Miller v. Tennessee Bd. of Nursing
| Decision Date | 26 September 2007 |
| Docket Number | No. M2005-02383-COA-R3-CV.,M2005-02383-COA-R3-CV. |
| Citation | 256 S.W.3d 225 |
| Parties | Jean Louise MILLER v. TENNESSEE BOARD OF NURSING. |
| Court | Tennessee Court of Appeals |
Jean Louise Miller, Nashville, Tennessee, Pro Se.
Robert E. Cooper, Jr., Attorney General and Reporter, and Sara E. Sedgwick, Assistant Attorney General, for the appellee, Tennessee Board of Nursing.
WILLIAM C. KOCH, JR., P.J., M.S., delivered the opinion of the court, in which PATRICIA J. COTTRELL and FRANK G. CLEMENT, JR., JJ., joined.
This appeal involves a disciplinary proceeding against a registered nurse. After receiving a report that a registered nurse left her patients in a hospital's medical/surgical unit before the end of her shift, the Tennessee Board of Nursing commenced a contested case proceeding to discipline the nurse. Following the hearing, the Board ordered the nurse to pay a $1,000 civil penalty and also immediately suspended the nurse's license pending a psychological evaluation. The nurse sought judicial review of the Board's decision by the Chancery Court for Davidson County, and the trial court affirmed the Board's finding that the nurse had abandoned her patients, the assessment of the civil penalty, and the immediate suspension of the nurse's license. The nurse appealed. We have determined that the record contains substantial and material evidence that the nurse abandoned her patients and that the Board did not act arbitrarily by requiring the nurse to pay a $1,000 civil penalty. However, we have determined that the Board acted arbitrarily when it immediately suspended the nurse's license pending a psychological examination in the absence of any evidence or finding that the nurse was presently mentally unfit to practice nursing.
Jean Louise Miller worked as a licensed practical nurse for five years before she completed nursing school and became licensed as a registered nurse in Pennsylvania in 1988. For the next fifteen years, Ms. Miller led a nomadic existence, practicing as a registered nurse in Pennsylvania, Virginia, Florida, New Jersey, Connecticut, Maine, Oklahoma, and finally Tennessee. She never worked very long at any particular job. She characterizes herself as a "traveling nurse," and she has frequently worked for staffing agencies that would find her temporary assignments at different institutions and locations.
Ms. Miller moved to Tennessee in 1997. Between June 1997 and May 2000, she worked at five different hospitals in the Nashville area. In February 2002, while employed at a home health agency, Ms. Miller became convinced that several of her paychecks had been stolen and reported the thefts to the Metropolitan Police Department. She got into a disagreement with the police officer to whom she was reporting these thefts. After she tore up the report and spit in the officer's face, she was charged with the misdemeanor offenses of vandalism and resisting arrest. She was briefly incarcerated and later entered a conditional plea of guilty in the Metropolitan Nashville General Sessions Court and was placed on probation under Tenn.Code Ann. § 40-35-313 (2006).
Her arrest, incarceration, and conviction affected Ms. Miller significantly. She testified that she felt "defenseless" and that she became "deliberately paranoid." She feared that the police were tapping her telephone and keeping her under surveillance. Accordingly, she explained that she "lost a lot of sleep" and was "stressed out" because she was convinced that she would be returned to jail if she was arrested again while on probation. Ms. Miller sought counseling and treatment following the incident but eventually decided to "work it out" herself at home because she was not satisfied with the treatment she was receiving. According to Ms. Miller, she eventually completed her probation satisfactorily. However, Ms. Miller did not present any evidence to demonstrate that her record was, in fact, expunged in accordance with Tenn.Code Ann. § 40-35-313(a).
The incident that precipitated this dispute took place on April 15, 2002. Ms. Miller was working for the Starmed Staffing Group ("Starmed"), and, in January 2002, she had been contracted for thirteen weeks to the Cookeville Regional Medical Center. She was working on the 7:00 p.m. to 7:00 a.m. shift on the hospital's med/surg unit.1 That night, Ms. Miller was responsible for four to five patients with differing conditions. One patient had chronic obstructive pulmonary disease; one was recovering from surgery; and one was a prenatal patient who required monitoring of her fetal heart tones. While Ms. Miller reported that all of her patients were stable, she was concerned about the prenatal patient because she had been trying unsuccessfully since the beginning of her shift to have someone from obstetrics listen to the fetal heart tones.
Ms. Miller began to feel ill between 4:30 and 5:00 a.m. She entered the staff bathroom and vomited. The vomit, nausea, and stomach pain led her to suspect that she had gastritis because she had had the condition before. She left the bathroom and walked to the nurse's station. There she informed the other four nurses on duty in the med/surg unit that night that she was ill and that she was leaving the hospital to go home. The charge nurse instructed her to find the supervisor and report that she was leaving the hospital before the end of her shift.
Ms. Miller left the floor and got on the elevator. However, while she was on the elevator, she decided that she would not inform the supervisor that she was leaving the hospital. Ms. Miller was concerned that the supervisor would instruct her to go to the emergency room. She did not want to go to the emergency room because she had already decided to see her personal physician in Nashville and because she was concerned that she would not be able to pay for a visit to the emergency room. Accordingly, Ms. Miller simply left the hospital without talking with anyone else.
She testified later that, as she left, she was not concerned about any of her patients, except for the prenatal patient whose fetal heart tones had not been monitored before she left. She believed that the patients would not require much care before the end of her shift, and that the other nurses could take care of them because they were not busy. Ms. Miller was satisfied that the written notes in her patients' charts would adequately acquaint the hospital staff with the status of her patients and the care they had received during her shift. She also decided that the other nurses knew that she had been trying to have someone monitor the fetal heart tones of the prenatal patient and that they would follow up on that procedure as well.
The following day, Cookeville Regional Medical Center informed Starmed that it was terminating Ms. Miller's contract, and Starmed, in turn, informed Ms. Miller than her services were no longer required. In addition, Cookeville Regional Medical Center reported Ms. Miller to the Tennessee Board of Nursing ("Board"). On November 1, 2002, the Division of Health Related Boards of the Tennessee Department of Health ("Division") filed a written notice of charges against Ms. Miller. The Division charged that Ms. Miller should be disciplined because she was "guilty of a crime" based on her conditional guilty pleas to vandalism and resisting arrest and because she was mentally incompetent and had engaged in unprofessional conduct.
The Board conducted a contested case hearing on June 27, 2003. Ms. Miller represented herself during the proceeding. Following the submission of the evidence, the Board concluded that Ms. Miller was guilty of a crime in violation of Tenn.Code Ann. § 63-7-115(a)(1)(B) (2004) and had engaged in unprofessional conduct by abandoning or neglecting a patient requiring nursing care in violation of Tenn.Code Ann. § 63-7-115(a)(1)(F) and Tenn. Comp. R. & Regs. 1000-2-.13(1)(c) (2006). The Board made no findings with regard to Ms. Miller's mental competency. Based on these findings, the Board suspended Ms. Miller's license to practice nursing "pending a psychological evaluation of Respondent's suitability to practice nursing" and ordered her to pay a $1,000 civil penalty and costs.
Ms. Miller sought judicial review of the Board's decision in the Chancery Court for Davidson County. Ms. Miller represented herself during this proceeding, as she had in the proceedings before the Board. On August 16, 2005, the trial court filed a memorandum and order concluding that Ms. Miller had "walked out before the end of her nursing shift at Cookeville Regional Medical Center, disobeying the charge nurse who instructed her to notify a supervisor that she was leaving." The court, like the Board, concluded that "once Ms. Miller accepted the job at Cookeville Regional Medical Center and accepted the role of caretaker for the patients on her shift, she was bound by her statutory and regulatory duty to care for them or make sure that others assumed the caretaker role before she left." Accordingly, the trial court affirmed the Board's conclusion that Ms. Miller had engaged in unprofessional conduct in violation of Tenn.Code Ann. § 63-7-115(a)(1)(F) and Tenn. Comp. R. & Regs. 1000-2-.13(1)(c).
The trial court also expressed concern regarding the adequacy of the Division's evidence that Ms. Miller had committed a crime and the inelasticity of the penalty for violating Tenn.Code Ann. § 63-7-115(a)(1)(B). In light of its conclusion that the record contained substantial and material evidence that Ms. Miller had abandoned her patients when she left work early, the trial court declined to rule on the issue of whether Ms. Miller was "guilty of a crime" under the nursing statutes. Ms. Miller has perfected this appeal.
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