STATE OF MICHIGAN DEPARTMENT OF CONSUMER AND INDUSTRY SERVICES BUREAU OF HEARINGS

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1 STATE OF MICHIGAN DEPARTMENT OF CONSUMER AND INDUSTRY SERVICES BUREAU OF HEARINGS In the matter of Kathleen Ann Dils, RN, Petitioner v Bureau of Health Services, Respondent / Docket No Agency No Agency: Bureau of Health Services Case Type: Appeal Reinstatement Issued and entered this 27 th day of March, 2001 by Howard T. Spence Administrative Law Judge PROPOSAL FOR DECISION PROCEDURAL HISTORY This proceeding was initiated by the filing of a petition by Kathleen Ann Dils, registered nurse (Dils or Petitioner). Ms. Dils is seeking the reinstatement of her license to practice in the state of Michigan as a registered nurse. On February 24, 1998, the Disciplinary Subcommittee of the Michigan Board of Nursing issued a Final Order suspending the license of Ms. Dils for a minimum period of six months and one day. The suspension was for violating Sections 16221(a), 16221(b)(ii), and 16221(b)(iii) of the Michigan Public Health Code (Code), 1978 PA 368, being MCL et seq. It is from that Order of Suspension that Ms. Dils is seeking reinstatement at this time. The Office of Health Services, now the Bureau of Health Services (BHS or Respondent), has opposed the reinstatement of the license of Ms. Dils.

2 Page 2 In response to Ms. Dils Petition for Reinstatement, the Bureau of Hearings (BOH) scheduled the matter for hearing before Administrative Law Judge Howard T. Spence (ALJ). That hearing was held in Lansing, Michigan, on December 4, 2000, as scheduled. Ms. Dils appeared on a pro se basis. BHS was represented at this hearing by Assistant Attorney General Paul W. Jones. ISSUES AND APPLICABLE LAW The applicable sections of the Code are those set forth in the allegations of the initial formal complaint and the reinstatement provisions of the Code. The reinstatement provisions of the Code are set forth in Sections and of the Code. MCL and MCL are set forth in their entirety as follows: Sec (1) An individual whose license is limited, suspended, or revoked under this part may apply to his or her board or task force for a reinstatement of a revoked or suspended license or reclassification of a limited license pursuant to section or (2) An individual whose registration is suspended or revoked under this part may apply to his or her board for a reinstatement of a suspended or revoked registration pursuant to section (3) A board or task force shall reinstate a license or registration suspended for grounds stated in section 16221(i) upon payment of the installment. (4) Except as otherwise provided in this subsection, in case of a revoked license or registration, an applicant shall not apply for reinstatement before the expiration of 3 years after the effective date of the revocation. In case of a license or registration that was revoked for a violation of section 16221(b)(vii), a violation of section 16221(c)(iv) consisting of a felony conviction, or any other felony conviction involving a controlled substance, an

3 Page 3 applicant shall not apply for reinstatement before the expiration of 5 years after the effective date of the revocation. The department shall return an application for reinstatement received before the expiration of the applicable time period under this subsection. (5) The department shall provide an opportunity for a hearing before final rejection of an application for reinstatement. (6) Based upon the recommendation of the disciplinary subcommittee for each health profession, the department shall adopt guidelines to establish specific criteria to be met by an applicant for reinstatement under this article or article 7. The criteria may include corrective measures or remedial education as a condition of reinstatement. If a board or task force, in reinstating a license or registration, deviates from the guidelines adopted under this subsection, the board or task force shall state the reason for the deviation on the record. (7) An individual who seeks reinstatement or reclassification of a license or registration pursuant to this section shall pay the application processing fee as a reinstatement or reclassification fee. If approved for reinstatement or reclassification, the individual shall pay the per year license or registration fee for the applicable license or registration period. Sec (1) A board or task force may reinstate a license or issue a limited license to an individual whose license has been suspended or revoked under this part if after a hearing the board or task force is satisfied by clear and convincing evidence that the applicant is of good moral character, is able to practice the profession with reasonable skill and safety to patients, has met the criteria in the rules promulgated under section 16245(6), and should be permitted in the public interest to resume practice. Pursuant to the rules promulgated under section 16245(6), as a condition of reinstatement, a disciplinary subcommittee, upon the recommendation of a board or task force, may impose a disciplinary or corrective measure authorized under this part and require that the licensee attend a school or program selected by the board or task force to take designated courses or training to become competent or proficient in those areas of practice in

4 Page 4 which the board or task force finds the licensee to be deficient. The board or task force may require a statement on a form approved by it from the chief administrator of the school or program attended or the person responsible for the training certifying that the licensee has achieved the required competency or proficiency. (2) As a condition of reinstatement, a board or task force shall place the licensee on probation for 1 year under conditions set by the board or task force. If a licensee whose license has been revoked cannot apply for reinstatement for 5 years after the date of revocation, then, as a condition of reinstatement, the board or task force shall require the licensee to take and pass the current licensure examination. (3) A board or task force shall not reinstate a license suspended or revoked for grounds stated in section 16221(b)(i), (iii), or (iv) until it finds that the licensee is mentally or physically able to practice with reasonable skill and safety to patients. The board or task force may require further examination of the licensee, at the licensee's expense, necessary to verify that the licensee is mentally or physically able. A licensee affected by this section shall be afforded the opportunity at reasonable intervals to demonstrate that he or she can resume competent practice in accordance with standards of acceptable and prevailing practice. SUMMARY OF EVIDENCE Ms. Dils appeared and testified on her own behalf at the reinstatement hearing. She presented no other live witnesses to testify in support of her Petition for Reinstatement. She did offer ten exhibits, five of which were accepted into the evidentiary record. Exhibit 4 is a letter from Mr. Rick Frankhart of the Michigan Health Professional Recovery Corporation (MHPRC) dated November 20, That letter acknowledges that Ms. Dils has enrolled in an MHPRC monitoring agreement and program effective August 28, Exhibits 7, 8,

5 Page 5 9, and 10 are copies of certificates of continuing education for nursing courses in which Ms. Dils has participated. Exhibits 1, 2, 3, 5, and 6 were marked but not admitted into this proceeding. BHS did not present any witnesses to testify in this proceeding. BHS did offer two exhibits which were admitted into the record. Exhibit A is a copy of the original formal complaint issued against Ms. Dils by BHS. Exhibit B is a copy of the Final Order of the Nursing Board dated February 28, Ms. Dils testified that her license was suspended as a result of her having developed an addiction to alcohol. She reported that her alcoholism was chronic and that she has been struggling with it for years. Although she could not pinpoint the time of the onset of her drinking problems, she did note that drinking problems appeared to run in her family. Ms. Dils did not appear at the hearing on the formal complaint issued by BHS in November At the reinstatement hearing, she did acknowledge that the allegations in the formal complaint were true and accurate. She did testify, however, that she never worked when she was drinking or impaired by alcohol. She also acknowledged that she had taken a prescription drug which was for her mother, but she denied having any drug problems per se. She stated that the drug she took was taken as a substitute for alcohol when she took it. Ms. Dils testified that she has an extended history of successful practice as a registered nurse in Michigan. She has an associates degree in education and began her nursing career in 1983 as a registered nurse. She worked part time from 1983 until 1996 as

6 Page 6 a nurse while raising a family. She is now divorced from her first marriage and separated from her second husband. She has worked at a number of hospitals in her career and has experience as a step down nurse and as a medical surgery nurse and has also worked in oncology, orthopedics, and urology units. She has also worked as a registered nurse in an industrial setting at Ford Motor Company. Ms. Dils testified that she realized for the first time that her alcoholism was a problem when she was fired from employment as a nurse at Hospice of Michigan in She had tried unsuccessfully to deal with her alcoholism for a number of years. She stated that her termination from the hospice position jolted her to realize that she needed help with her drinking problem. She acknowledged that a previous attempt to control her drinking through assistance from MHPRC failed in She failed to comply with routine urine sample drops and also tested positive for controlled substances on one occasion. She was terminated from the MHPRC program in 1997 and subsequently entered into the license disciplinary process which concluded with her suspension for six months and a day in Ms. Dils has made a significant and determined effort to address and control her drinking problems since her license was suspended. She testified that as of the time of the reinstatement hearing she had been sober for over one year with a sobriety date of November 21, She had admitted herself into a residential treatment program at Ottagan Addiction Rehabilitation, Inc., in Holland, Michigan. She was in that residential program from November 24, 1999, until June 20, Although she did not appear at the hearing in support of Ms. Dils application, Ms. Janet Laing, M.S.W., A.C.S.W., wrote a letter

7 Page 7 to BHS which was attached to Ms. Dils Petition for Reinstatement. Ms. Laing is the Program Director/Therapist at Ottagan. She confirmed that Ms. Dils was in the Ottagan program, and while there she regularly participated in rehabilitation programing including Alcoholics Anonymous (AA) meetings. The letter also tended to corroborate Ms. Dils testimony regarding sobriety. The letter indicated that Ottagan had routinely tested Ms. Dils for alcohol and certain drugs and that she had passed those drug screen tests. Ms. Dils has now been reinstated into a monitoring program with MHPRC. Her new monitoring contract was effective September 1, The monitoring contract is for a period of three years. A copy of her MHPRC contract was not offered into the record as an exhibit but is attached to Ms. Dils Application for Reinstatement. She is required to continue attending AA meetings, and she has also attended Caduceus meetings in the west Michigan area. She is receiving treatment from a Dr. Haynes of West Michigan Addiction Consultants in Grand Rapids and is scheduled to see him on a quarterly basis. To assure compliance, Ms. Dils was, at the time of the reinstatement hearing, on a program which utilized 250 mg. of Anabuse. Anabuse is a drug prescribed to assure Ms. Dils abstains from using alcohol products. Her Anabuse medication administrations are witnessed by an Amy Harriman, who is Ms. Dils roommate. Ms. Dils is personally paying now for her alcoholism treatment and for the MHPRC oversight. She stated that she now is paying well over $45 a week for MHPRC monitoring and other expenses attributable to attempting to abstain from alcohol abuse. She expects costs associated with her alcohol monitoring and therapy to be as high as $100 a

8 Page 8 week in the future. She regards that significant expenditure as justified if it helps her get her life back on track and her nursing licenses reinstated. Ms. Dils has not been employed in any nursing field since her license suspension. At the time of the reinstatement hearing, she was employed in a factory woodworking shop. She does not expect to have difficulty finding employment as a nurse once again if her license is reinstated. She testified that she has approached a number of hospitals in her area about possibly being employed as a registered nurse if her license is reinstated. She testified that she had received favorable responses from those hospitals. Ms. Dils testified that she has completed a few hours of continuing education as documented in her application and in Exhibits 7, 8, 9, and 10. However, she testified that the hospitals she has contacted as potential employers have not been concerned about her lack of significant continuing education in the past two years. She stated that those hospitals had stated that if she was reinstated, they would place her in their own training programs which would assure that her skills were up-to-date and consistent with their nursing needs. Ms. Dils also testified that, although she has not been employed recently as a nurse, she has continued to read nursing journals including the American Journal of Nursing and RN Magazine. She stated that she has a strong and continuing interest in things relating to the field of medicine. FINDINGS OF FACT The Findings of Fact in this case are those set forth above in the Summary of Evidence and are summarized in the enumerated findings in this section. These Findings of

9 Page 9 Fact take into account the entirety of the testimony of the witness and an assessment of her credibility at the time of her testimony. 1. Ms. Dils license was suspended by the Michigan Board of Nursing Disciplinary Subcommittee on February 24, 1998, for a period of six months and one day. 2. The suspension was imposed when Ms. Dils failed to contest a formal complaint issued by BHS which alleged, among other things, that she was impaired due to alcohol abuse. 3. Ms. Dils has filed a Petition for Reinstatement of her license which has been opposed initially by BHS. 4. During the time that her license has been suspended, Ms. Dils has been involved in a number of activities designed to help her cope with her alcohol addiction and abuse problem. 5. Ms. Dils voluntarily submitted to a period of inpatient care at Ottagan Addiction Rehabilitation, Inc., between November 1999 and June She has been involved in group and individual therapy programs designed to help her understand and cope with her alcohol abuse problem, and she continues in such therapeutic programming including Caduceus and AA. 7. She has attempted to maintain basic nursing skills required by a registered nurse during the time that her license has been suspended through some continuing education courses and also by independent reading of nursing magazines and journals.

10 Page She has been involved in only a small amount of volunteer activity in the community. That limited involvement is commensurate with the time that she has had available to her since her return to the community from the inpatient rehabilitation. 9. Ms. Dils is willing to submit to restrictions and conditions for reinstatement licensure which may be imposed by the Nurrsing Board at this time. CONCLUSIONS OF LAW During the time that her license has been suspended, Ms. Dils has attempted to address her alcoholism problem on an independent basis. She has been involved in inpatient treatment for alcoholism and also has been involved in the community in both group and individual therapy for alcohol addiction. She recognizes that her battle with alcohol abuse will be an ongoing and difficult one. She has been sober for over a year as of the time of the reinstatement hearing. The ALJ concludes that Ms. Dils can practice as a registered nurse at this time in a manner that is safe and competent and that she does not endanger the public due to alcohol abuse. She has not been away from the practice of nursing for a very extended period of time; and she has considerable experience in nursing, over some fifteen plus years, to assist her with reentry into the nursing profession. Her skills and knowledge of nursing have been maintained during the time her license was suspended to some degree by her continued review of the literature relating to the work and techniques of nursing. At this time, she is not abusing alcohol or drugs that would impact on her ability to make judgments in the best interests of patients with whom she may come in contact if reinstated.

11 Page 11 There is no attack on the good moral character of the Petitioner. Her problem is one of personal alcohol abuse and does not involve any criminal activity. Her description of her interest in her patients and her own remorse over her alcohol involvement lead this ALJ to conclude that she does have the good moral character required for reinstatement of license at this time. The Legislature and the related licensing board have concluded that individuals who develop alcohol abuse problems such as Ms. Dils has developed may, in fact, be allowed to continue in the practice of their license authority if it is clear that they can do so in a safe and competent manner. Alcohol abuse or addiction is a problem which cannot be cured once and for all in many instances. Ms. Dils realistically realizes that she may need further support in this area in the future. She describes her condition as chronic, and she has subjected herself to taking Anabuse to assure sobriety. The ALJ is not aware of anything further that Ms. Dils could do at this point in time to demonstrate that she is a proper subject for reinstatement. A recommendation for reinstatement of licensure is therefore being made at this time by the ALJ. In order to ensure ongoing protection of the public and also to assure the successful continuation of Ms. Dils alcohol abuse rehabilitation, the ALJ recommends that the Board consider imposing the type of restrictions or conditions on her license reinstatement to which Ms. Dils expressed a willingness to submit at least initially a period of ongoing monitoring and drug screening seems reasonable in the circumstances. She should also be subject to a period of probation and required to continue successfully in the MHPRC program.

12 Page 12 RECOMMENDED ORDER The Administrative Law Judge directs that this Proposal for Decision and related record be transmitted to the Nursing Board for consideration for reinstatement of Ms. Dils with ongoing monitoring conditions during a period of probation. EXCEPTIONS Either party may take Exceptions to the Findings of Fact and/or Conclusions of Law set forth in this Proposal for Decision by filing such Exceptions with the Board of Nursing within 15 days of the entry of this Proposal for Decision. Any Exceptions should be addressed to the Board of Nursing, Bureau of Health Services, Attention: Ray Garza, 611 W. Ottawa Street, 1 st Floor, P. O. Box 30670, Lansing, Michigan Responses to any such Exceptions may be filed within 5 days of their service on a party. Howard T. Spence Administrative Law Judge