ORDER OF EMERGENCY SUSPENSION OF LICENSE. H. Frank Farmer, Jr., M.D., Ph.D., State Surgeon General, ORDERS the

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1 STATE OF FLORIDA DEPARTMENT OF HEALTH Final Order No. DOH- I FILED DATE - Department of Health By:TALVUL Pdate" Deputy Agency Clerk In Re: Emergency Suspension of the License of ORDER OF EMERGENCY SUSPENSION OF LICENSE H. Frank Farmer, Jr., M.D., Ph.D., State Surgeon General, ORDERS the emergency suspension of the license of, to practice as a registered nurse. Ms. Stungis holds license number RN Her address of record is 4238 NW 67 Terrace, Gainesville, Florida The following Findings of Fact and Conclusions of Law support the emergency suspension of Ms. Stungis' license to practice as a registered nurse. FINDINGS OF FACT 1. The Department of Health (Department) is the state agency charged with regulating the practice of nursing pursuant to Chapters 20, 456 and 464, Florida Statutes. Section (8), Florida Statutes (2010), authorizes the State Surgeon General to summarily suspend Ms. Stungis' license to practice as a registered nurse in accordance with Section (6), Florida Statutes (2010). 2. At all times material to this order, Ms. Stungis was licensed to practice as a registered nurse pursuant to Chapter 464, Florida Statutes. 3. On or about February 12, 2010, the Intervention Project for Nurses (IPN) received an anonymous telephone call. The caller reported that Ms. Stungis had a

2 severe drinking problem and was employed at North Florida Regional Medical Center (NFRMC). IPN notified the caller that IPN does not accept anonymous reports. 4. IPN is the impaired practitioner program for the Board of Nursing, pursuant to Section , Florida Statutes. IPN is a program that monitors the evaluation, care and treatment of impaired nurses. IPN oversees random drug screens and provides for the exchange of information between treatment providers, evaluators and the Department for the protection of the public. 5. On or about February 19, 2010, IPN received a second anonymous phone call again reporting that Ms. Stungis was a nurse who needed help for severe alcoholism. The caller reported that Ms. Stungis was employed in the operating room (OR) at NFRMC. 6. On or about February 19, 2010, an IPN representative contacted the Nurse Manager of the OR at NFRMC and left her a voic message indicating that IPN received two anonymous telephone calls reporting that a nurse who worked in the OR at NFRMC had a severe alcohol problem. IPN did not reveal Ms. Stungis' name in the voic . 7. On or about February 19, 2010, the Nurse Manager called IPN back and reported that one of their nurses, Ms. Stungis, had an alcohol problem. The Nurse Manager reported that the alcohol had not yet affected Ms. Stungis' work performance, but was "taking its toll on Ms. Stungis." The Nurse Manager reported that she had discussed the issue with Ms. Stungis who agreed to go to alcoholics anonymous (AA). The Nurse Manager stated she would be discussing the situation with the Chief Nursing 2

3 Officer (CNO). The IPN representative informed the Nurse Manager that IPN would not pursue anything further regarding Ms. Stungis unless and until NFRMC contacted IPN and referred Ms. Stungis to IPN. 8. On or about February 19, 2010, the Nursing Administrator from NFRMC contacted IPN and stated that Ms. Stungis should have been referred to IPN when she first acknowledged she had a problem with alcohol. The Nursing Administrator informed the IPN representative that they would be meeting with Ms. Stungis on the following Monday and would be referring her to IPN. 9. On or about February 25, 2010, an IPN representative had a telephone conversation with Ms. Stungis. During the conversation, the IPN representative believed that Ms. Stungis sounded impaired. Ms. Stungis was unable to provide her social security number and often transposed various numbers when trying to report her telephone number. Ms. Stungis stated she was going out of town the following day, but was available to discuss her referral to IPN on the following Sunday. The IPN representative directed Ms. Stungis to contact IPN on Monday, March 1, On or about March 1, 2010, Ms. Stungis contacted IPN and discussed her referral with an IPN Clinical Assistant. Ms. Stungis reported that she started drinking approximately 28 years ago when she was 17 years old. Ms. Stungis reported that her last drink was on or about February 26, Ms. Stungis reported that she drank wine about four times a week, three to four glasses at a time. Ms. Stungis reported episodes of dizziness and shakiness that she described as possible seizures or stress related events. Ms. Stungis stated she was seeing a physician for these symptoms. 3

4 Ms. Stungis denied the abuse of any other substances and reported that she had never undergone treatment for alcohol or drug abuse. The IPN Clinical Assistant advised Ms. Stungis about the requirements of IPN participation, including the requirements to refrain from nursing practice and submit to an IPN-facilitated evaluation. 11. On or about April 1, 2010, Ms. Stungis submitted to an IPN-facilitated evaluation conducted by William M. Greene, M.D., a specialist in addiction medicine. During the evaluation, Ms. Stungis admitted that she had a problem with alcohol. She reported drinking on a daily basis, but denied drinking at work. Ms. Stungis reported drinking up to two liters of wine every two days. Ms. Stungis denied abusing other drugs. Ms. Stungis described a history of depression and anxiety attacks. Dr. Greene diagnosed Ms. Stungis with alcohol dependence with physiological dependence, anxiety disorder, and depressive disorder. Dr. Greene recommended that Ms. Stungis be placed under IPN monitoring, receive substance abuse treatment at the intensive outpatient level, and be followed by a psychiatrist. Dr. Greene opined that Ms. Stungis was unable to practice nursing with reasonable skill and safety at that time. 12. On or about April 26, 2010, Ms. Stungis entered into intensive outpatient substance abuse treatment at the Florida Recovery Center. 13. On or about August 20, 2010, Ms. Stungis contacted IPN and reported that she relapsed on alcohol the previous week by drinking wine. The IPN Case Manager told Ms. Stungis that IPN would continue to support her if her treatment team at the Florida Recovery Center was willing to allow her to continue in the outpatient treatment program. 4

5 14. On or about December 10, 2010, Ms. Stungis completed substance abuse treatment at the Florida Recovery Center. 15. On or about January 29, 2011, Ms. Stungis signed a five-year IPN monitoring contract which required her to remain free from all mood-altering, controlled, or addictive substances including alcohol. The contract also required her to attend aftercare sessions at the Florida Recovery Center, attend a facilitated nurse support group, attend AA/narcotics anonymous (AA/NA) meetings, see a psychiatrist for medication management, and submit to drug testing. Ms. Stungis was approved to return to practice as a registered nurse. Ms. Stungis returned to work in the OR at NFRMC. 16. On or about March 7, 2011, Ms. Stungis submitted to an IPN-required urine test that included a test for ethyl glucuronide (EtG), an alcohol metabolite detectable in urine for approximately five days after exposure to alcohol. 17. On or about March 16, 2011, IPN received the result from Ms. Stungis' drug test that indicated the urine was dilute and was positive for EtG indicating that Ms. Stungis had been exposed to alcohol. 18. Dilute urine occurs when a person drinks large amounts of fluid. Drugs are more difficult to detect in dilute urine and consuming large amounts of fluid is a method used to avoid drug detection in urine specimens. 19. On or about March 16, 2011, the IPN Case Manager contacted Ms. Stungis and advised her about the positive test. Ms. Stungis denied alcohol consumption and explained that she had been using hand sanitizer and was drinking extra fluids due to a 5

6 recent illness. The IPN Case Manager advised Ms. Stungis to refrain from nursing practice and submit to another IPN-facilitated evaluation. 20. On or about April 5, 2011, Ms. Stungis submitted to an IPN-facilitated evaluation conducted by Scott A. Teitelbaum, M.D., a specialist in addiction medicine. At the evaluation, Ms. Stungis initially denied drinking and reported that her last use of alcohol was in about August of 2010, when she relapsed while in intensive outpatient treatment. As the conversation progressed with Dr. Teitelbaum, Ms. Stungis admitted that she returned to drinking in mid-february to March of 2011, drinking alcohol on a regular basis. It took some time for Ms. Stungis to admit that she was drinking this amount, initially reporting that she did not relapse, then stating she only had one drink, and finally admitting to drinking regularly for a period of a month. Dr. Teitelbaum diagnosed Ms. Stungis with alcohol dependence, anxiety, and depression. He recommended that Ms. Stungis enter into substance abuse treatment at a residential treatment program or a partial hospitalization program with a housing component, preferably at a treatment center that specialized in treating healthcare professionals. Dr. Teitelbaum opined that Ms. Stungis was not able to practice nursing with reasonable skill and safety and stated, "Reconsideration may be given to her to return to the practice of nursing after successful completion of treatment and continued involvement of monitoring by IPN." 21. On or about April 25, 2011, IPN sent a letter to Ms. Stungis by certified mail advising Ms. Stungis about Dr. Teitelbaum's recommendations to enter into substance abuse treatment at either a residential treatment program or a partial 6

7 hospitalization program with a housing component. The letter contained the contact information for several facilities where Ms. Stungis could receive the recommended treatment. IPN gave Ms. Stungis a deadline of May 6, 2011 to arrange the treatment. 22. On or about May 6, 2011, Ms. Stungis contacted IPN and requested an extension of her deadline to enter into treatment due to financial constraints. IPN extended the treatment deadline to June 6, On or about May 19, 2011, IPN sent Ms. Stungis a letter advising her to enter into substance abuse treatment at either a residential treatment program or a partial hospitalization program with a housing component. The letter provided Ms. Stungis with the contact information for various facilities where she could receive the recommended treatment. The letter indicated that Ms. Stungis had a deadline of June 6, 2011, to arrange entrance into treatment. 24. On or about June 6, 2011, after receiving no notice that Ms. Stungis had entered into the recommended treatment, IPN contacted Ms. Stungis by phone and left a voic message directing her to contact IPN by close of business that day or she would be dismissed from IPN. 25. On or about June 7, 2011, after receiving no response from Ms. Stungis, IPN dismissed Ms. Stungis from IPN for failing to comply with the conditions of her IPN monitoring contract. 26. Section (1)(hh), Florida Statutes (2010), subjects a licensee to discipline, including suspension, for being terminated from a treatment program for impaired practitioners, which is overseen by an impaired practitioner consultant as 7

8 described in Section , Florida Statutes, for failure to comply, without good cause, with the terms of the monitoring or treatment contract entered into by the licensee, or for not successfully completing any drug or alcohol treatment program. 27. Ms. Stungis failed to comply with the terms of her IPN monitoring contract by failing to remain free from all mood-altering, controlled, or addictive substances including alcohol and failing to enter into recommended chemical dependency treatment following a relapse on alcohol. 28. Section (1)(j), Florida Statutes (2010), subjects a licensee to discipline, including suspension, for being unable to practice nursing with reasonable skill and safety to patients by reason of illness or use of alcohol, drugs, narcotics, or chemicals or any other type of material or as a result of any mental or physical condition. 29. Ms. Stungis is unable to practice nursing with reasonable skill and safety to patients by reason of alcohol dependence. Despite IPN monitoring and intensive outpatient treatment, Ms. Stungis returned to drinking alcohol once while in treatment, and relapsing on alcohol 2 months after completion of treatment. According to a physician who specializes in addiction medicine, Ms. Stungis cannot practice nursing with reasonable skill and safety, needs substance abuse treatment at a residential treatment program or a partial hospitalization treatment program with housing, and should not be considered for the return to nursing practice until she completes treatment and is monitored by IPN. Ms. Stungis did not enter into the recommended treatment and is no longer monitored by IPN. 8

9 30. Section (6), Florida Statutes, authorizes the Department to summarily suspend a registered nurse's license if the Department finds that the nurse presents an immediate serious danger to the public health, safety, or welfare. 31. Because registered nurses are required to assess the condition of their patients and make complex decisions regarding patient care, mental fitness and emotional stability are essential traits that a registered nurse must possess in order to competently practice nursing. Ms. Stungis' diagnosed alcohol dependence, her 28 year long history of alcohol abuse, her relapse on alcohol only 2 months after completing treatment, and her failure to enter into additional treatment, demonstrate that Ms. Stungis does not possess the mental fitness and emotional stability necessary to practice nursing safely. According to an evaluation by a specialist in addiction medicine, Ms. Stungis is not able to practice nursing with reasonable skill and safety to patients and needs to complete the recommended substance abuse treatment and be monitored by IPN before being considered for the return to nursing practice. 32. Ms. Stungis' disregard for the laws and regulations governing the practice of nursing, and her lack of mental fitness and emotional stability represent a significant likelihood that Ms. Stungis will cause harm to the health, safety, or welfare of patients. This probability constitutes an immediate serious danger to the health, safety, or welfare of the citizens of the State of Florida. Nothing short of the immediate suspension of Ms. Stungis' license will ensure the protection of the public from this danger. 9

10 CONCLUSIONS OF LAW Based on the foregoing Findings of Fact, the State Surgeon General concludes as follows: 1. The State Surgeon General has jurisdiction pursuant to Sections and (8), Florida Statutes, and Chapter 464, Florida Statutes. 2. Ms. Stungis violated Section (1)(hh), Florida Statutes (2010), by being terminated from a treatment program for impaired practitioners, which is overseen by an impaired practitioner consultant as described in Section , Florida Statutes, for failure to comply, without good cause, with the terms of the monitoring or treatment contract entered into by the licensee, or for not successfully completing any drug treatment or alcohol treatment program. 3. Ms. Stungis violated Section (1)0), Florida Statutes (2010), by being unable to practice nursing with reasonable skill and safety to patients by reason of illness or use of alcohol, drugs, narcotics, or chemicals or any other type of material or as a result of any mental or physical condition. 4. Ms. Stungis' continued practice as a registered nurse constitutes an immediate serious danger to the health, safety, or welfare of the public and this summary procedure is fair under the circumstances to adequately protect the public. WHEREFORE, in accordance with Section (6), Florida Statutes, it is ORDERED THAT: 1. The license of, license number RN , is immediately suspended. 10

11 2. A proceeding seeking formal suspension or discipline of the license of, to practice as a registered nurse will be promptly instituted and acted upon in compliance with Sections and (6), Florida Statutes. DONE and ORDERED this g day of July, H. Frank Farmer, Jr., M.D State Surgeon General h. PREPARED BY: Kathy Gatzlaff F/B/N Consultant Attorney DOH, Prosecution Services Unit 4052 Bald Cypress Way, Bin C-65 Tallahassee, Florida (850) Telephone (850) Telefax 11

12 NOTICE OF RIGHT TO JUDICIAL REVIEW Pursuant to Sections (6), and , Florida Statutes, this Order is judicially reviewable. Review proceedings are governed by the Florida Rules of Appellate Procedure. Proceedings are commenced by filing a Petition for Review, in accordance with Florida Rule of Appellate Procedure 9.100, with the District Court of Appeal, accompanied by a filing fee prescribed by law, and a copy of the Petition with the Agency Clerk of the Department within 30 days of the date this Order is filed. 12