Fairuza Stevenson v. State Of Wa, Dept. Of Health

CourtCourt of Appeals of Washington
DecidedMay 27, 2015
Docket45834-9
StatusUnpublished

This text of Fairuza Stevenson v. State Of Wa, Dept. Of Health (Fairuza Stevenson v. State Of Wa, Dept. Of Health) is published on Counsel Stack Legal Research, covering Court of Appeals of Washington primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

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Fairuza Stevenson v. State Of Wa, Dept. Of Health, (Wash. Ct. App. 2015).

Opinion

FILED COURT OF APPEALS DIVISION II

2015 MAC' 27 AM 9: 33

STATE OF WASHINGTON

BY DEPYJTY

IN THE COURT OF APPEALS OF THE STATE OF WASHINGTON

DIVISION II

FAIRUZA STEVENSON, No. 45834 -9 -II

Appellant, UNPUBLISHED OPINION

v.

STATE OF WASHINGTON, DEPARTMENT OF HEALTH, NURSING CARE QUALITY AS SURANCE COMMISSION,

Respondent.

BJORGEN, A.C. J. — Fairuza Stevenson appeals a superior court order affirming a decision

by the Washington State Department of Health' s Nursing Care Quality Assurance Commission Commission). The Commission found that Stevenson, by refusing over several days to obey a

physician' s order to provide doses of a medication to Patient A, had breached the standard of

conduct for nurses and acted outside the scope of practice allowed by Stevenson' s registered

nurse' s license. Based on these findings, the Commission concluded that Stevenson was subject

to discipline under the Uniform Disciplinary Act ( UDA), chapter 18. 130 RCW, and sanctioned

her.

On appeal, Stevenson claims that ( 1) the Commission' s findings that she breached the

relevant standard of conduct and acted outside the scope of practice are not supported by No. 45834 -9 -II

substantial evidence, ( 2) the Commission' s conclusions that she violated provisions of the UDA

are erroneous, and ( 3) collateral estoppel, res judicata, and an earlier stipulation agreement made

pursuant to CR 2A with the Department of Social and Health Services ( DSHS) to settle a related

matter bar the Commission' s order. We hold that ( 1) substantial evidence supports the

Commission' s findings, ( 2) the Commission correctly concluded that Stevenson violated several

provisions of the UDA, and ( 3) nothing precluded the Commission' s order. Consequently, we

affirm the superior court.

FACTS

Stevenson is a registered nurse and operates an adult family home through a corporation

called Stevenson Group Inc. Stevenson provides nursing services through her work at the home.

Patient A first came to the adult family home operated by Stevenson Group Inc. in 2005. 1

By 2007, one of Patient A' s physicians had prescribed a blood thinning medication to treat some

of her health problems. Another physician had prescribed antibiotics. The combination of these

drugs produced bleeding in one of Patient A' s eyes, requiring her admission to a local hospital

for treatment. Patient A' s discharge orders discontinued the doses of the blood thinner.

In November 2007, Patient A again was hospitalized, this time for fever and abdominal

pain. Dr. Meituck Hu, Patient A' s treating physician, diagnosed an infection in her leg related to

a prosthetic implant and prescribed antibiotics to remedy it. Because she believed the problem

with the prosthetic implant would limit Patient A' s mobility, Hu also prescribed prophylactic

doses of enoxaparin, another blood thinner, to prevent deep vein thrombosis, the potentially fatal

1 To protect her privacy, the agency record refers to the patient at issue as Patient A. We follow that nomenclature.

2 No. 45834 -9 -II

formation of blot clots in Patient A' s legs. Hu' s discharge orders continued Patient A' s daily

doses of enoxaparin for one month.

After discharge on November 24, 2007, Patient A returned to the adult family home

operated by Stevenson Group Inc. Stevenson, aware of Patient A' s history, made attempts to

contact Patient A' s primary care physician to ask him to discontinue the enoxaparin based on

fears it could lead to eye bleeding and vision loss. While waiting for this order, Stevenson

refrained from giving Patient A the daily enoxaparin dose Hu had prescribed. Stevenson had

great difficulty in getting the order to discontinue enoxaparin from the primary care physician,

but made no attempts to contact Hu, physicians covering for Hu at the hospital, or Patient A' s

other physicians. Eventually, feeling that she could not wait any longer, Stevenson gave Patient

A an enoxaparin dose on December 3, 2007, hours before the primary care physician faxed an

order to discontinue the drug.

Stevenson' s refusal to give Patient A the enoxaparin spawned two state administrative

actions. In the first, DSHS took action against Stevenson Group Inc., the entity licensed to

operate the adult family home. Specifically, DSHS alleged that the failure to give the enoxaparin

violated WAC 388- 76- 620, a provision requiring the adult family home to " ensure that the

resident receives necessary [ medical] services." 2' Administrative Record ( AR) at 149 -50 ( citing

WAC 388 -76 -620). Stevenson, as the representative of the home, signed a corrective action plan

and Stevenson Group Inc. settled the matter by paying an $ 800 fine to DSHS from its corporate

checking account.

2 The DSHS complaint against the adult family home also alleged a second violation unrelated to this appeal.

3 No. 45834 -9 -II

The second administrative action concerned Stevenson' s license to practice as a

registered nurse. The Commission alleged that Stevenson violated various subsections of RCW

18. 13. 180 and WAC 246 -240 -710( 2) when she refused to give Patient A the enoxaparin.3

Stevenson' s motion to dismiss the matter, based on her theory that the settlement with DSHS

precluded any action by the Commission, was denied and the matter proceeded to an

administrative hearing before a panel of the Commission.

At the hearing, the Department of Health, which prosecuted the complaint, presented two

witnesses: Hu and Stevenson. Hu testified about her diagnosis and treatment of Patient A,

including her decision to prescribe prophylactic doses of enoxaparin. Hu admitted that she had

not known about Patient A' s recent eye bleeding episode when she ordered the enoxaparin, but

3 RCW 18. 130. 180 provides, in relevant part: The following conduct, acts, or conditions constitute unprofessional conduct for any license holder under the jurisdiction of this chapter:

4) Incompetence, negligence, or malpractice which results in injury to a patient or which creates an unreasonable risk that a patient may be harmed;

7) Violation of any state or federal statute or administrative rule regulating the profession in question, including any statute or rule defining or establishing standards of patient care or professional conduct or practice;

12) Practice beyond the scope of practice as defined by law or rule.

WAC 246- 840 -710 provides that:

The following conduct may subject a nurse to disciplinary action under the Uniform Disciplinary Act, chapter 18. 130 RCW:

2) Failure to adhere to the standards enumerated in WAC 246- 840 -700 which may include, but are not limited to:

d) Willfully or repeatedly failing to administer medications and /or treatments in accordance with nursing standards.

4 No. 45834 -9 -II

stated that knowing about the incident would not have changed her order: she believed that

Patient A' s problems with her implant limited her mobility and placed her at a risk of fatal deep

vein thrombosis, requiring prophylactic doses of enoxaparin. On questioning from one of the

commission members, Hu testified that the benefits of prophylactic enoxaparin outweighed any

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