Nurse Loses License After Tampered With Demerol Found

After a hearing which occurred on August 11, 1993, on August 17, 1993 the Arkansas State Board of Nursing entered its Order suspending Susan Jayne Bohannon’s nursing license in Arkansas. The Arkansas State Board of Nursing ordered that Susan Jayne Bohannon’s nursing license in Arkansas be suspended for three years with conditions placed on reinstatement.
The findings of fact made by the Board are not abstracted.

Bohannon was charged with violating Ark.Code Ann. § 17-86-309(a)(4) and (6) as being “habitually intemperate or … addicted to the use of habit forming drugs” and “guilty of unprofessional conduct” based upon the following:

During but not limited to July 1992, while employed by Bates Memorial Hospital, Bentonville, Arkansas, [she] did make false or failed to correct documentation as to the administration of narcotics. 2. During the aforementioned time, [she] did divert controlled substances such as Demerol from her employer. 3. Prior to employment at Bates Hospital, respondent was employed at Eureka Springs Hospital, where she did make false or failed to make correct documentation as to the administration of narcotics.

Jim Bona, an investigator for the Arkansas Department of Health, testified that on July 1, 1992, Rick DeFreece, Director of Pharmacy at Bates Memorial Hospital, submitted seven vials of meperidine hydrochloride (Demerol) for quantitative analysis. All seven vials were obtained from the emergency room controlled drug supply. The Arkansas Department of Health Toxicology Laboratory report found that all seven vials were adulterated. Subsequently, audit procedures were put in place, and inventories were checked by the hospital pharmacy at least once, and more often twice daily.

On July 7, 1992, the pharmacy director found three vials of Demerol from a medicine cart on the medical/surgical unit that appeared to have been tampered with in the same manner as those from the emergency room. These vials were submitted to the Toxicology Laboratory for testing, and it was determined that one of the vials was adulterated.

Hospital records and testimony from Salena Wright, Nurse Manager of the Emergency Department, indicated that Bohannon worked in the emergency department until June 30, 1992, at which time she was transferred to the medical/surgical unit. Ms. Wright stated that Bannon was transferred because she was not performing well in the emergency room and was having problems getting along with physicians and other nurses. Hospital records indicated that Bannon was the only employee to sign out Demerol in the emergency department and the medical/surgical unit on the dates in question.

Ms. Wright stated that Bannon had been assigned to care for patient “D.D.” just before she resigned from Bates on July 7, 1992. D.D. came to the emergency room with acute abdominal pain and was given an injection of *927 Demerol. D.D. was admitted to the medical/surgical unit at 5:00 a.m. on July 6, 1992, free of pain. Ms. Wright cared for the patient and charted that she was pain free throughout the day. Bannon took over the care of D.D. at 7:00 p.m. that evening. On July 7, Ms. Wright discovered that Bannon had charted an injection of Demerol at 7:50 p.m. on July 6 and at 5:00 a.m. on July 7. Ms. Wright asked D.D. if she had received anything for pain, and the patient told her that she had complained of a headache and received two pills, but that was all.

After this incident, Ms. Wright did a retrospective review of other patients for whom Bannon had cared. She found that Bannon had cared for another patient on July 1, 1992, who had been unresponsive. Although there was no change in the patient’s condition, the medication administration charts, signed by Bannon , reflected that she gave Demerol at 8:10 p.m. on July 1, and again at 2:00, 3:00, and 6:00 a.m. on July 2. There was no indication of irritability or restlessness to warrant pain medication. It was the only Demerol the patient was given throughout her stay at the hospital.

Ms. Wright and Marian Fowler, Director of Human Resources, both testified that Bannon had been very candid about being a recovering substance abuser when she applied at the hospital. Ms. Fowler stated that Bannon agreed to submit to random drug tests throughout her tenure at the hospital as a part of the process for nurses in recovery. On July 7, 1992, Ms. Fowler and Ms. Wright asked Bannon to submit to a drug test. At first Bannon agreed, but became increasingly agitated and irritated and stated that she thought she was being “set up.” However, after three trips to the bathroom in a supposedly unsuccessful attempt to collect a urine specimen, Bannon refused to take the test and stated that she was resigning from her employment.

Prior to her employment at Bates Memorial, Bannon worked at Eureka Springs Memorial Hospital for twenty-one days. Testimony from administrators there provided ample evidence of faulty documentation and circumstantial evidence of drug use.

Sherry Gerster, Director of Nursing at Eureka Springs Memorial, testified that on her first day of employment, April 1, 1992, Bannon was assigned a patient who was taking Demerol every three hours. Bannon signed out seventy-five milligrams of Demerol from the pharmacy, but did not document the need or action for the medication in her nurse’s notes. On April 7, 1992, Bannon was assigned to care for a patient for whom Demerol had been prescribed, but who did not receive any except when Bannon was on duty. On April 8, Bannon took care of this same patient and documented giving Demerol at 12:15 p.m., but did not document in her nurse’s notes the reason it was given. In addition, while the medication and treatment documentation states that the drug was given at 12:15 p.m., the drug was not signed out on the controlled administration record until 12:40 p.m. At 3:15 p.m. on that same day, it was documented in the medication and treatment record that the patient was complaining of back pain and was given fifty milligrams of Demerol. However, nothing is documented in the nursing notes, and the Demerol was not signed out on the controlled drug administration record until 6:15 p.m.

Ms. Gerster stated that Bannon was caring for another patient on the same shift that day who had been prescribed seventy-five milligrams of Demerol and twenty-five milligrams of Phenergan. At 3:15 p.m., Bannon was given orders by a physician to give the medication, and such is documented in the medication and treatment record and in the nurse’s notes. However, the controlled drug administration record reveals that Bannon signed out one-hundred milligrams of Demerol to this patient and administered all of it.

Further, Ms. Gerster testified that Bannon documented having given a postoperative patient seventy-five milligrams of Demerol twenty minutes before she was to be discharged from the hospital. Ms. Gerster stated that this was in violation of hospital policy.

Ms. Gerster also testified that Bannon took care of an outpatient surgery patient whom another nurse observed and recorded at 11:20 a.m. as having no nausea and eating *928 ice chips. At 1:00 p.m, Bannon documented that he complained of pain and nausea, vomited twice, and was given seventy-five milligrams of Demerol. However, at 1:10 p.m, it was documented that he was discharged in good spirits and in no acute distress. The hospital’s discharge criteria mandate that a patient will not be discharged if he is nauseated or vomiting.

Finally, Ms. Gerster stated that on April 9, Bannon cared for a patient for whom Demerol had been prescribed to be given as needed for pain. Although the patient was not in distress at 7:30 a.m., fifty milligrams of Demerol was signed out on the controlled drug record for her at 8:12 a.m. and again at 4:00 p.m. There was only one entry in the medication and treatment record for a dose of fifty milligrams of Demerol with no time recorded, but there were entries for doses of fifty milligrams of Demerol and twenty-five milligrams of Phenergan; one at 8:00 a.m. and one at 4:00 p.m.

Tina Long, who was Assistant Director of Nursing at Eureka Springs Hospital while Bannon was employed there, testified that she observed Bannon leaving the hospital with the keys to the narcotics cabinet. The keys are not supposed to leave the hospital. Ms. Long confronted Bannon and reminded her that the keys were not to leave the hospital. Bannon replied that she had been hoping Ms. Long would not find out that she had taken the keys.

Ms. Long also stated that on April 21, 1992, Bannon worked a twelve-hour shift, from 7:00 a.m. to 7:00 p.m. At 3:00 p.m., Bannon was given the narcotics keys. Ms. Long received an electronic page at 7:00 p.m. from another employee who had checked the narcotics cabinet and suspected tampering. The employee stated that she had not handled the drugs. Ms. Long and the employee discovered that a seventy-five milligram vial of Demerol appeared to have been adulterated. They found a hub cover from a hypodermic needle in the employee bathroom right after Bannon had been there. Ms. Long called Bannon’s home at 8:10 p.m. to ask her to come in for a drug screen, but reached an answering machine and did not leave a message. Bannon was scheduled to work another twelve-hour shift on April 22, but called in sick.

In summary, there is substantial evidence to support the Board’s finding that Bannon diverted drugs from her employers at Bates Memorial Hospital and at Eureka Springs Memorial Hospital and made false documentation about those drugs at both facilities. This also constituted substantial evidence to support the finding that Bannon acted in an unprofessional manner. Accordingly, we affirm the ruling of the Board.