case #09-7137

www.nursing.ohio,gov
Colu~nbus, Ohio 43215-7410
(614) 466-3947
CONSENT AGREEMENT BETWEEN ESTHER TORRES, L.P.N. APPLICANT AND OHIO BOARD OF NURSING
This Consent Agreement is entered into by and between ESTHER TORRES, L.P.N. APPLICANT (MS. TORRES) 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. TORRES 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. On or about December 14, 2009, MS. TORRES submitted to the Board an Application for Licensure by Examination to Practice in Ohio as a Licensed hactical Nurse. MS. TORRES knowingly and voluntarily admits that:
B.
C.
Esther Torres, L.P.N. Applicant Page 2 On or about September 16, 2005, in Lyndhurst Municipal Court, MS. TORRES was convicted of Attempted Theft, Receiving Stolen Property and Possession of Criminal Tools, all misdemeanor offenses stemming from a retail theft incident. MS. TORRES has reported to the Board that her prior actions were terrible mistakes and she is now a changed person.
D.
MS. TORRES was permitted to take the NCLEX-PN, and on or about April 5,2010, MS. TORRES 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. TORRES knowingly and voluntarily agrees with the Board to the following terms, conditions, and limitations: Upon completion of the application process, which includes successfully passing the National Council Licensure Examination for Licensed Practical Nurses, MS. TORRES shall be granted a license to practice nursing as a licensed practical nurse in the State of Ohio. MS. TORRES'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 May 2012: 1.
MS. TORRES shall obey all federal, state, and local laws, and all laws and rules governing the practice of nursing in Ohio. MS. TORRES 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 Requirement

3.
By July 1, 2010, MS. TORRES shall, in addition to the requirements of licensure renewal, successfully complete and submit satisfactory documentation of successfui completion of the following continuing education taken subsequent to the effective date of this Consent Agreement: ten (10) hours of Ethics.
4.
Prior to accepting employment as a nurse, each time with every employer, MS. TORRES shall notify the Board.
5.
MS. TORRES 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.
Esther Torres, L.P.N. Applicant Page 3
TORRES 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 July 1, 2010 or within thirty (30) days of accepting nursing employment. MS. TORRES 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. Reporting Requirements of Licensee
6.
MS. TORRES shall report to the Board, in writing, any violation of this Consent Agreement within thirty (30) days of the occurrence of the violation. MS. TORRES shall sign release of information forms allowing health professionals and other organizations to submit the requested documentation directly to the Board. MS. TORRES 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. TORRES 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.
7.
10.
MS. TORRES 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. TORRES 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. TORRES shall verify that the reports and documentation required by this Consent Agreement are received in the Board office. MS. TORRES 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.
Esther Torres, L.P.N. Applicant Page 4
Tem~orarv Practice Restrictions MS. TORRES 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. TORRES to provide nursing services for fees, compensation, or other consideration or as a volunteer. MS. TORRES 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. TORRES agrees that her license to practice nursing as a licensed practical nurse will be automatically suspended if it appears to the Board that MS. TORRES has violated or breached any terms or conditions of the Consent Agreement. Following the automatic suspension, the Board shall notify MS. TORRES via certified mail of the specific nature of the charges and automatic suspension of her license. Upon receipt of this notice, MS. TORRES 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. TORRES 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 ail 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.

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. TORRES and the Board. The Board may only alter the probationary period imposed by this Consent Agreement if: (1) the Board determines that MS. TORRES has complied with all aspects of this Consent Agreement; and (2) the Board determines that MS. TORRES is able to practice according to acceptable and prevailing standards of safe nursing care without Board monitoring, based upon an interview with MS. TORRES and review of the reports as required herein. Any period during which MS. TORRES does not work in a position for
Escher Torres, L.P.N. Ayplicant Page5 1 which a nursing license is required slid1 not count towmd fulfilling the probationnry period imposed by tius Consent Agreement.
MS, TORRES chowle ledges that she has had an oppofi~it~lty (ask questions to
cotlcardlig the tenns of dlis Collseuc Aglzciueat aud that dl quescio~~s askskcd havc bccn aiswecediin a satisfactory manner.
MS. TOQRES waives all of her rights under Chapter 119, ORC,uthey relate to matters
that are the subject of this Consent Agreement. MS. TORRES waives any and 811 claims or causes of action she lntty liave against the B o ~ d and its rnertlbefc, offioerc, am ploy re^ ancVor agents :wising out of matters, which , are the subject of this Coasent Agreement.
Tlus Corisent Agreement shall be co~~sidered pubkic record as thiir term is wed in a Section 1k9.43, ORC. The informntion conrairied herein may be reported to appropriate organizac/ons, cLaca bulks and goverk~n~enral bodies.
This Confent Agreement is not an adjudication order ns discttssrrl in C.hapt,er 119, ORC. Any action initiated by tlle Bonrd based on alleged violations of this Cot~sent Agreerl~ent shdll cornp(y with the Adminisrra~ive Pcowdt~res Act, Chapter 119, ORC.
MS. TOBRESundersrands that this Consent Age431ixenr is subject to ratification by the

Board *dor to sipnatuk by the Board President and shall becoriie effective upon the last date of si~mtuce belaw.
-.BERTHA L,OVET.,ACE, President Ohi6 Board of Nursing
DATE
Case # 11-005350
July 27, 2012

Michelle Lynn Vacha, L.P.N. 392 Lake Forest Drive Bay Village, Ohio 44140 Dear Ms. Vacha: 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. Pursuant to an Order issued by the Board, effective September 23, 2011, your license to practice nursing as a licensed practical nurse was suspended for an indefinite period of time, but not less than one year, with conditions for reinstatement (September 2011 Order). A copy of the September 2011 Order is attached hereto and incorporated herein. The September 2011 Order was signed as received at your address of record on October 11, 2011. Despite this Order, you continued your employment as a licensed practical nurse at Suburban Pavilion Nursing and Rehabilitation Center, North Randall, Ohio. Specifically, on or about October 11, 2011 through December 27, 2011, you engaged in the practice of nursing, without a license to do so, by accepting compensation for over 500 hours worked while serving in the capacity of a licensed practical nurse. Section 4723.28(B)(2), ORC, authorizes the Board to discipline a licensee for engaging in the practice of nursing, having failed to renew a nursing license issued under Chapter 4723, ORC, or while a nursing license is under suspension. 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
Michelle Lynn Vacha 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, 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,
Judith A. Church, R.N., C.N.P. Supervising Member Certified Mail Receipt No. 7012 1010 0002 1688 cc: Henry G. Appel, Assistant Attorney General

IN THE MATTER OF: MICHELLE LYNN VACHA. L.P.N. ORDER: 2212 CASE # 2011-000426
ORDER
By letter, dated May 23, 201 1, notice was given to MICHELLE LYNN VACHA, L.P.N., that the Ohio Board of Nursing intended to consider disciplinary action regarding MS. VACHA's license to practice nursing as a licensed practical nurse in the State of Ohio, and that MS. VACHA 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. VACHA.
MS. VACHA did not submit a hearing request within thirty (30) days from the mailing of the
notice. Upon consideration of the charges stated against MICHELLE LYNN VACHA in the May 20, 201 1 Notice of Opportunity for Hearing and evidence supporting the charges, the Board finds that MS. VACHA 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. VACHA's license to practice nursing as a licensed practical nurse is hereby suspended for an indefinite period of time but not less than one (1) year with the conditions for reinstatement set forth below, and that following reinstatement, MS. VACHA's license shall be subject to a stayed suspension under the probationary terms, conditions, and limitations set forth below for a minimum period of three (3) years, with the Temporary Practice Restrictions set forth below.
REQUIREMENTS AND CONDITIONS FOR REINSTATEMENT

1. MS. VACHA shall obey all federal, state, and local laws, and all laws and rules governing the praclice of nursing in Ohio. 2. MS. VACHA shall appear in person for interviews before the full Board or its designated
Page 1 of 7
representative as requested by the Board or its designee. 3. Prior to requesting reinstatement by the Board, MS. VACHA shall submit a request to the Bureau of Criminal Identification and Investigation (BCII) to conduct a criminal records check of MS. VACHA, including a check of Federal Bureau of Investigation (FBI) records, and shall cause BCII to submit MS. VACHA's criminal records check reports to the Board. 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. Prior to requesting reinstatement by the Board, MS. VACHA 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. Prior to requesting reinstatement by the Board, MS. VACHA 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 other comparable courses approved in advance by the Board, taken subsequent to the effective date of this Order: fifteen (15) hours of Ethical Decision Making; six (6) hours of Professional Nursing Practice: Nurse Practice Acts, Professional Standards, And Code Of Ethics; and thirty (30) hours of Professional Ethics. Monitoring 6. Prior to requesting reinstatement by the Board, MS. VACHA shall, at her own 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. VACHA shall provide the psychiatrist with a copy of this Order and Notice of Opportunity for Hearing 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. VACHA's license, and a statement as to whether MS. VACHA is capable of practicing nursing according to acceptable and prevailing standards of safe nursing care.
7. MS. VACHA 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, the Board may utilize the professional's recommendations and conclusions from the evaluation as a basis for additional terms, conditions, and limitations on MS. VACHA's license.
Page 2 of 7
Reporting Requirements of MS. VACHA

8 . MS. VACHA shall sign release of information forms allowing health professionals and other organizations to submit requested documentation or information directly to the Board.
9. MS. VACHA 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. VACHA 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. 11. MS. VACHA 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. VACHA shall submit the reports and documentation required by this Order to the attention of the Compliance Unit, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, OH 43215-7410. 13. MS. VACHA shall verify that the reports and documenlation required by this Order are received in the Board office. 14. MS. VACHA shall inform the Board within three (3) business days, in writing, of any change in address andlor telephone number.
DURATION
The Board may only alter the indefinite suspension imposed if: (1) MS. VACHA submits a written request for reinstatement; (2) the Board determines that MS. VACHA has complied with all conditions of reinstatement; and (3) the Board determines that MS. VACHA is able to practice according to acceptable and prevailing standards of safe nursing care based upon an interview with MS. VACHA and review of the documentation specified in this Order.
Following reinstatement, the suspension shall be stayed and MS. VACHA's license shall be subject to the following probationary terms, conditions, and limitations for a minimum period of three (3) years.
1. MS. VACHA shall obey all federal, state, and local laws, and all laws and rules governing the practice of nursing in Ohio. 2. MS. VACHA shall appear in person for interviews before the full Board or its designated representative as requested by the Board or its designee.
Page 3 of 7
3. Prior to accepting employment as a nurse, each time with every employer, MS. VACHA - shall notify the Board. 4. MS. VACHA 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. VACHA 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. VACHA 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. VACHA

5. MS. VACHA shall sign releases of information forms allowing health professionals and other organizations to submit the requested documentation directly to the Board.
6. MS. VACHA 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.
7. MS. VACHA 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.
8. MS. VACHA 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. 9. MS. VACHA 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.
10. MS. VACHA shall verify that the reports and documentation required by this Order are received in the Board office. 11. MS. VACHA 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. Prior to working as a nurse, if requested by the Board or its designee, MS. VACHA shall complete a nurse refresher course or extensive orientation approved in advance by the Board.
Page 4 of 7
Temporarv Practice Restrictions
MS. VACHA 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. VACHA to provide nursing services for fees, compensation, or other consideration or as a volunteer.
MS. VACHA 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. VACHA's suspension shall be lifted and MS. VACHA's license to practice
nursing as a licensed practical nurse will be automatically suspended if it appears to the Board that MS. VACHA has violated or breached any terms or conditions of this Order. Following the automatic suspension, the Board shall notify MS. VACHA via certified mail of the specific nature of the charges and automatic suspension of her license. Upon receipt of this notice, MS.' VACHA may 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. VACHA has complied with all aspects of this Order; and ( 2 ) the Board determines that MS. VACHA is able to practice according to acceptable and prevailing standards of safe nursing care without Board monitoring, based upon an interview with MS. VACHA and review of the reports as required herein. Any period during which MS. VACHA 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 m d a y of September, 2 0 a .
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., 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 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
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 U d a y of September, 2011.
Betsy J. Houchen,R.N., MS., J.D. Executive Director Sevtember 23.201 1 Date
(SEAL)
Page 6 of 7
I hereby certify that a true and accurate copy of the foregoing Order, concerning MICHELLE
LYNN VACHA, was sent via certified mail, return receipt requested, this 3rd day of October,
2011 to MICHELLE LYNN VACHA, 392 Lake Forest Drive, Bay Village, OH 44140.
I also certify that a copy of the same was sent via regular U.S. mail this 3rd day of October, 201 1 to Lamont Pugh, SAC, Sanctions & Exclusions, Department of Health and Human Services, Office of Inspector General, Office of Investigations, P.O. Box 81020, Chicago, IL 60601-
81020.
Betsy J. Houchen, R.N., M S . , J.D. Executive Director
bal cc: Michelle T. Sutter, Assistant Attorney General
Certified Mail Receipt No. 701 1 1150 0000 9357 4422
Page 7 of 7
-, m nceninsd FOB
0 0 Rslurn Rscaipt Fee 0 (EndomsmsntRsqu~red)

R ~ s t d ~ t Osllvey Fee sd (Endorssment Required)
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MICHELLE VACHA 392 Lake Forest Drive Bay Village, OH 44140
Case # 10-5752
July 27, 2012

Kelly G. Waddell, L.P.N. 36300 Grafton Eastern Road Grafton, Ohio 44044 Dear Mr. Waddell: 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. On or about December 15, 2010, while working as a licensed practical nurse at Century Oak Care Center in Middleburg Heights, Ohio, you took a picture with your cell phone of a resident bending over naked and forwarded the picture to the cell phones of two co-workers. You were subsequently terminated from employment. On or about January 12, 2011, you were interviewed by a Board Compliance Agent and admitted to taking the picture of the resident, while he was bending over with his pants down. You stated you forwarded the picture to another employee because you thought it was funny and wanted to share. You stated you checked your cell phone later and realized you had also forwarded the picture to another co-worker who was off duty. Section 4723.28(B)(16), ORC, authorizes the Board to discipline a licensee for violation of this chapter or any rules adopted under it. Specifically, Rule 4723-4-04(H), Ohio Administrative Code (OAC), states a licensed practical nurse shall, maintain the confidentiality of client information obtained in the course of nursing practice. The licensed practical nurse shall communicate client information with other members of the health care team for health care purposes only. 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. Accordingly, the Board is authorized to impose one or more of the sanctions as cited in Section 4723.28 ORC.
Kelly G. Waddell, L.P.N. Page 2 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@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 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,
Case# 12-002726
July 27, 2012

Ryan Layne Walkin, R.N. 5211 Bridlington Toledo, Ohio 43623 Dear Mr. Walkin: 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. Under the May 2011 Consent Agreement, your license to practice as a registered nurse was reprimanded. A. Item 1. of the May 2011 Consent Agreement states, Within ninety (90) days from the effective date of this Consent Agreement, MR. WALKIN 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: five (5.4) [sic] hours of Professional Accountability and Legal Liability for Nurses; eight (8) hours of Legal & Ethical Dilemmas; and, one (1) hour in Ohio Law & Rules Series: On the Scope of Nursing Practice. Despite this provision, as of July 2 2012, you have not submitted documentation to the Board of completing five hours of Professional Accountability and Legal Liability for Nurses; eight hours of Legal & Ethical Dilemmas; and one hour in Ohio Law & Rules Series: On the Scope of Nursing Practice. Your Monitoring Agent mailed a letter to you on or about February 7, 2012 warning you that the documentation was not received. 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 3. of the May 2011 Consent Agreement states, MR. WALKIN agrees he will submit a request to the Bureau of Criminal Identification and Investigation (BCII) to conduct a criminal records check of MR. WALKIN, including a check of Federal bureau of Investigation (FBI) records, and shall cause BCII to submit MR. WALKINs criminal records check reports to the Board. MR. WALKINs completed criminal records check, including the FBI check, must be received by the Board within three (3) MONTHS following the effective date of the Consent Agreement.
Ryan Layne Walker, R.N. Page 2 Despite this provision, as of July 2, 2012, the Board has not received a completed criminal records check, including the FBI check, from BCII. Your Monitoring Agent mailed a letter to you on or about February 7, 2012 warning you that the criminal records check was not received. 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 Items 1. and 3. of the May 2011 Consent Agreement. YOU ARE FURTHER NOTIFIED THAT YOUR LICENSE TO PRACTICE NURSING AS A REGISTERED NURSE, RN #288620 IS HEREBY 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 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. Under the May 2011 Consent Agreement, your license to practice as a registered nurse was reprimanded. 2. Item 1. of the May 2011 Consent Agreement states, Within ninety (90) days from the effective date of this Consent Agreement, MR. WALKIN 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: five (5.4) [sic] hours of Professional Accountability and Legal Liability for Nurses; eight (8) hours of Legal & Ethical Dilemmas; and, one (1) hour in Ohio Law & Rules Series: On the Scope of Nursing Practice. Despite this provision, as of July 2, 2012, you have not submitted documentation to the Board of completing five hours of Professional Accountability and Legal Liability for Nurses; eight hours of Legal & Ethical Dilemmas; and one hour in Ohio Law & Rules Series: On the Scope of Nursing Practice. Your Monitoring Agent mailed a letter to you on or about February 7, 2012 warning you that the documentation was not received.
Ryan Layne Walker, R.N. Page 3 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 3. of the May 2011 Consent Agreement states, MR. WALKIN agrees he will submit a request to the Bureau of Criminal Identification and Investigation (BCII) to conduct a criminal records check of MR. WALKIN, including a check of Federal bureau of Investigation (FBI) records, and shall cause BCII to submit MR. WALKINs criminal records check reports to the Board. MR. WALKINs completed criminal records check, including the FBI check, must be received by the Board within three (3) MONTHS following the effective date of the Consent Agreement. Despite this provision, as of July 2, 2012, the Board has not received a completed criminal records check, including the FBI check, from BCII. Your Monitoring Agent mailed a letter to you on or about February 7, 2012 warning you that the criminal records check was not received. 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 email address, hearing@nursing.ohio.gov.
Ryan Layne Walker, R.N. Page 4 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,
Case #2011-000918
Ohio Board of S ~ l r ~ i n g w,vw.,,t,rsing,ohio.gn~

17 South I.ligh Si.rcet.Sl~ile 400
0
Coii~rnbus. C)liio 43215-74.10
(614) 466-1947
CONSENT AGREEMENT BETWEEN RYAN LAYNE WALKIN, R.N. AND OHIO BOARD OF NURSING
This Consent Agreement is entered into by and between RYAN LAUNE WALKIN, R.N. (MR. WALKIN) 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.
MR. WALKIN voluntarily enters into this Consent Agreement being fully informed of his 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 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. In February 2000, MR. WALKIN was first issued his license to practice nursing as a registered nurse, RN 288620. MR. WALKIN's nursing license has been lapsed since September 2003. In March 201 1, MR. WALKIN submitted an application to reactivate or reinstate his nursing license (Application).
B.
C.
Ryan Layne Walkin, R.N. Page 2
D.
MR. WALKIN ltnowingly and voluntarily admits that on his Application, he reported that in November 2010, in Lucas County Court of Common Pleas Case No. G-4801-CR-0201001801-00, MR. WALKIN pled no contest to and was found guilty of Non-Support of Dependents, a fifthdegree felony, in violation of Section 2919.21fB) & (G)(l), ORC. The Board is in receipt of a letter from Joni Wysocki, Nonsupport Initiatives Program, Probation Officer, Lucas County Court of Common Pleas, dated March 25, 201 1. The letter reports that MR. WALKIN's Community Control terms, in part, require him to reinstate his nursing license. The letter further indicates that although MR. WALKIN reports to his scheduled probation meetings and consistently remits payments for his court costs, he has failed to meet his full monthly chiid support order ($1,062.63) every month since the onset of his Community Control supervision in December 2010. A review of pertinent court documents indicate that MR. WALKIN is subject to Community Control terms for a period of five (5) years, beginning in November 2010, and that as of the date of the drafting of this Consent Agreement, MR. WALKIN has not been cited with any Community Control violations. MR. WALKIN further knowingly and voluntarily admits that in July 2009, in Toledo (Ohio) Municipal Court Case No. CRA-09-08963-0202, he pled no contest to and was found guilty of one (1) count of Passing Bad Checks, a first-degree misdemeanor, in violation of Section 2913.1 1, ORC. MR. WALKIN has reposted to the Board that this conviction stemmed from him writinglissuing a check on an account containing insufficient funds. After review of all pertinent information, the Board Supervising Member for Discipline Matters has recommended that MR. WALKXN7s nursing license may be renewed after he has signed this Consent Agreement and upon completion of the renewal process. AGREED CONDITIONS
E.
F.
G.
H.
Wherefore, in consideration of the foregoing and mutual promises hereinafter set forth, and in lieu of any formal proceedings at this time, MR. WALKIN knowingly and voluntarily agrees with the Boasd to the following terms, conditions and limitations: upon meeting the requirements for renewayreinstaternent, MR. WALKIN's nursing license shall be renewedreinstated, and said license shall be REPRIMANDED.
1. Within ninety (90) days from the effective date of this Consent Agreement, MR. WALKIN shall, in addition to the requirements of licensure renewal,
Ryan Layne Walkin, R.N. Page 3 successfully complete and submit satisfactory documentation of successful completion of the following continuing education taken subsequent to the effective date of this Consent Agreement: five (5.4) hours of Professional Accountability and Legal Liability for Nurses; eight (8) hours of Legal & Ethical Dilemmas; and, one (1) hour in Ohio Law & Rules Series: On the Scope of Nursing Practice. 2. Prior to working in a position that requires a nursing license, MR. WALKIN shall 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.
3 . MR. WALKIN agrees that he will submit a request to the Bureau of Criminal Identification and Investigation (BCII) to conduct a criminal records check of MR. WALKIN, including a check of Federal Bureau of Investigation (FBI) records, and shall cause BCII to submit MR. WALKIN's criminal records check reports to the Board. MR. WALKIN's completed criminal records check, including the FBI check, must be reeeived by the Board within three (3)
MONTHS following the effective date of the Consent Agreement.

4. MR. WALKIN shall comply with the terms of his Community Control ordered in Lucas County Court of Common Pleas Case No. G-4801-CR-0201001801-00.
FAILURE TQ COMPLY MR. WALKIN agrees that his license to practice nursing as a registered nurse will be automatically suspended if it appears to the Board that MR. WALKIN has violated or breached any terms or conditions of the Consent Agreement. Following the automatic suspension, the Board shall notify MR. WALKIN via certified mail of the specific nature of the charges and automatic suspension of his license. Upon receipt of this notice, MR. WALKIN 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, MR. WALKIN 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.
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. WALKIN and the Board.
Ryan Layne Walkin, R.N. Page 4
ACKNOWLEDGMENTS/LIABILDY RELEASE
MR. WALKIN 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. WALKIN waives all of his rights under Chapter 119, ORC, as they relate to matters that are the subject of this Consent Agreement.
MR. WALKIN waives any and all claims or causes of action he may have against the Board, of and its members, officers, employees andlor agents arising out of matters that are the s~ibject 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
MR. WALKIN understands that this Consent Agreement is subject to ratification by the Board
DATE
/A /be
, /
BERTHA LOVELACE, President Ohio Board o f Nursing
DATE
Case #12-002881
July 27, 2012

Julie Anne Waller, R.N. 121 W. Letson St. Kenton, Ohio 43326 Dear Ms. Waller: 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 May 21, 2012, in Hardin County Court of Common Pleas Case Number CRI 20112088, you were found guilty of one (1) count of Trafficking in Heroin, a felony of the fifth degree, in violation of Section 2925.03(A)(1), (C)(6)(a), ORC; and one (1) count of Permitting Drug Abuse, a felony of the fifth degree, in violation of Section 2925.13(A), (C)(3), ORC. On or about May 21, 2012, in Hardin County Court of Common Pleas Case Number CRI 20112089, you were found guilty of one (1) count of Trafficking in Heroin, a felony of the fifth degree, in violation of Section 2925.03(A)(2), (C)(6)(a), ORC; and one (1) count of Permitting Drug Abuse, a felony of the fifth degree, in violation of Section 2925.13(A), (C)(3), 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. Trafficking in Heroin, felonies of the fifth degree, in violation of Section 2925.03(A)(1), (C)(6)(a), ORC and Section 2925.03(A)(2), (C)(6)(a), ORC; and Permitting Drug Abuse, felonies of the fifth degree, in violation of Section 2925.13(A), (C)(3), ORC, constitute felony drug abuse offenses as defined in Section 2925.01, ORC.
Julie Anne Waller, R.N. Page 2 WHEREFORE, PURSUANT TO SECTION 3719.121(C), ORC, YOU ARE HEREBY NOTIFIED THAT YOUR LICENSE TO PRACTICE NURSING AS A REGISTERED NURSE, RN-329823, 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 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 21, 2012, in Hardin County Court of Common Pleas Case Number CRI 20112088, you were found guilty of one (1) count of Trafficking in Heroin, a felony of the fifth degree, in violation of Section 2925.03(A)(1), (C)(6)(a), ORC; and one (1) count of Permitting Drug Abuse, a felony of the fifth degree, in violation of Section 2925.13(A), (C)(3), ORC. On or about May 21, 2012, in Hardin County Court of Common Pleas Case Number CRI 20112089, you were found guilty of one (1) count of Trafficking in Heroin, a felony of the fifth degree, in violation of Section 2925.03(A)(2), (C)(6)(a), ORC; and one (1) count of Permitting Drug Abuse, a felony of the fifth degree, in violation of Section 2925.13(A), (C)(3), ORC The acts underlying Case Number CRI 20112088 occurred on or about September 14, 2010, and involve you selling, or offering to sell, Heroin, or a compound, mixture, preparation, or substance containing Heroin. Further acts underlying this case involve you permitting your vehicle to be used for the commission of a felony drug abuse offense. The acts underlying Case Number CRI 20112089 occurred on or about August 2, 2010, and involve you transporting or delivering Heroin, or a compound, mixture, preparation, or substance containing Heroin, when you knew or had reasonable cause to believe that the controlled substance was intended for sale or resale. Further acts underlying this case involve you permitting your vehicle to be used for the commission of a felony drug abuse offense. 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.
Julie Anne Waller, R.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 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,
Case # 12-001601, 09-3660
July 27, 2012

Amy Kathleen Will, R.N. 2910 Campbell St. Sandusky, Ohio 44870 Dear Ms. Will: 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 July 13, 2009, you submitted a pre-employment drug screen specimen that was positive for Marijuana. 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 March 27, 2012, while working as a nurse at Firelands Regional Medical Center in Sandusky, Ohio, you admitted to taking Percocet 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. 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.
Amy Kathleen Will, 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 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,
Case #12-000860
July 27, 2012

Stephanie Woods, R.N. Applicant 31075 Wellington Drive Apt 30303 Novi, MI 48377 Dear Ms. Woods: In accordance with Chapter 119, 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 a licensure, permanently revoke, suspend, or place restrictions on a license to practice nursing as a registered nurse granted to you; 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 February 2012, you submitted an Application for Licensure by Examination to Practice Nursing as a Registered Nurse in Ohio and that Application is pending before the Board. a) The State of Michigan Department of Community Health Bureau of Health Professions Board of Nursing (Michigan Board) issued a Consent Order and Stipulations (Michigan Board 2009 Order) that became effective on or about January 27, 2009 and imposed a fine and probationary terms on your license to practice nursing as a licensed practical nurse in that state. Copies of the Michigan Board 2009 Order and the related Administrative Complaint are attached hereto and incorporated herein. Section 4723.28(B)(1), ORC, authorizes the Board to deny a license or otherwise 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.
Stephanie Woods, R.N. Applicant 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 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 application; revoke, permanently revoke, suspend or place restrictions on a license to practice nursing as a registered nurse granted to you; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely,
STATE OF MICHIGAN DEPARTMENT OF COMMUNITY HEALTH BUREAU OF HEALTH PROFESSIONS BOARD OF NURSING DISCIPLINARY SUBCOMMITTEE In the Matter of STEPHANIE WOODS, L.P.N. License Number: 47-03-059179 File Number: 47-08-108353 CONSENT ORDER AND STIPULATION CONSENT ORDER WHEREAS, an Administrative Complaint, hereafter Complaint, was issued on October 7, 2008, charging Stephanie Woods, L.P.N., hereafter Respondent, with having violated sections 16221(a), 16221(b)(i), Z6221(b)(vi), 16221(c)(iii), 16221(e)(i), and 16221(h) of the Public Health Code, 1978 PA 368, as amended; MCL 333.1 101 and
m;
WHEREAS, Respondent neither admits nor denies the allegations of fact and law as set forth in the Complaint dated October 7, 2008, but agrees that the Disciplinary Subcommittee of the Michigan Board of Nursing, hereafter Disciplinary Subcommittee, shall treat the allegations as true for purposes of this Consent Order, which finding shall have the same force and effect as if evidence and argument were presented in support of the allegations; and
- - - - - --
WHEREAS, the 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, .,q c- .; i: (.k ,',A,(~,~i!j :',4 3 l r i l ,
,!(~i,~ :\.i ,~;)i,js 1.y
IT IS HEREBY FOUND that the allegations of fqct and law set forth in the Complaint are true for the purposes of this Consent Order and constitute violations of 6221(b)(i), 16221(b)(vi), 16221(c)(iii), 16221(e)(i) and 16221(h) of the sections 16221(a), I Public Health Code, m.
Accordingly,
IT IS HEREBY ORDERED that, for the aforesaid violations of the Public Health Code, Respondent is placed on PROBATION for a period of ONE YEAR, commencing on the effective date of this Order. Reduction of the probationary period shall only occurwhile Respondent is employed as a nurse, The terms of probation shall be as follows:
I .
CONTINUING EDUCATION. Respondent shall successfully complete one continuing education course accepted by the Michigan Board of Nursing, hereafter Board, in each of the following areas: a) professional accountability; and b) legal liability. This continuing education shall be completed during the probationary period, and shall not 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 regards to the continuing education relating to professional accountability, Respondent may successfully complete "Professional -Accountability" offered bythe National Council of StaicBoara's of Nursing, available at w.learninnext.com or request preapproval of a comparable continuing education course. Respondent shall mail requests for approval of the continuing education and proof of successful completion of the continuing education to the Department of Community Health, hereafter Department. at the address set forth below.
2.
EMPLOYER REPORTS. In the event Respondent is employed as a nurse. Respondent shall immediatelv provide a copv of this ~ r d e r ' a n d 'the Complaint dated 0ctober 7, 2008: 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, at any time, fails to comply with 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 change requires Respondent to have a license to practice as a nurse. Respondent shall provide a copy of this Order and the Complaint dated October7,2008, to each successor employer and supervisor, if the employment requires Respondent to have a nursing license. he successor employer or supervisor shall be knowledaeable of- Resoondent's histow and shall continue to file reports with the Department idvising of Respondent's work performance, as set forth above.
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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 becoming 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 of 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. RESIDENCY AND PRACTICE OUTSIDE MICHIGAN. Periods of residencvand ~ractice outside Michiaan shall not reduce the peribd of this Order. Respondent shall report any changes of residency or practice outside Michigan no more
5.
6.
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.
7.
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 filed at the end of the third month of probation, and subsequent reports to be filed every three months thereafter until Respondent is discharged from probation. 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 shall direct all communications required by the terms o f this Order, except fines, to: Department o f Community Health, Bureau of Health Professions, Sanction Monitoring, P.O.Box 30670, Lansing, MI 48909. The timely filing of all information relatingto this Order shall be ~ e s ~ o n d e n tresponsibility, and failure to file said information 's within the time limitations herein provided shall be deemed a ar~ violation of an order of the ~ i s c i ~ i i nSubcommittee.
8.
COSTS. Respondent shall be solely responsible for payment of ail costs incurred in complying with the terms of this Order.
IT IS FURTHER ORDERED that Respondent shall be automatically discharged from probation atthe end of the probationary period, PROVIDED Respondent has complied with ihe ierrrls of this Order and has not violated the Public Health Code.
IT IS FURTHER ORDERED that for the aforesaid violations of the Public Health Code, Respondent shall perform 80 hours of Board-approved COMMUNITY SERVICE within six months of the effective date of this Order. Prior to Respondent
performing the community service, Respondent shall obtain pre-approval of the proposed community service from the Chairperson of the Board or the Chairperson's designee.
IT IS FURTHER ORDERED that Respondent shall mail requests for preapproval of the proposed community service and proof of the successful completion of community service to the Department of Community Health, Bureau of Health Professions, Sanction Monitoring, P.O. Box 30670, Lansing, MI 48909.
IT IS FURTHER ORDERED that for the aforesaid violations of the Public Health Code, Respondent is FINED in the amount of $1,000.00 to be paid to the State of Michigan within one year of the effective date of this Order.
IT IS FURTHER ORDERED that the fine shall be mailed to the Department of Community Health, Bureau of Health Professions, Sanction Monitoring, P.O. Box
30185, Lansing, MI 48909. The fine shall be paid by check or money order made payable
to the State of Michigan, and the check or money order shall clearly display the file number
47-08-108353.
IT IS FURTHER ORDERED that in the event Respondent is issued a registered nurse license while this Order is in effect, the registered nurse license shall be subject to all terms of this Order.
IT IS 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 promulgatedthereunder, the Disciplinary Subcommittee may proceed to take disciplinary action pursuant to 1996 AACS, R 338.1632 and section 16221(h) of the Public Health Code, 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:
3
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MICHIGAN BOARD OF NURSING Bv: ' chairperson, Disciplinary Subcommittee STIPULATION
1.
Respondent neither admits nor denies the allegations offact and law
contained in the Complaint dated October 7, 2008, but agrees that the Disciplinary Subcommittee shall treat the allegations as true for purposes of this Consent Order, which finding shall have the same force and effect as if evidence and arguments were presented in support thereof.
2.
Respondent understands and intends that by signing this Stipulation
Respondent is waiving the right, pursuant to the Public Health Code, the rules promulgatedthereunder, and the Administrative Procedures Act of 1969,1969 PA 306, as amended; MCL 24.201
mseq, Department to prove the charges set forth in to require the

f,.;
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the Complaint by presentation of evidence and legal authority, and to appear with an
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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
report pursuant to the foregoing Consent Order to release to the Department and tlie Department of Attorney General any and all information necessaryforfull compliance with the foregoing Consent Order and to assure the protection of the public health, safety, and welfare.
I
I
4.
Factors taken into consideration in the formulation of the within
Consent Order are as follows: Respondent admitted that she was working as a graduate nurse when the facility promoted her. Respondent stated that the facility promoted her because she was a good nurse. Respondent stated that she accepted the promotions based on financial hardship. Respondent stated that she is the sole provider for her family; her husband is a diabetic who went blind and requires dialysis, and her son has leukemia-like symptoms. Respondent had to file for bankruptcy. Additionally, Respondent has not been able to obtain her transcript for her registered nurse license because she still owes tuition. Respondent denied that she misrepresentedthat she had gotten married, but stated that it has been a burden to carry the fact that she was not honest about her license status. Respondent expressed remorse for her conduct. Respondent has been a licensed practical nurse since 1985 and has a pending application for licensure as a registered nurse license. Respondent has no other complaints or allegationsagainst her license.
5.
Linda Tafi, R.N., a member of the Board who supports this proposal,
and the Department's representative are both free to discuss this matter with the Disciplinary Subcommittee and recommend acceptance of the resolution set forth in the foregoing Consent Order.
6.
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
7.
The foregoing proposal is conditioned upon acceptance by the
Disciplinary Subcommittee, Respondent and the Department expressly reservingthe right to further proceedings without prejudice should the Consent Order be rejected.
AGREED TO BY:
AGREED TO BY:
d& /&. , . k/
Melanie B. Brim, Director Bureau of ~ e a l t h Professions Department of Community Health Dated: State o f " ~ i c h i ~ a n ) County of b l l d )
ss
2%d,d
Stephanie Woods, L.P.N. ~espondent
Dated:
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On the &"day of , before me, a Notary Public in and for said county, appeared@tephani&Voods, L.P.N., who, upon oath, stated that she has read the foregoing Consent Order and Stipulation by her subscribed, that she knows the contents thereof to be true, and that the signing of said Consent Order and Stipulation is her free act and deed. n I\
M,
Notary P u b l i c ~ County O ~ State of Michigan MYCommission expires -b'dfo" 2 1 01

This is the last and final page of a Consent Order and Stipulation in the matter of Stephanie Woods. L.P.N., File Number 47-08-108353 before the Disciplinaiy Subcommittee of the Michigan Board of Nursing. consisting of nine pages, this page included.
SR
STATE OF MlCHlGAN DEPARTMENT OF COMMUNIN HEALTH BUREAU OF HEALTH PROFESSIONS BOARD OF NURSING DISCIPLINARY SUBCOMMITTEE In the matter of STEPHANIE WOODS, L.P.N. License Number: 47-03-059179
.E
File Number: 47-08-108353
ADMINISTRATIVE COMPLAINT NOW COMES fhe Michigan Department of Community Health, hereafter Complainant, by Melanie B. Brim, Director, Bureau of Health Professions, and files this complaint against Stephanie woods, L.P.N., hereafter Respondent, alleging upon information and belief as follows:
1,
The Michigan Board of Nursing,
hereafter Board, I an s
administrative agency established by the Public Health Code, 1978 PA 368, as

amended; MCL 333.1101
m.Pursuant to section 16226 of the Public Health Code,
m,the Board's Disciplinary Subcommittee is empowered to discipline licensees for

violations of the Public Health Code.
2.
Respondent is currently licensed to practice as a licensed practical licensed to practice as a reg;stered

1~
nurse in the state of Michigan. Respondent is nurse in the state of n/lfchigan.

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3.
"Good moral character" is defined at section 1 of 1974 PA 38, as as the propensity on the part of the person to serve the
amended; MCL 338.41
public in the licensed area in a fair, honest and open manner.
4.
Section 17211(2) of the Public Health Code,
m,provides, in
pertinent part, that the following words, titles, or letters, are restricted to use only to those persons authorized by Article 15 of the Public Health Code: "registered professional nurse", "registered nurse", and "r.n."
5.
In March 1987, Respondent began employment as a licensed
practical nurse at Sinai-Grace Hospital, hereafter facility, in Detroit, Michigan.
6.
In September 2001, upon Respondent earning an associate's
degree, the facility promoted Respondent to a registered nurse and clinical manager, a position consistent with a registered nurse overseeing staff.
7.
From September 9, 2001, through April 15, 2008, Respondent
represented herself as a registered nurse and worked at the facility as a registered nurse and clinical manager without a registered nurse license.
8.
In April 2008, pursuant to a Joint Commission on Accreditation of
Healthcare Organizations review, the facility reviewed employee licenses and noticed that Respondent's license information was different from the information she provided with the registered nurse license. Afler allowin Res ondent an opportunity to explain
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the differences, which she was unable to do, the facility concluded that the information in Respondent's file was for a different person with the same first name as Respondent.
9.
On April 15, 2008, Respondent resigned in lieu of termination from
facility employment for practicing as a registered nurse without a license and for assuming the identify of another registered nurse for the purpose of providing the facility with a Michigan registered nursing license number. The facility subsequently reported Respondent's resignation to Complainant pursuant to section 20175(5)(b) of the. Public. Health Code, ,. -
COUNT l Respondent's conduct, as set forth above, evidences a violation of general duty, consisting of negligence or failure to exercise due care, including negligent delegation to or supervision of employees or other individuals, whether or not injury results, in violation of section 16221(a) of the Public Health Code, a.
COUNT ll Respondent's conduct, as set forth above, evidences a departure from, or
health profession, whether or not actual injury to an individual occurs, in violation of section 16221(b)(i) of the Public Health Code, m.
COUNT Ill Respondent's conduct, as set forth above, evidences a lack of good moral character, in violation of section 16221(b)(vi) of the Public Health Code, supra.
COUNT IV Respondent's conduct, as set forth above, evidences practice outside the scope of a license, in violation of section 16221(c)(iii) of the Public Health Code, supra.
I
I
I
COUNT V Respondent's conduct, as set forth above, evidences unprofessional conduct involving misrepresentation to a consumer or patient, in violation of section
. 16221(e)(i) of the Public Health Code, supra.
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COUNT VI Respondent's conduct, as set forth above, evidences practice as a registered nurse without a valid license, contrary to section 17211 of the Public Health Code, supra, in violation of section 1622f(h) of the Public Heaith 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
!I
Public Health Code, rules promulgated thereunder, and the Administrative Procedures Act of 1969, 1969 PA 306, as amended; MCL 24.201 etsecr.
RESPONDENT IS HEREBY NOTIFIED that, pursuant to section 16231(7) of the Public Health Code, m,Respondent has 30 days from the date of receipt of
I
this Complaint to submit a written response to the allegations contained herein. The written response shall be submitted to Complainant, Melanie B. Brim, Director, Bureau of Health Professions, Department of Community Health, P.O. Box 30670, Lansing, MI
48909.
.. .
,
RESPONDENT IS FURTHER NOTIFIED that, pursuant to section 16231(8) of the Public Health Code, w,Respondent's 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 transmitt'al of this Complaint directly to the Board's Disciplinary Subcommittee for imposition of an appropriate sanction.
:. . .
I
DATED:
"
7 ZOOCd 1
~APJ Melanie B. Brim, Director Bureau of Health Professions
&h
This is the last and final page of an Administrative Comolaint in tho matter of Stephanie Woods, L.P.N., before the Disciplinary Subcommittee of the Michigan Board of Nursing, File Number 47-08-108353. consisting of five pages, this page included.
Case #11-004789
July 27, 2012
Theresa C. Worrell, R.N., L.P.N. 837 Virginia Avenue Vandalia, Ohio, 45327 And 837 Virginia Avenue Vandalia, Ohio 45377-3-17 Dear Ms. Worrell: 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 June 5, 2012, in Montgomery County Court of Common Pleas Case Number 2012 CR 00221, 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.
Theresa C. Worrell, R.N., L.P.N. Page 2 WHEREFORE, PURSUANT TO SECTION 3719.121(C), ORC, YOU ARE HEREBY NOTIFIED THAT YOUR LICENSES TO PRACTICE NURSING AS A REGISTERED NURSE, RN-338767, AND AS A LICENSED PRACTICAL NURSE, PN-124308, ARE 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 Sections 4723.03(A) and/or (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 licenses to practice 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 June 5, 2012, in Montgomery County Court of Common Pleas Case Number 2012 CR 00221, 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 between May 2011 and November 18, 2011, and involve you obtaining or exerting control over Dilandid [sic]without the consent of the owner to wit: Kindred Hospital or person authorized to give consent. 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 December 20, 2011, you admitted to a Board Compliance Agent that beginning in or about April 2011, you diverted Dilaudid from Kindred Hospital in Dayton, Ohio, where you worked as a nurse. You admitted to withdrawing then administering only a partial dose of Dilaudid to patients. You admitted that the remainder of the dose you placed in a vial and diverted. You stated that you diverted approximately two (2) ml to three (3) ml of Dilaudid three (3) to four (4) times per week. You stated that you only diverted from patients whose condition did not require a full dose of Dilaudid. You admitted to falsely documenting the patients condition to justify withdrawing a full dose of Dilaudid.
Theresa C. Worrell, R.N., L.P.N. Page 3 In a written statement, dated December 20, 2011, you wrote, I would use the doses I gave to patients and give them a partial dose and take the rest home for my use. The last time I used dilaudid was November 18th, 2011. 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)(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(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), Ohio Administrative Code, 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), 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. 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 Immediate Suspension and Opportunity for Hearing, deny, permanently revoke, revoke, suspend or place restrictions on your licenses to
Theresa C. Worrell, R.N., L.P.N. Page 4 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,
Certified Mail Receipt No. 7012 1010 0002 4225 4719 Second Address Certified Mail Receipt No. 7012 1010 0002 4225 4726 cc: Henry G. Appel, Assistant Attorney General

Notices Ohio Nursing Board July 2012

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Notices Ohio Nursing Board July 2012

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Case #11-003446

July 27, 2012

NOTICE OF OPPORTUNITY FOR HEARING

July 27, 2012

NOTICE OF OPPORTUNITY FOR HEARING

Gail Lynn Allen, R.N. Page 2

Gail Lynn Allen, R.N. Page 3

Judith A. Church, R.N., C.N.P. Supervising Member

Gail Lynn Allen, R.N. Page 4

July 27, 2012

NOTICE OF OPPORTUNITY FOR HEARING

July 27, 2012

NOTICE OF OPPORTUNITY FOR HEARING

Ohio Board of Nursing

Coli~mhus. Ohio 4321.5-7410

BASIS FOR ACTION

Krzlly Ann Armstrong, R.N Page 2

CONDITIONS FOR REINSTATEMENT

Kelly Ann Armstrong, R.N. Page 3

Monitoring of Rehabilitation and Treatment

Psychiatric Evaluation and Treatment

Kelly Ann Armstrong, R.N. Page S

Reporting Requirements of Licensee

Kelly Ann Amstrong, R.N. Page 6

e l l y Ann Annstrong, R.N. Page 8

CYNTHIA A. KRUEGER, President Ohio Board of Nursing

NOTICE OF OPPORTUNITY FOR HEARING

Bertha Lovelace, R.N., B.A., C.R.N.A. Supervising Board Member

July 27, 2012

NOTICE OF OPPORTUNITY FOR HEARING

June 26, 2012

NOTICE OF IMMEDIATE SUSPENSION AND OPPORTUNITY FOR HEARING

Judith A. Church, R.N., C.N.P. Supervising Board Member

July 27, 2012

NOTICE OF AUTOMATIC SUSPENSION AND OPPORTUNITY FOR HEARING

Ohio Board of Nursing

C:c.~lr~iiibus. Ohio 43215-7410

BASIS FOR ACTION

Diana Lynn Von Bauer, L.P.N Page 3

Diana Lynn Von Bauer, L.P.N Page 5 15.

Diana Lynn Von Bauer, L.P.N Page 6

DURATION1 MODIFICATION OF TERMS

BERTHA LOVELACE, President Ohio Board of Nursing

July 27, 2012

NOTICE OF OPPORTUNITY FOR HEARING

July 27, 2012

NOTICE OF OPPORTUNITY FOR HEARING

July 27, 2012

NOTICE OF OPPORTUNITY FOR HEARING

Robin Brown Medicaid Provider No. 2793722

THEOHIO DEPARTMENT JOBAM) FAMILY OF SERVICES 30 EAST BROADSTREET a g

z! l . ax Docket No.: IOHCSI 8C ,

~e~artmeit of Family Services

PROPOSED ADJUDICATION ORDER For Termination of Provider Agreement

..." the violations listed in (D)(l)

30 East Broad Street Columbus, Ohio 43215 jfs.ohio.gov

An Equal Opportunity Employer and Service Provider

Department of J O and Farnify Services ~

IN THE MAllER OF:

DOCKET NO. 10HCS18

In the matter of Robin Brown Adjudication Order

July 28, 2010

Date of Joumalization and Effective Date of Order

Appeals Coordinator Date of certification