IN THE MATTER OF BEFORE THE MAHA KANDIL MARYLAND

MAHA KANDIL
License Number: R179953
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BEFORE THE
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IN THE MATTER OF
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MARYLAND BOARD
OF NURSING
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FINAL ORDER OF REVOCATION OF REGISTERED NURSING LICENSE The Maryland Board of Nursing (lithe Board") pursuant to the Administrative
Procedure Act ("the APA"), Md. State Government Code Ann. ("State Govt.") § 10­
226(c)(1) (2009 Rep!. Vol.) and the Maryland Nurse Practice Act (the "Nurse Practice
Act"), Md. Health Occupations Code Ann. ("Health Occ.") §§ 8-101 et seq. (2009 Rep!.
Vo!.), finds the following:
BACKGROUND
On February 1,2011, the Board issued an ORDER FOR SUMMARY
SUSPENSION OF REGISTERED NURSING LICENSE AND NOTICE OF CHARGES
("Order of Suspension"), to Maha Kandil ("Respondent"), License Number R179953.
The Order of Suspension was sent by certified and regular mail to the last known
address registered by Respondent with the Board. The Order of Suspension is
attached hereto and fully incorporated into this FINAL ORDER OF REVOCATION OF
REGISTERED NURSING LICENSE. The Allegations of Fact and Conclusions of Law in
the Suspension Order are adopted as the Findings and Conclusions in this document.
Included with the Suspension Order was a letter from the Board informing
Respondent that there would be a Show Cause Hearing on February 22,2011, before
the Board, for Respondent to have the opportunity to show cause as to why her license
should not remain suspended.
55 FO - M. Kandil, R179953
Due to inclement weather, the February 22, 2011 Show Cause hearing was
rescheduled. By letter dated March 3, 2011, the Board notified the Respondent that her
Show Cause Hearing was rescheduled for March 21, 2011. Respondent failed to attend
the Show Cause Hearing.
On March 24, 2011, the Board issued a letter to Respondent informing her that
the Board voted to continue the suspension of her Registered Nursing license.
The Order of Suspension also placed Respondent on notice that she had thirty
(30) days from the date of notice of the Board's decision after the Show Cause hearing.
Additionally, Respondent was placed on notice that if a written request for an
evidentiary hearing was not sent within the specified time period, an Order would be
issued revoking her license. Respondent failed to submit a written request for an
evidentiary hearing.
Because Respondent failed to request an evidentiary hearing, the Board now
issues the following Order:
ORDER
In consideration of the foregoing, it is this 2J6-1f.-day Ofr
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2011,
by a majority vote of a quorum of the Board:
ORDERED that the Registered Nursing license of Maha Kandil, License Number
R179953, is hereby REVOKED; and it is further
ORDERED that this Order of Revocation is a Final Order of the Board; and it is
further
ORDERED that this Final Order is a public document pursuant to the Maryland
Public Information Act, State Govt. § 10-611, et seq. (2009 Repl. Vol.) and that for
purposes of public disclosure, the Board may disclose this document at its discretion to,
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SS FO - M. Kandil, R179953
including but not limited to, any national reporting bank or other entity to whom the
Board is mandated to report.
Nancy Ad
MBA, RN
President
Maryland Board of Nursing
NOTICE OF JUDICIAL APPEAL
Any person aggrieved by a final decision of the Board under Md. Health Occ. Code Ann.
section 8-6A-1 0 may take a direct judicial appeal within thirty (30) days) as provided by
Md. Health Occ. Code Ann. section 8-6A-11, Md. State Gov't. Code Ann. section 10-222
and Title 7, Chapter 200 of the Maryland Rules, including Md. Rule 7-203 ("Time for
Filing Action").
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IN THE MATTER OF
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BEFORE THE
MAHA KANDIL
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MARYLAND BOARD
License Number: R179953
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OF NURSING
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ORDEIR FOR SUMMARY SUSPENSION OF REGISTERED NURSING LICENSE AND NOTICE OF CHARGES BACKGROUND On or about April 20, 2010, the Maryland Board of Nurs'ing (lithe Board") received
information that the ITcensee, Maha Kandil, R179953 ("Respondent") was disciplined by
the Pennsylvania State Board of Nursing CPA Board"). On April 20 , 2010, the PA Board
ordered the Respondent's Pennsylvania Nursing license be suspended indefinitely,
retroactive to January 26, 2010, after determining that she is unable to practice nursing
with reasonable skill and safety to patients by reason of mental or physical illness or
condition or physiological or psychological dependence upon alcohol, hallucinogenic or
narcotic drugs or other drugs which tend to impair judgment or coordination .
While following up on this new information, the Board learned that the
Respondent failed to cooperate with two lawful investigations by the Maryland Board
following complaints regarding her nursing practice in Mary'land in 2007 and 2008 .
Based on further information received by the Board, the Board has reason , as set
forth below, to find that the public health, safety or welfare imperatively requires
emergency action under Md. Code Ann ., State Gov't. § 10-226 (c) (2) (Repl. Vol. 2009)
Summary Suspension - M. Kandil, R179953
ALLEGATIONS OF FACT AND REASONS IN SUPPORT OF
SUMMARY SUSPENSION AND CHARGES
The Board has received reliable information that the following facts are true:
1)
On September 6, 20()7, Respondent was issued a Temporary Registered
Nursing License in the State of Maryland. The Temporary Ucense expired on
December 5,2007.
2)
On December 18, 2007, Respondent was issued Registered Nursing License
R179953 in the· State of Maryland. Respondent's license is currently nonrenewed having expired on May 28, 2008.
3)
On or about April 20,
2010,
the Board
received
information from the
Pennsylvania Board of Nursing ("PA Board"), that they ordered the Respondent's
Pennsylvania Nursing license be suspended indefinitely, retroactive to January
26, 2010, after determining that she is unable to practice nursing with reasonable
skill and safety to patients by reason of mental or physical illness or condition or
physiological or psychological dependence upon alcohol, hallucinogenic or
narcotic drugs or other drugs which tend to impair judgment or coordination.
Discipline in Pennsylvania
4)
On April 20, 2010, the PA Board issued a Final Adjudication and Order placing
the Respondent's Pennsylvania Nursing License, RN-602919, in indefinite
suspension retroactive to January 26, 2010 based on the following Findings of
Fact:
#6
#7
On or about September 29, 2008 through October 9, 2008, Respondent
was aSSigned by Fastaff Agency to Delaware County Memorial Hospital,
501 North Lansdowne Ave., Drexel Hill, PA 19026.
From on or about September 29, 2008 through October 9, 2008, while
assigned to Delaware County Memorial Hospital, Respondent committed
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Summary Suspension - M. Kandil , R179953
#8 #9
#10
#11
#12
#13
#14 #19 #21 #22 #23 #26
recordkeeping errors , medication administration errors and was suspected
of narcotics diversion .
On or about October 7, 2008, Respondent was asked by her employer to
submit to a urine screen, which she did and was positive for Butalbital ,
Nordiazepam, Oxapam and Temazepam .
Respondent failed to produce a prescription for the medications for which
she tested positive.
Respondent was subsequently terminated from Delaware County
Memoria l Hospital and Fastaff Agency.
Respondent was referred to the Professional Health Monitoring Program
to determine if she was eligible for the Voluntary Recovery program,
Respondent refused enrollment in the VRP .
On or about October 23, 2009, the Commonweailth filed a petition to
compel a mental and physical examination of Respondent with the
Probable Cause Screening Committee of the State Board of Nursing .
On or about October 23, 2009, the Board's Probable Cause Screening
Committee granted the Commonwealth's petition and issued an order
compelling Respondent to submit to a mental and physical exami nation.
Respondent failed to attend the examination with [the assigned doctor] on
December 22, 2009 at 5:00pm .
On or about January 4, 2010, the Commonwealth filed a motion to enter
default and deem facts admitted and served it on Respondent by first
class mail at her address on file with the Board at 206 Boox St., Forked
River, NJ 08731.
Respondent did not answer the petition to compel a mental and physical
examination and did not respond to the motion to enter default and deem
facts admitted .
On or about January 6, 2010, the Board issued a memorandum order
giving Respondent notice that if she did not request a hearing by January
26, 2010, her license would be indefinitely suspended.
Respondent has not requested a hearing or otherwise responded in any
way to the Commonwealth or to the Board.
[Final Adjudication and Order, p 3-6]
Maryland Complaint #1
5) On or about November 9, 2007 , the Board received a complaint regarding the
Respondent's nursing practice from a hospital located in Baltimore, Maryland
("Hospital A").
6) On or about October 22, 2007, Respondent started working for Hospital A as part
of a travel assignment from an agency based in Florida ("Agency").
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Summary Suspension - M. Kandii, R179953
7)
8)
Respondent's actions du
her orientation and
RN1 reported to the unit's
h~"f"1C>
nurse she was
concerns regarding
several staff
On or about October
to the unit.
Nurse that
concerns about
that a patient on the unit
(the Respondent). RN1
already requested that the Respondent not
assigned to care for
When the patient in question was asked to elaborate.
patient noted that when
the Respondent was trying to start the patient's IV, the Respondent "kept
scratching her nose
stated that
and her eyes were rolling
had been a heroi n
in her
"
for several years
recognized another drug addict when she saw one."
9)
Another nurse. RN2,
the Respondent
patient food carts and while taking then into the
10)
RN2 and
was "pulling her
that while
two bowls of soup off
k room she dropped them."
was eating a
up and shirt up
scratching her
back and underarms." When co-workers
Respondent if she was
alright, Respondent
last night and had drank
that "she had a visitor
some alcohol and that made her itch."
11 )
Towards the end of
pyxis 2 and asked RN2 to
Respondent pulled 8mg of
3mg with her.
I
IV from the
waste in
Oialudid is a narcotic (opiate)
used to treat or prevent moderate to severe pain. It is a
II CDS.
(also called AccuDose) is an automated drug-dispensing device that
CDS and other
medications. Each time it is accessed, it records information including name of medication, dose. time of
return of medication (if it is not used), patient name and identification of nurse accessing the
Each nurse has his/her own
or password to gain access to the medications.
rno./'1'I""t,
is wasted if the
or unit dose is greater than the
dose or if the
is not used. Properly
a medication means disposing of
unused portion of the
I
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Summary Suspension - M. Kandil, R179953
pyxis, and then when she went to physically waste the 3mg, the Respondent
turned away from her and said she would have her preceptor, RN 1, waste the
drug with her. Approximately 15 minutes later RN2 asked RN 1 if Respondent had
wasted the Dilaudid with her and RN 1 stated that she had not RN2 then asked
Respondent what had happened to the 3mg of Dilaudid. Respondent answered
that she had thrown it away.
12) On October 25, 2007, Respondent was sent to Hospital A's Occupational Health
Services department and ordered to submit to a "for cause" drug and alcohol
screen.
13) Respondent
tested
positive
for
the
following
substances'
Benzodiazepines 4 , Propoxyphene 5 , Hydromorphone6 and Alprazolam
14)
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Opiates,
.
The drug screen results were forwarded to the Respondent's Agency who terminated her and made her rehire status with the Agency - "Do Not Hire." Maryland Complaint #2 15) On or about January 29, 2008, the Board received a second complaint regarding
the Respondent's nursing practice from a hospital located in Baltimore, Maryland
("Hospital B").
16) The complaint alleged that on January 15, 2008, Respondent visited the
hospital's Human Resources Department. While meeting with the Manager of
Human
Resources and
Business
Partner for Patient Care
("Manager"),
drug, typically with a witness who observes the disposal, and recording the wasting pursuant to facility policy. Unused packaged medications can also be returned to the Pyxis machine. 2
4 Benzodiazepine [benzo-+diazep(am)+ine j: Benzodiazepines work directly on the brain and nerves ~central nervous ~ystem) to ~roduce a calming effect. Propoxyphene IS a narcotic analgesIc structurally related to methadone. It is a Schedule IV CDS.
6 Hydromorphone is a narcotic analgesic used to treat moderate to severe pain. It is a schedule II CDS.
7 Alprazolam (brand name = Xanax) is a benzodiazepine used to treat anxiety and panic disorder. It is a
Schedule IV CDS
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Summary Suspension - M. Kandil, R179953
the co
times du
"very
were
Respondent
" Respondent
off while
could not stop scratching several parts of her body."
17)
The
reported that following their conversation, Respondent left
about
Employee
18)
Following
19)
Respondent's
Director and the
duty with the
Department
Once reaching her assigned unit, Respondent was
Employee
her concerns
Manager immed
to return to work on the floor.
area
rn<;;>rcn
and submit to "for cause" urine/blood
Respondent was
home pending
to report directly to
and alcohol testing.
screen results.
Respondent tested positive for: Oxymorphone 3, Hydromorphone, Nordiazepam9 ,
12
20)
21)
On
2008, Respondent was terminated from Hospital B for violations
of the
Substance
Following
complaint, the
Policy.
invited the
Rehabilitation Program. The
failed to
enter the
to the Board's
invitation.
22}
The
investigator made multiple attempts to contact
complete
investigation. The
failed to
Respondent to
investigator
Oxymorphone is used to treat moderate to severe
It is a schedule I
Nordiazepam, is a
with depressant effect on the central nervous
It is a schedule IV
CDS.
to Oxazepam is used to treat anxiety disorders or alcohol withdrawal symptoms. It is a schedule IV CDS.
II Temazepam is in a group of drugs called
It affects chemicals in the brain that may
become
and cause
problems
It is a schedule IV
!l Tramadol is a narcotic-like
reliever
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Summary Suspension - M. Kandil, R179953
and the contact information the Respondent had provided to the Board were
deemed to be out of date.
23) Respondent's recent discipline in Pennsylvania, her frequent traveling to different
jurisdictions in a possible attempt to avoid discipline, and ongoing problem with
using multiple controlled dangerous substances while on the job makes her
practice as a registered nurse dangerous and makes any patient under her care
a potential victim. Furthermore, while Respondent's nursing license is currently
non-renewed in the State of Maryland. without Board action, Respondent is not
prevented from renewing her license. Based on the information in paragraphs 1
through 22, as well as the information contained in the Background, the Board
finds that the public health, safety or welfare imperatively requires emergency
action in this case .
24) Based on the allegations of fact under Background and in paragraphs 1 through
22, the Board voted to charge Respondent with violations of the Nurse Practice
Act (the "Act"), Md. Code Ann ., Health Occupations Article, §§ 8-101 et. seq.
(2009 Repl. Vol.) as listed below. The pertinent provisions of Health Occupations
Article § 8-316 (a) , and the violations under which the above allegations of fact in
paragraphs 1 through 22 are brought and for which the Board has charged
Respondent, are as follows:
(a) In general. - Subject to the hearing provisions of § 8-317 of this
subtitle, the Board may ... reprimand any licensee, place any
licensee on probation, or suspend or revoke the license of a
licensee if the ... licensee:
(3) Is disciplined by a licensing, military, or disciplinary authority
in this State or in any other state or country or convicted or
disciplined by a court in this State or in any other state or
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Summary Suspension - M. Kandil, R179953
country for an act that would be grounds for disciplinary
action under the Board's disciplinary statutes ; to wit:
(7) Provides professional services while: (ii) Using any
narcotic or controlled dangerous substance, as
defined in § 5-101 of the Crimina:1 Law Arti.cle, or
other drug that is in excess of therapeutic amounts or
without valid medical indication;
(8) Does an act that is inconsistent with generally
accepted professional standards in the practice of
registered nursing or licensed practical nursing;
(12) Is physically or menta'lly incompetent;
(19) Is addicted to, or habitually uses, any narcotic or
controlled dangerous substance as defined in § 5-101
of the Criminal Law Article;
(20) Fails to cooperate with a lawful investigation
conducted by the Board;
(25) Engages in conduct that violates the profeSSional
code of ethics , to wit:
COMAR 10.27.19.02(B) A nurse may not, when
acting in the capacity or identity of a licensed nurse:
(5) Practice nursing if unfit to perform procedures
or make decisions because of physical or
mental impairment, including , but not limited
to, the effects of prescription drug,s;
COMAR 10.27.19.02(C) A nurse may not engage in
behavior that dishonors the profession whether or not
acting in the capacity or identity of a licensed nurse.
including. but not limited to:
(4) Diverting any medication or providing false or
misleading information to an authorized
prescriber or a pharmacist to obtain or attempt
to obtain any medication;
(8) Using . possessing. supplying, administering,
or attempting to use, possess, supply, or
administer prescription drugs or controlled
dangerous substances without valid medical
indication;
(9) Reporting for employment under the influence
of alcohol or drugs, without having provided
evidence of valid prescriptions for all drugs in
the sarnple;
(8) Does an act that is inconsistent with generally accepted
professional standards in the practice of registered nursing
or licensed practical nursing;
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Summary Suspension - M. Kandil, R179953
(19) Is addicted to, or habitually uses, any narcotic or controlled
dangerous substance as defined in § 5-101 of the Criminal
Law Article;
(20) Fails to cooperate with a lawful investigation conducted by
the 80ard ;
(25) Engages in conduct that violates the professional code of
ethics, to wit:
COMAR 10.27.19.02(8) A nurse may not, when acting in the
capacity or identity of a licensed nurse:
(5) Practice nursing if unfit to perform procedures or
make decisions because of physical or mental
impairment, including, but not limited to, the effects of
prescription drugs;
COMAR 10.27.19.02(C) A nurse may not engage in
behavior that dishonors the profession whether or not acting
in the capacity or identity of a licensed nurse, including, but
not limited to:
(4) Diverting any medication or providing false or
misleading information to an authorized prescriber or
a pharmacist to obtain or attempt to obtain any
medication;
(8) Using, possessing, supplying, administering, or
attempting to use, possess, supply, or administer
prescription
drugs
or
controlled
dangerous
substances without valid medical indication;
(9) Reporting for employment under the influence of
alcohol or drugs, without having provided evidence of
valid prescriptions for all drugs in the sample;
(28) After failing to renew a license or after a temporary license
has lapsed, commits any act that would be grounds for
disciplinary action under this section;
The applicable section of SG § 10-226 (c) (2) provides that:
(2) A unit may order summarily the suspension of a license if the unit:
(i) Finds that the public health, safety, or welfare imperatively
requires emergency action; and
(ii) Promptly gives the licensee:
1. Written notice of the suspension, the finding and the
reasons that support the finding ; and
2. An opportunity to be heard.
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Summary Suspension - M. Kandil, R 179953
CONCLUSIONS OF LAW Based on the foregoing investigative information, the Board finds that the public
health, safety or welfare imperatively requires emergency action in this case, pursuant
to Md . Code Ann., State Gov't. § 10-226 (c) (2) (2009 Repl. Vol.)
ORDER
It is, by a majority of a quorum of the Maryland Board of Nursing:
ORDERED that, pursuant to the authority vested in the Board by Md. Code Ann.,
Health Occ ., § 8-316 (a) (2009 Repl. Vol.) and Md. Code Ann., State Gov't., § 10-226
(c)(2) (2009 Repl. VoL), the license of MAHA KANDIL, R179953, an individual licensed
to practice REGISTERED NURSING, is hereby SUMMARILY SUSPENDED; and be it
further
ORDERED that, there will be a Show Cause Hearing on Tuesday, February 22,
2011, at 10:00 a.m. before the Board at the Board of Nursing, 4140 Patterson Avenue,
Baltimore, Maryland 21215, for Respondent to have the opportunity to show cause as to
why her license should not be suspended; and be it further
ORDERED that, if Respondent's license is suspended following a Show Cause
Hearing, upon a written request by Respondent, an evidentiary hearing to consider the
merits of this Summary Suspension and charges cited in this Order will be held at the
Board of Nursing, within a reasonable period of time from the date upon which the
Board receives the written request; and be it further
ORDERED that, if Respondent requests an evidentiary hearing before the Board,
Respondent must make the request in writing within thirty (30) days from the date of the
Show Cause Hearing.
If a request for hearing is not received within thirty (30) days
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Summary Suspension - M. Kandil, R179953
from the date of the Show Cause Hearing, Respondent waives all rights now and in the
future to any hearing with respect to this Order or the associated charges, or to any
proceedings that would contest the validity of the factual allegations of this Order for
Summary Suspension and to any appeals; and be it further
ORDERED that, if a request for hearing is not received within thirty (30) days
from the date of the Show Cause Hearing, a Final Order for Revocation of License,
including Findings of Fact and Conclusions of Law, will be issued to Respondent; and
be it further
ORDERED that, in the event Respondent requests an evidentiary hearing, the
proceeding before the Board will be conducted in accordance with the Administrative
Procedure Act (UAPA"), Md. Code Ann., State Gov't., § 10-201 et seq. (2009 Repl. Vol.),
§ 8-317 of the Act and regulations promulgated by the Board at COMAR 10.27.02. The
APA gives Respondent the right to be represented by counsel authorized to practice law
in Maryland, to request subpoenas for evidence and witnesses, to call witnesses, to
present evidence, to cross examine every witness called by the Board, to obtain a copy
of the hearing procedure upon written request, and to present summation and
argument. Unless otherwise prohibited by law, Respondent may agree to the evidence
and waive her right to appear at the hearing; and be it further
ORDERED that, for purposes of public disclosure, as permitted by Md . Code
Ann., State Gov't., § 10-617(h) (2009 Repl. Vol.) this document consists of the foregoing
Summary Suspension of Registered Nursing License and Notice of Charges and that
the Board may disclose this document to any national reporting bank or other entity to
whom the Board is mandated to report; and be it further
JJ
Summary Suspension - M. Kandil, R179953
ORDERED that, this Order is a public document pursuant to Md. Code Ann.,
State Gov't. §§ 10-601, et. seq., (2009 Repl. VoL).
h16t.4d' II, ZM
Date
Patricia A. Noble R.N .,
Executive Director
Maryla nd ~~~'NUii1rsITrIn1cgl---
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