IN THE MATTER OF * BEFORE THE MARYLAND MELISSA MILLER

IN THE MATTER OF
MELISSA MILLER
*
*
BEFORE THE MARYLAND
*
BOARD OF NURSING
*
LICENSE No. 0001154310 (VIRGINIA) *
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CONSENT ORDER OF REPRIMAND
On or about June 12, 2009, the Maryland Board of Nursing (the "Board") received a
complaint regarding the nursing practice of Melissa Miller (the "Respondent"). As a result of this
complaint, the Board initiated an investigation .. Based on the information provided to the Board
during the investigation, on December 27,2011, the Board isstLed " Charges Under the Maryland
Nurse Practice Act" (the "Charges"), which charged the Respondent's Multi-State Licensing
Privilege (" Privilege") with violations ofthe Maryland Nurse Practice Act. Specifically, the Board
alleged that the Respondent violated Md. Health Oee. Code Ann. ("H.O.") §§ 8-316(a)(8) ("Does an
act that is inconsistent with the generally accepted professional standards in the practice of registered
nursing") and (25) ("Engages in conduct that violates the professional code of ethics").
On April 10, 2012, the Respondent along with her attorney, Andreas Lundstedt, Esq.,
attended a settlement conference with Board representatives in an effort to resolve this matter prior
to a hearing before the Board. The Respondent and the Board subsequently agreed to the following
Findings of Fact, Conclusions of Law and Order.
FINDINGS OF FACT
The Board finds that:
1.
At all times relevant to this Order, the Respondent was licensed to practice as a
registered nurse ("RN'~) in the Commonwealth of Virginia, license number 0001154310. Based on
the Respondent's licensure in Virginia, the Respondent, in accordance with the Multistate Licensure
Compact, H.O. §§ 8-7A-O! et seq., specifically RO. § 8-7A-O 1(4)("A license to practice registered
nursing issued by a home state to a resident of that state will be recognized by each party state as
authorization for a multi state licensing privilege to practice as a registered nurse in a party state"),
was granted a privilege to practice registered nursing in the State of Maryland.
2.
On or about June 12, 2009, the Board received a complaint regarding the
Respondent's practice from Facility A, a hospital in Hagerstown, Maryland.
3.
According to the complaint, a phannacy Pyxis audit noted that, in April 2009, the
Respondent removed one hundred and
4.
fOLlr
(l04) Dilaudid I IV syringes from the Pyxis.
further investigation c1iscovered that the times of removal from the Pyxis of nineteen
(19) doses of IV Dilaudid, two (2) doses of po Dilaudid, one (1) dose ofXanax2, and two (2) doses
of Percocet 3 did not match the times of administration charted or was not documented on the
medication administration record ("MAR").
5.
It was also discovered that: the Respondent often got orders for IV Dilaudid for
patients that did not have orders for Dilaudid; patients did not need Dilaudid given by the nurses
prior to or subsequent to the Respondent's shifts; and the Respondent was giving Dilaudid to patients
assigned to other nurses without the assigned nurses' knowledge.
6.
On May 21,2009, the Respondent was confronted by her nurse manager regarding the
discrepancies. During the interview, the Respondent was observed to be "very scattered, confused of
I A schedule II controlled dangerous substance llsed to treat moderate to severe pain. Generic name is hydromorphone hydrochloride. 2
Trade name for Aprazolam, a schedule IV CDS llsed to treat anxiety. 3
A schedule II CDS. 2
the events ofthe day and forgetful." In addition, the Respondent refused a drug screen, started crying
and admitted to the use of "street drugs ."
She further admitted that she had been in rehabilitation
several times in the past for drug abuse. She was placed on administrative leave and her employment
was subsequently terminated on May 28, 2009.
7.
A comparison ofthe Respondent's Pyxis withdrawal and patients' MARs found the
following:
Patient VL
syringe from Pyxis, with 1 mg given and 1 mg wasted. The Respondent documented on the MAR
that at 1300 and 1400, she administered 1 mg hydromorphone. There is no record that a 1400 dose
was removed from the Pyxis.
9.
On AprilS, 2009, at 0714, 0904,1228,1355 and 1523, the Respondent removed two
(2) hydromQrphone 1mg/ml syringes. The Respondent documented on the MAR that at 0715,0910,
administration ofthe 1228, 1355 or ~ 523 removals. There is no record ofrem ova I frorn the Pyx is, for
the 1130 and 1345 doses, which coincide with the administration times .
10.
On April IS, 2009, at 0725 and 1016, one (1) hydromorphone Img/ml syringe was
removed, and at 1245 and 1545, two (2) syringes were removed. The Respondent documented on
the MAR that she administered 1mg \) r h)'dr0 morpho n~ .n 0745 und 2 mg at 1250 and 1555. Tllclt is
no documentation that the dose withdrawn at 1016 was administered.
11.
On April 20, 2009, at 0837, 1134 and 1620, two (2) hydromorphone Img/ml syringes
were removed .
The Respondent documented on the MAR that she administered 2 mg
3
hydromorphone at 0815 and 1200. There is no docmnentation of administration of the 1620 dose
that was withdrawn. There is no record that a dose was withdrawn prior to the 0815 administration
time.
12.
On April 21, 2009" at 0717, 1004,1429 and 1724, two (2) hydromorphone Img/ml
syringes were removed . The Respondent documented on the MAR that 2 mg of hydromorphone
was administered at 0730 and 1700. There is no documentation that the doses removed at 1004,
1429 and 1724 were administered. There no record of a withdrawal prior to the 1700 dose
administration.
Patient DS
13.
On April 11,2009, at 1024,1113 and 1301, one (1) hydromorphone 1mg/ml syringe
was removed . There is no documentation that these doses were administered.
Patient RH
15.
On April 15, 2009, at 0730, 0924 and 1111, one (1) hydromorphone 1mg/ml syringe
was removed, and at 1140,1411,1607 and 1759, two (2) syringes were removed. At 0730, one (1)
oxycodone 10 mg tablet was removed. The Respondent documented on the MAR that at 0730 and
0940, she administered 1 mg of Dilaudid and, at 1200, 1410 and 1605, she administered 2 mg of
Dilaudid. There is no documentation that the hydromorphone doses withdrawn at 1111 and 1759
were administered. There is no documentation that the 0730 dose of oxycodone was administered.
16.
On April 16, 2009, at 0816,1017 and 1152, two (2) hydromorphone 1mglml syringes
were removed and, at 0727, one (1) oxycodone lOmg tablet was removed.
The Respondent
documented on the MAR that, at 1000 and 1205,2 mg Dilaudid were administered. There is no
record of a withdrawal prior to the 1000 Dilaudid dose administration. The 0727 dose ofoxycodone
4
that was withdrawn was not documented as being administered.
17.
On April 20, 2009, at 0742, two (2) hydromorphone 1mg/mI syringes were removed;
at 0743, one (1) oxycodone 20 mg tablet was removed; and at 0744, one (I) oxycodone 10 mg tablet
was removed. The Respondent documented on the MAR that, at 0745 and 1215, she administered 2
mg ofDilaudid. There is no record of a Pyxis withdrawal prior to the 1215 dose of Dilaudid being
administered. There was documentation of administration ofthe 0743 and 0744 doses ofOxycodone
that were withdrawn.
Patient CG
18 .
On April 24, 2009 at 1750, one (1) hydromorphone 1mg/mI syringe was withdrawn;
at 1751, two (2) Alprazolam 0.5 mg tablets were withdrawn; and at 1759, two (2) oxycodone/APAP
tablets were withdrawn.
The Respondent was not assigned to this patient and none of the
medications withdrawn were documented as administered.
Patient BD
19.
On April 27, 2009, at 0739,1023,1618 and 1854, one (1) hydromorphone Img/ml
syringe was removed. The Respondent documented on the MAR that, at 0730 and 1030, she
administered 0.5 mg and 1 mg, respectively, ofDilaudid. There is no documentation on the MAR
that the 1618 and 1854 doses were administered.
20.
,
.. .. ~
' "
~
••, .• f"'\'. \ J....
·
~ ·
On April 28, 2009, at 0747, 1234 and 1609, one (1) hydromorphone lmg/ml syringe
j
.•v · _· .·
"r l .
. " , . .f )
~ · .· T ·· · "
.. ... ·
.. .
.
.,
Dilaudid and, at 1230, the patient's IV was not patent. There is no documentation on the MAR that
the 1609 dose was administered.
5
Patient EM
21.
On April 28, 2009, at 0910 and 1655, one (1) hydromorphone 1mg/ml syringe was
removed. The Respondent documented on the MAR that, at 0920,1315 and 1710, she administered
0.5 mg Dilaudid. There was no wasle documented for the 1710 dose that was administered and no
record of removal for the 1315 dose administered.
22.
On April 28, 2009, one (1) hydrocodone/APAp4 (I5ml) cup was removed at 1127
and two (2) cups were removed at 152U. The Respondent documented on the MAR that, at 1130 and
1525, 15 mg Lortab/Vicodin was administered. She administered (1) cup at 1525 but removed (2)
cups at 1520.
23.
On May 2, 2009, at 0747, 0936, 1035, 1141,1238,1424,1650 and 1809, the
Respondent removed one (1) hydromorphone 1mg/ml syringe. The Respondent documented on the
MAR that, at 0800, 1030, 1140, 1245, 1430, 1630 and 1805, she administered 0.5 mg Dilaudid.
There is no documentation ofthe administration ofthe 0936 dose that was withdrawn. The 1650 and
1809 withdrawals occurred after the 1630 and 1805 administration times.
24.
On May 6, 2009 at 0813, the Respondent removed one (1) oxycodone 5mg tablet.
The Respondent documented that, at 0800, she administered oxycodone 5 mg tablet. The removal
time was after the administration time .
25.
On May 6, 2009, at U947 and 1530, two (2) hydrocodone/APAP 15 ml cups were
removed. The Respondent documented that at 0930, she administered 15 mg of Lortab/Vicodin.
An elixir containing hydrocodone and acetaminophen, which is a schedule" CDS. Trade names include Lortab and
Vicodin.
4
6
Respondent removed two (2) cups at 0947 and administered one (I) cup. The 0947 withdrawal time
was after the 0930 administration time.
There is no documentation that the 1530 dose that was
withdrawn was administered to the patient.
26.
On May 6,2009 at 1326, one (1) oxycodone 5/325 (Percocet) tablet was removed.
The Respondent documented that, at 1315, she administered one (1) Percocet tablet. The 1326
withdrawal time was after the 1315 administration time.
27.
The Board finds that the Respondent's recUlTing medication administration errors
constitute acts that are inconsistent with the generally accepted professional standards ofprofessional
nursing within the meaning of H.O. § 8-316(a)(8).
CONCLUSIONS OF LAW
Under the Nurse Practice Ad, the Board, acting as a party state to the Nurse Multistate
Licensure Compact, may take action i.:I.gainst the multistate licensing privilege of any nurse within the
State. H.O. § 8-7 A-Ol (5) ("Party states may .. . limit or revoke the multi state licensing privilege of
any nurse to practice in the state and may take any other actions under the applicable state laws
necessary to protect the health and safety of the citizens of the party state."). Furthermore, nurses
practicing under the Nurse Multistate Licensure Compact in party states with a multistate licensing
privilege are obliged to comply with the practice laws of that state. See H.O. § 8-7A-Ol(6)(a)
("Every nurse practicing in a party state must comply with the state practice laws of the state in
which the patient is located at the tim~ that care is rendered . In addition, the practice of nursing is not
limited to patient care, but shall include all practices of nursing, as defined by the laws of a party
state.").
In this case, based on the foregoing Findings of Fact, the Board concludes that the
7
CONSENT By this Consent, I acknowledge that I have read this Consent Order in its entirety and I
hereby admit the truth of the Findings of Fact, and accept and submit to the foregoing Consent Order
and its conditions. I acknowledge the validity of this Consent Order as if entered into after the
conclusion of a formal evidentiary hearing in which I would have had the right to legal counsel
authorized to practice law in Maryland , to confront witnesses, to give testimony, to request
subpoenas for witnesses, to call witnesses on my own behalf~ to introduce testimony and evidence on
my own behalf, and to all other substantive and procedural protections provided by law. I waive
these rights, as well as any appeal rights under Maryland Code Annotated, State Government Article
§ 10-222.
I sign this Consent Order after having an opportunity to consult with an attorney, voluntarily
and without reservation, and I fully understand and comprehend the language, meaning, terms, and
effect of this Consent Order.
9
Respondent violated H.O. § 8-316(a) of the Act as follows :
(8) Does an act that is inconsistent with the generally accepted professional
standards in the practice of registered nursing.
ORDER
Based upon the foregoing Findings of Fact and Conclusions of Law, it is hereby:
ORDERED that the
multi~tate
licensing privilege of MELISSA MILLER to practice
registered nursing in the State of Maryland, is hereby REPRIMANDED; and be it further
ORDERED that this is a Final Decision and Order of the Maryland Board of Nursing and, as
such, is a PUBLIC DOCUMENT pursuant to Maryland State Gov't Code Ann. § 10-611 et seq.
(2009 Rep!. Vol.).
Nancy Adams, RN, MBA
The Board President's Signature
Appears on the Original Document
ot