Clawson v. Board of Registered Nursing

CourtCalifornia Court of Appeal
DecidedDecember 17, 2021
DocketA159990
StatusPublished

This text of Clawson v. Board of Registered Nursing (Clawson v. Board of Registered Nursing) is published on Counsel Stack Legal Research, covering California Court of Appeal primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Clawson v. Board of Registered Nursing, (Cal. Ct. App. 2021).

Opinion

Filed 12/17/21 CERTIFIED FOR PUBLICATION

IN THE COURT OF APPEAL OF THE STATE OF CALIFORNIA

FIRST APPELLATE DISTRICT

DIVISION FIVE

WILLIAM MICHAEL CLAWSON, Plaintiff and Appellant, A159990 v. BOARD OF REGISTERED NURSING, (City & County of San Francisco Defendant and Respondent. Super. Ct. No. CPF19516578)

Plaintiff appeals from the denial of his petition for writ of administrative mandate following the revocation of his nursing license by the Board of Registered Nursing (Board) for gross negligence and unprofessional conduct in carrying out licensed nursing functions and unprofessional conduct–deceit. We affirm. FACTUAL AND PROCEDURAL BACKGROUND I. Board Hearing Nina’s Care Home (Nina’s) was a residential care facility for the elderly (RCFE) licensed by the Community Care Licensing Division (CCL) of the State Department of Social Services. Following the unexpected death of the Nina’s administrator, an attorney for the administrator’s estate, Lisa Russ, hired plaintiff to assist with the closure of Nina’s. Plaintiff, who was a registered nurse and a certified legal nurse consultant, agreed to assess each of the residents and recommend a new facility for them, as required by the

1 RCFE closing procedures. The purpose of the assessments was to help the residents choose an appropriate facility based upon their needs.1 On May 11, 2013, plaintiff and Mia B.2 performed the assessment for J.N., an 83-year-old resident of Nina’s. Mia B. lifted up J.N.’s clothing so that the plaintiff could see her skin condition. Plaintiff testified the assessment was “very quick. We were in there for maybe two minutes.” Plaintiff found that J.N.’s skin on her coccyx and on each of her heels was red and nonblanching to the touch, which he believed was significant.3 He did not touch the bandages covering J.N.’s feet. Nor did he notice that one of J.N.’s knees was significantly contracted. Plaintiff signed the resident appraisal form using his “RN” initials and described J.N.’s overall health condition as: “Frail and cachextic [sic] female

1 Health and Safety Code section 1569.682, subdivision (a)(1)(A) requires that prior to transferring a resident to another facility an RCFE must “[p]repare . . . a relocation evaluation of the needs of that resident, which shall include: [¶] . . . [r]ecommendations on the type of facility that would meet the needs of the resident based on the current service plan.” Health and Safety Code section 1569.70 provides guidelines for the varying levels of care provided by an RCFE, and section 1569.72, subdivision (a) states, with a limited exception for some temporary illnesses, “no resident shall be admitted or retained in a residential care facility for the elderly if . . . : [¶] . . . [t]he resident requires 24-hour, skilled nursing or intermediate care [or] [¶] . . . is bedridden . . . .” 2Mia B. had worked at Nina’s as a care worker for 24 years. She did not have any nursing credentials. When the administrator of Nina’s died, Mia B. became the interim administrator. She did not wish to be the interim administrator and did not understand why she became the interim administrator. Mia B.’s English was limited, such that she was not comfortable completing paperwork. 3 An expert witness for the Board testified, “By definition, a non- blanchable area . . . already demonstrates a skin compromise . . . and that is a stage one [pressure ulcer].”

2 with severe cognitive impairment, poor appetite, chronic nausea and diarrhea, and weight loss. Soft diet tolerated fair. Skin is friable with redness to bony prominences. Scratches self severely with fingernails.” Plaintiff also signed a “Needs and Services Plan” in which he described J.N. as: “Frail, pleasant elderly female with severe cognitive impairment, cachexia, and fragile skin. Disoriented, alert, unable to respond appropriately. Unable to walk, but can stand briefly with assistance. Unable to self-transfer from bed to chair or wheel chair. Minimally able to reposition self in chair or bed. Longstanding history of alcohol abuse per medical record. Easily agitated and becomes very anxious, requiring medication. Conservator is Public Guardian, Kelly Schwartz. Significant medical history includes rheumatoid arthritis, depression, low thyroid, urinary incontinence with chronic and severe urinary tract infections (requiring hospitalization), anorexia with significant weight loss, Alzheimer’s dementia, diarrhea, and poor nutrition and fluid intake with hospitalization for dehydration. Long standing history of self-injury from fingernail scratching to face and body per care providers. Overall skin condition is fragile with compromised skin integrity to groin, significant redness to bony prominences including coccyx, heels, toes. Foot dressings cover toes.” (All caps omitted.) On both forms, plaintiff’s signature certified that “to the best of [his] knowledge [J.N.] does not need skilled nursing care.” (All caps omitted.) On May 23, 2013, the caregivers from the new RCFE, Frye’s Care Home, came to transfer J.N. They immediately noticed that J.N. was in significant pain. Every time they moved J.N. she cried out in pain. When they arrived at Frye’s, the caregivers tried to give J.N. a shower and body check. They discovered multiple bandages on her arm, knee and toes. The bandages “were stuck to [J.N.’s] skin and her wounds,” and they were not

3 freshly placed. The wounds “all smelled really bad.” The sore on the back of J.N.’s knee was very large, and her tendons were visible. J.N.’s toes were black, and she had “a very strong infection odor.” One witness described J.N.’s condition as “very horrifying.” The Frye’s caregivers called 911 and went to the hospital with J.N. J.N. died several weeks later. On May 31, 2013, a CCL investigator contacted plaintiff. Plaintiff identified himself to the CCL investigator as a registered nurse specializing in elder care in CCL-licensed facilities and explained that he had been hired by the estate and the estate’s attorney. A few months later, the CCL investigator conducted a recorded interview with plaintiff. Plaintiff stated he had performed J.N.’s assessment and described how he had directed Mia B. to perform tasks at his direction. He stated he performed a “head-to-toe” assessment by having Mia B. lift J.N.’s clothing so that plaintiff could see areas of “bony prominences . . . .” He asked Mia B. to touch J.N.’s skin where it was very red so he could see how quickly the “capillary refill” occurred. He recalled looking at J.N.’s coccyx and stated there was no wound there. Plaintiff told the investigator that J.N.’s feet were covered in dressings, which he did not remove to look at her skin. He understood from Mia B. that the dressings had been placed there by J.N.’s podiatrist. He did not know what the wound care plan was and did not see any documentation in J.N.’s records regarding the treatment plan for J.N.’s feet. Plaintiff stated that there was no malodor of J.N. during the assessment or when he was at the facility on May 23 when J.N. was transferred to Frye’s. He stated that he “would have been assessing if there were any odors of feces or urine or bacterial infection as a registered nurse, that’s what we do, and [his] assessment skills are fine.” In the May 2013 time frame, plaintiff further

4 confirmed to others orally and in writing that he had performed J.N.’s assessment. About 14 months after the incident, the Board interviewed plaintiff as part of its investigation. At that time, plaintiff denied performing J.N.’s physical assessment, stating that Mia B. “was the one in charge.” He told the investigator that Mia B. “decided what body part would be looked at and whether or not the clothing was moved, and if any of the gauze or bandages on the residents would be moved to expose anything.” He further denied even guiding or instructing Mia B. during the assessment.

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Bluebook (online)
Clawson v. Board of Registered Nursing, Counsel Stack Legal Research, https://law.counselstack.com/opinion/clawson-v-board-of-registered-nursing-calctapp-2021.