STATE OF FLORIDA DEPARTMENT OF HEALTH Final Order No. DOH-18-0953- By: F ED ATEMAY., 2018 artment of JVF,/, Deputy Agency Clerk -MQA In Re: Emergency Restriction of the License of ORDER OF EMERGENCY RESTRICTION OF LICENSE Celeste Philip, M.D., M.P.H., State Surgeon General, ORDERS the emergency restriction of the license of, (Mr. Neff) to practice as a practical nurse in the State of Florida. Mr. Neff holds license number PN 5181402. Mr. Neff's address of record is 12763 24th Street Circle East, Parrish, Florida 34219. The following Findings of Fact and Conclusions of Law support the emergency restriction of Mr. Neff's license to practice as a nurse in the State of Florida. 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 (2017). Section 456.073(8), Florida Statutes (2017), authorizes the State Surgeon General to summarily restrict Mr. Neff's license to practice as a nurse in the State of Florida, in accordance with Section 120.60(6), Florida Statutes (2017). 2. At all times material to this Order, Mr. Neff was licensed as a practical
nurse in the State of Florida, pursuant to Chapter 464, Florida Statutes and was employed at Pines of Sarasota Rehabilitation & Senior Care Community, located in Sarasota, Florida. 3. On or about January 1, 2018, Mr. Neff presented to Pines of Sarasota for his scheduled shift. 4. The shift supervisor observed Mr. Neff acting erratically. Mr. Neff informed Pines of Sarasota staff that there were bed bugs in the facility. Mr. Neff alleged that he "collected" the bed bugs in a jar to show the shift supervisor, however, the jar was empty. 5. Mr. Neff complained that there were bed bugs in his skin, eyes, and hair, and attempted to dig them out with his nails. 6. Staff observed that Mr. Neff's erratic behavior worsened throughout the night and that Mr. Neff failed to provide care for his patients. screen. 7. Pines of Sarasota staff requested Mr. Neff submit to a urine drug 8. Mr. Neff attempted to obtain a urine sample from his co-workers and a patient. 2
9. Mr. Neff's urine sample was confirmed positive for cocaine.1 Mr. Neff did not have a lawful prescription or legitimate medical reason to ingest cocaine. 10. On or about April 17, 2018, Mr. Neff was evaluated by Lawrence Wilson, M.D., a medical doctor specializing in addiction medicine, pursuant to Department-order. 11. Mr. Neff admitted to Dr. Wilson that he ingested cocaine on December 31, 2017, a day before reporting to his nursing shift. However, Mr. Neff likely minimized the amount of cocaine that he ingested based on his impairment while at work and the results of the toxicology screening on January 1, 2018. 12. Mr. Neff submitted a nail sample for toxicology screening, which returned non-negative2 for cocaine, as well as amphetamines,3 opiates,4 and 1 According to Section 893.03(2), Florida Statutes (2017), cocaine is a Schedule II controlled substance that has a high potential for abuse and has a currently accepted but severely restricted medical use in treatment in the United States. Abuse of cocaine may lead to severe psychological or physical dependence. 2 Non-negative test results indicate that the initial test result was at or above the specified cutoff levels and will require further review to determine the cause of the result. 3 According to Section 893.03(2), Florida Statutes (2017), amphetamine is a Schedule II controlled substance that has a high potential for abuse and has a currently accepted but severely restricted medical use in treatment in the United States. Abuse of amphetamine may lead to severe psychological or physical dependence. 4 Opiate, or opioid, drugs have similar actions as the drug opium and are typically prescribed to treat pain. Opioid drugs are synthetically manufactured, while opiate drugs are naturally occurring, but the terms opioid and opiate are often used interchangeably. Opiate drugs are addictive and subject to abuse. 3
THC.5 When Dr. Wilson requested for Mr. Neff to provide another sample to confirm these non-negative findings, Mr. Neff refused to comply. 13. Mr. Neff also submitted a urine sample that was confirmed positive for hydromorphone,6 buprenorphine, temazepam,7 diazepam,8 oxazepam,9 THC, and alcohol metabolites. 14. Buprenorphine is an opioid partial agonist, which is commonly prescribed to treat opioid addiction by reducing withdrawal symptoms from opioids. 15. Mr. Neff did not disclose to Dr. Wilson that he was prescribed buprenorphine, nor did he disclose to Dr. Wilson that he had a history of opiate addiction necessitating the use of buprenorphine. 5 Tetrahydrocannabinols (THC) are the psychoactive ingredients in marijuana, or cannabis. According to Section 893.03(1), Florida Statutes (2017), cannabis is a Schedule I controlled substance that has a high potential for abuse and has no currently accepted medical use in treatment in Florida. The term does not include "low-thc cannabis" or medical marijuana, as defined in Section 381.986, Florida Statutes, if manufactured, possessed, sold, purchased, delivered, distributed, or dispensed, in conformance with Section 381.986, Florida Statutes. 6 Hydromorphone is commonly prescribed to treat pain. According to Section 893.03(2), Florida Statutes (2017), hydromorphone is a Schedule II controlled substance that has a high potential for abuse and has a currently accepted but severely restricted medical use in treatment in the United States. Abuse of hydromorphone may lead to severe psychological or physical dependence. 7 Temazepam is prescribed to treat insomnia. According to Section 893.03(4), Florida Statutes (2017), temazepam is a Schedule IV controlled substance that has a low potential for abuse relative to the substances in Schedule III and has a currently accepted medical use in treatment in the United States. Abuse of temazepam may lead to limited physical or psychological dependence relative to the substances in Schedule III. 8 Diazepam, commonly known by the brand name Valium, is prescribed to treat anxiety. According to Section 893.03(4), Florida Statutes (2017), diazepam is a Schedule IV controlled substance that has a low potential for abuse relative to the substances in Schedule III and has a currently accepted medical use in treatment in the United States. Abuse of diazepam may lead to limited physical or psychological dependence relative to the substances in Schedule 9 Oxazepam is a metabolite of temazepam and diazepam. 4
16. Dr. Wilson opined that Mr. Neff's deceptive failure to disclose his current ingestion of buprenorphine, as shown by his urine drug screen results, and his suspected continued ingestion of opiates, as suggested by the nonnegative nail toxicology screens, indicates that Mr. Neff has an opiate use disorder of indeterminate severity. 17. Mr. Neff also admitted to ingesting cannabis, which was supported by his positive urine drug screen for THC. Mr. Neff did not have a lawful order to use medical marijuana. 18. Dr. Wilson diagnosed Mr. Neff with opioid use disorder, stimulant (cocaine-type) use disorder, alcohol use disorder, cannabis use disorder, and sedative/hypnotic/anxiolytic use disorder. 19. Dr. Wilson opined that Mr. Neff is unable to practice nursing with reasonable skill and safety to patients. Dr. Wilson recommended Mr. Neff engage in treatment for his multiple substance use disorders at a residential, inpatient, partial hospitalization program with housing component level of care with an Intervention Project for Nursesl (IPN) approved treatment provider. Dr. Wilson i IPN is the impaired practitioner program for the Board of Nursing, pursuant to Section 456.076, Florida Statutes (2017). IPN monitors the evaluation, care, and treatment of impaired nurses. IPN oversees random drug screens and provides for the exchange of information between treatment providers, evaluators, and the Department for the protection of the public. 5
also recommended Mr. Neff engage in a monitoring contract with IPN. 20. At the time of this Order, Mr. Neff has not engaged in treatment and is not being monitored by IPN. 21. In the course of their practice, nurses have access to medications, including controlled substances, which have a high likelihood for abuse and harm. Nurses must dispense and administer such drugs in a manner that is safe and effective for the patient and only dispense to authorized patients. Nurses must also possess good judgment, be able to recognize abnormal signs or symptoms of patients, and provide emergency care when needed. Because Mr. Neff may not be capable of administering medications to, or caring for, patients in a manner that is correct and safe due to his impairment in the practice of nursing; his diagnoses of opioid use disorder, stimulant (cocaine-type) use disorder, alcohol use disorder, cannabis use disorder, and sedative/hypnotic anxiolytic use disorder; the opinions and recommendations by Dr. Wilson; and his failure to engage in the recommended treatment, Mr. Neff's continued unrestricted practice as a nurse presents an immediate, serious danger to the health, welfare, and safety of the public. 22. Based on Mr. Neff's ingestion of cocaine prior to a nursing shift; his diagnoses of opioid use disorder, stimulant (cocaine-type) use disorder, alcohol 6
use disorder, cannabis use disorder, and sedative/hypnotic anxiolytic use disorder; the opinions and recommendations by Dr. Wilson; and his failure to engage in the recommended treatment; there are no less-restrictive means other than the terms outlined in this Order that will adequately protect the public. Mr. Neff's failure to engage in recommended treatment and failure engage in a monitoring contract with IPN, indicate that his impairment is likely to continue, without restriction. CONCLUSIONS OF LAW Based on the foregoing Findings of Fact, the State Surgeon General concludes as follows: 1. The State Surgeon General has jurisdiction over this matter pursuant to Sections 20.43 and 456.073(8), Florida Statutes (2017), and Chapter 464, Florida Statutes (2017), as set forth above. 2. Section 464.018(1)0), Florida Statutes (2017), authorizes discipline, including restriction, against a nurse 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. 7
3. Mr. Neff violated Section 464.018(1)(j), Florida Statutes (2017), by being unable to practice nursing with reasonable skill and safety to patients due to his opioid use disorder, stimulant (cocaine-type) use disorder, alcohol use disorder, cannabis use disorder, and sedative/hypnotic anxiolytic use disorder. 4. Section 456.072(1)(aa), Florida Statutes (2017), authorize discipline, including restriction, against a nurse for testing positive for any drug, as defined in Section 112.0455, Florida Statutes (2017), on any confirmed pre-employment or employer-ordered drug screening when the practitioner does not have a lawful prescription and legitimate medical reason for using the drug. 5. Section 456.074(3), Florida Statutes (2017), authorizes the State Surgeon General to summarily restrict the license of a nurse who tests positive for any drug on any government or private sector pre-employment or employerordered confirmed drug test, as defined in Section 112.0455, Florida Statutes (2017), when the practitioner does not have a lawful prescription and legitimate medical reason for using such drug. 6. Mr. Neff violated Section 456.072(1)(aa), and 456.074(3), Florida Statutes, by testing positive for cocaine, a drug, on an employer-ordered drug screen. 8
7. Section 120.60(6), Florida Statutes (2017), authorizes the State Surgeon General to summarily restrict a nurse's license upon a finding that the nurse presents an immediate, serious danger to the public health, safety, or welfare. 8. Mr. Neff's continued unrestricted practice as a nurse constitutes an immediate, serious danger to the health, safety, or welfare of the citizens of the State of Florida, and he tested positive for a drug on an employer-ordered drug screen without a lawful prescription and legitimate medical reason for using the drug, and this summary procedure is fair under the circumstances to adequately protect the public. WHEREFORE, in accordance with Section 120.60(6), Florida Statutes (2017), it is ORDERED THAT: 1. The license of, to practice as a practical nurse, license number PN 5181402, is immediately restricted to prohibit Forest William Neff, Jr., L.P.N. from practicing as a nurse until IPN or an IPN-approved evaluator notifies the Department that he is safe to resume practice as a nurse. 2. A proceeding seeking formal discipline of the license of Forest William Neff, Jr., L.P.N., to practice as a nurse in the State of Florida will be promptly 9
instituted and acted upon in compliance with Sections 120.569 and 120.60(6), Florida Statutes (2017). DONE and ORDERED this 2018. Celeste Philip, M.D., M.P.H. \f\i Surgeon General and Secretary PREPARED BY: Kristen M. Summers Assistant General Counsel DOH Prosecution Services Unit 4052 Bald Cypress Way, Bin C-65 Tallahassee, FL 32399-3265 Florida Bar Number 112206 (T) (850) 558-9909 (F) (850) 245-4662 (E) Kristen.Summers@flhealth.gov 10
NOTICE OF RIGHT TO JUDICIAL REVIEW Pursuant to Sections 120.60(6), and 120.68, Florida Statutes, the Department's findings of immediate danger, necessity, and procedural fairness shall be judicially reviewable. Review proceedings are governed by the Florida Rules of Appellate Procedure. Such proceedings are commenced by filing a Petition for Review, in accordance with Florida Rule of Appellate Procedure 9.100, and accompanied by a filing fee prescribed by law with the District Court of Appeal, and providing a copy of that Petition to the Department of Health within thirty (30) days of the date this Order is filed. 11