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Case #12-005262

Ohio Boa.rd of Nursing www.nursing.ohio.gov


17South HighStreet. Suite400 Columbus, Ohio 432lS-74lO (614) 466-3947
November 16,2012
NOTICE OF OPPORTUNITY FOR HEARING
Shelby A. Allen (aka "Shelby A. Hardgrove"), L.P.N. Applicant
3503 North County Line Road
Croton, Ohio 43013
Dear Ms. Allen:
In accordance with Chapter 119 Ohio Revised Code (aRC), you are hereby notified that the
Ohio Board of Nursing (Board) proposes under authority of Section 4723.28, aRC, to
permanently deny or deny your application for licensure to practice nursing as a licensed
practical nurse in Ohio; permanently revoke, revoke, suspend or place restrictions on a license
granted to you to practice nursing as a licensed practical nurse; reprimand or otherwise discipline
you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the
following reasons:
1. In August 2012, you submitted an application for licensure by examination to
practice nursing as a licensed practical nurse in Ohio.
On or about September 17,2008, in Muskingum County Common Pleas Court
Case No. CR2008-0232, you pled guilty to three (3) counts of Breaking and
Entering, all felonies of the fifth degree in violation of Section 2911.13(B), aRC,
and three (3) counts of Theft, all fifth degree felonies in violation of Section
2913.02(A)(l), one.
The acts underlying your criminal case noted above occurred on or about August
28,29, and 30,2008 in Muskingum County.
Section 4723.28(B)(4), aRC, authorizes the Board to discipline alicensee for conviction of, a
plea of guilty to, a judicial finding of guilt of, a judicial finding of guilt resulting from a plea of
no contest to, or a judicial finding of eligibility for intervention in lieu of conviction for, any
felony or of any crime involving gross immorality or moral turpitude.
Accordingly, the Board is authorized to impose one or more of the sanctions as cited in Section
4723.28 aRc. .
In accordance with Chapter 119, aRC, you are hereby informed that you are entitled to a hearing
on this matter. If you wish to request such hearing, the request must be made in writing and
must be received in the Board office within thirty (30) days of the time of mailing this notice.
Shelby A. Allen (aka "Shelby A. Hardgrove"), L.P.N. Applicant
Page 2
You are hereby further informed that if you timely request a hearing, you are entitled to appear at
such hearing in person, by your. attorney, or by such other representative as is permitted to
practice before the Board, or you may present you position, argument, or contentions in writing.
At the hearing you may also present evidence and examine witnesses appearing for and against
you.
Should you choose to request a hearing, please mail or deliver the request, in addition to any
other correspondence regarding this matter to: Lisa Ferguson-Ramos, Compliance Unit
Manager, 17 South High Street, Suite 400, Columbus, OH 43215.7410, 'or to the email
address,
If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing
of this notice, the Board may, in your absence and upon consideration of the factual and legal
allegations set forth in the Notice of Opportunity for Hearing, permanently deny or deny your
application for licensure to practice nursing as a licensed practical nurse in Ohio; permanently
revoke, revoke, suspend or place restrictions on a license granted to you to practice nursing as a
licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more
than five hundred dollars ($500.00) per violation.
Sincerely,
Judith A. Church, R.N., C.N.P.
Supervising Board Member
Certified Mail Receipt No. 7012 1010 0002 42573599
cc: Henry Appel, Assistant Attorney General
Case #11-002163
Ohio Board of Nursing www.nursing.ohio.gov
17 South HighStreet, Suite400 Columbus, Ohio 43215-7410 (614) 466-394-7
November 16,2012
NOTICE OF IMMEDIATE SUSPENSION AND
OPPORTUNITY FOR HEARING
Jayme Rae Bmfell, R.N., L.P.N.
333 Hillshafer
Findlay, Ohio 45840
Dear Ms. Barfell:
In accordance with Sections 2929.42 and/or 3719.12 of the Ohio Revised Code (ORC), the
Ohio Board of Nursing (Board) has been notified that, on or about November 1, 2012, in
Seneca County Court of Common Pleas Case Number 12-CR-0041, you pled guilty to one (1)
count of Theft of Drugs, a felony of the fourth degree, in violation of Section
2913.02(A)(1),(B)(6), ORC, and were found eligible for Intervention in Lieu of Conviction.
Section 3719.121(C), ORC, states in pertinent part as follows:
On receiving notification pursuant to Section 2929.42 or 3719.12 of the
Revised Code, the board under which a person has been issued a
license, certificate or evidence of registration immediately shall
suspend the license, certificate, or registration of that person on a plea
of guilty to, a finding by a jury or court of the person's guilt of, or
conviction of a felony drug abuse offense; a finding by a court of the
person's eligibility for intervention in lieu of conviction; a plea of guilty
to, or a finding by a jury or court of the person's guilt of, or the person's
conviction of an offense in another jurisdiction that is essentially the
same as a felony drug abuse offense; or a finding by a court of the
person's eligibility for treatment or intervention in lieu of conviction in
another jurisdiction.
Theft of Drugs, a felony of the fourth degree, in violation of Section 2913.02(A)(1), (B)(6),
ORC, constitutes a "felony drug abuse offense" as defined in Section 2925.01, ORC.
WHEREFORE, PURSUANT TO SECTION 3719.121(C), ORC, YOU ARE HEREBY
NOTIFIED THAT YOUR LICENSES TO PRACTICE NURSING AS A REGISTERED
NURSE, RN-313739, AND AS A LICENSED PRACTICAL NURSE, PNI07990, ARE
HEREBY SUSPENDED. Continued practice after receipt of this notice of suspension shall
Jayme Rae Barfell, R.N., L.P.N.
Page 2
be considered engaging in the practice of nursing without a current, valid license, which is a
violation of Section 4723.03(A), aRC and/or Section 4723.03(B), aRc.
You are further notified that in accordance with Chapter 119, aRC, the Board proposes under
authority of Section 4723.28, aRC, to deny, permanently revoke, revoke, suspend or place
restrictions on your licenses to practice nursing as a registered nurse and licensed practical
nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred
dollars ($500.00) per violation for the following reasons:
1. On or about November 1,2012, in Seneca County Court of Common
Pleas Case Number 12-CR-0041, you pled guilty to one (1) count of
Theft of Drugs, a felony of the fourth degree, in violation of Section
2913.02(A)(1),(B)(6), aRC, and were found eligible for Intervention in
Lieu of Conviction.
The acts underlying this case occurred on or about June 1, 2011, and
involve you obtaining or exerting control over Oxycodone beyond the
scope of consent of Tiffin Mercy Hospital, Seneca County.
Section 4723.28(B)(4), aRC, authorizes the Board to discipline a licensee for conviction of, a
plea of guilty to, a judicial finding of guilt of, a judicial finding of guilt resulting from a plea
of no contest to, or a judicial finding of eligibility for intervention in lieu of conviction for,
any felony. Section 4723.28(B)(5), aRC, authorizes the Board to discipline a licensee for
conviction of, a plea of guilty to, a judicial finding of guilt of, a judicial finding of guilt
resulting from a plea of no contest to, or a judicial finding of eligibility for intervention in lieu
of conviction for, violating any municipal, state, county, or federal drug law.
2. In an interview with a Board Compliance Agent, on or about June 17,
2011, you admitted that you had been prescribed pain medication and
at times, when you were running out of medication, you self-
administered a family member's Methadone. You stated that you also
self-administered an overdose of Ambien in or about September 2010.
Section 4723.28(B)(8), aRC, authorizes the Board to discipline a licensee for self-
administering or otherwise taking into the body any dangerous drug, as defined in Section
4729.01, aRC, in any way not in accordance with a legal, valid prescription issued for that
individual.
Accordingly, the Board is authorized to impose one or more of the sanctions as cited in
Section 4723.28, aRC.
In accordance with Chapter 119, aRC, you are hereby informed that you are entitled to a
hearing in this matter. If you wish to request such hearing, the request must be made in
writing and must be received in the Board office within thirty (30) days of the time of mailing
of this notice. As required by Section 3719.l21(C), aRC, the suspension ordered herein shall
remain in effect until this hearing is held.
Jayme Rae Barfell, R.N., L.PN.
Page 3
You are hereby further informed that, if you timely request a hearing, you are entitled to
appear at such hearing in person, by your attorney, or by such other representative as is
permitted to practice before the Board, or you may present your position, arguments, or
contentions in writing. At the hearing you may also present evidence and examine witnesses
appearing for and against you.
Should you choose to request a hearing, please mail or deliver the request, in addition to any
other correspondence regarding this matter, to: Lisa Ferguson-Ramos, Compliance Unit
Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus OH
432157410, or to the email address,
If the Board fails to receive a request for a hearing within thirty (30) days of the time of
mailing of this notice, the Board may, in your absence and upon consideration of the factual
and legal allegations set forth in this Notice of Immediate Suspension and Opportunity for
Hearing, deny, permanently revoke, revoke, suspend or place restrictions on your licenses to
practice nursing as a registered nurse and licensed practical nurse; reprimand or otherwise
discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation.
Sincerely,
Judith A. Church, R.N., C.N.P.
Supervising Board Member
Certified Mail Receipt No. 7012 1010 0002 4257 4855
cc: Henry G. Appel, Assistant Attorney General
Case #12-001540
Ohio Board of Nursing www.nursing.ohio.gov
17 South HighStreet, Suite400 Columbus, Ohio 43215-7410 (614) 466-3947
November 16,2012
NOTICE OF OPPORTUNITY FOR HEARING
Jennifer Barr
8790 W. Bolsinger
Oak Harbor, Ohio 43449
Dear Ms. Barr:
On or about September 26, 2012, the Ohio Board of Nursing (Board) issued to you a Notice
of Immediate Suspension and Opportunity for Hearing, a copy of which is attached hereto
and incorporated herein.
You are notified that in accordance with Chapter 119, ORC, the Board proposes under
authority of Section 4723.28 of the Ohio Revised Code, ORC, to deny, permanently revoke,
revoke, suspend or place restrictions on your license to practice nursing as a licensed practical
nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred
dollars ($500.00) per violation for the following reasons:
1. On or about September 10,2012, in Ottawa County Court of Common
Pleas Case Number 12 CR 048, you pled guilty to one (1) amended
count of Illegal Possession of Dangerous Drugs, a felony of the fourth
degree, in violation of Section 2925.23(B)(1), ORC; and one (1)
amended count of Attempted Deception to Obtain Dangerous Drugs, a
felony of the fourth degree, in violation of Section 2923.02 and
2925.22(A), ORC, and were found eligible for Intervention in Lieu of
Conviction.
The acts underlying this case occurred on or about March 7,2012, and
involve you making, uttering, selling, or possessing a prescription that
was false or forged involving Oxycodone. Further acts underlying this
case involve you attempting to procure the administration of, a
prescription for, or the dispensing of Oxycodone.
Section 4723.28(B)(4), ORC, authorizes the Board to discipline a licensee for conviction of, a
plea of guilty to, a judicial finding of guilt of, a judicial finding of guilt resulting from a plea
of no contest to, or a judicial finding of eligibility for intervention in lieu of conviction for,
any felony. Section 4723.28(B)(5), ORC, authorizes the Board to discipline a licensee for
conviction of, a plea of guilty to, a judicial finding of guilt of, a judicial finding of guilt
resulting from a plea of no contest to, or a judicial finding of eligibility for intervention in lieu
of conviction for, violating any municipal, state, county, or federal drug law.
Jennifer Barr
Page 2
Accordingly, the Board is authorized to impose one or more of the sanctions as cited in
Section 4723.28, ORC.
In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a
hearing in this matter. If you wish to request such hearing, the request must be made in
writing and must be received in the Board office within thirty (30) days of the time of mailing
of this notice.
You are hereby further informed that, if you timely request a heariug, you are entitled to
appear at such hearing in person, by your attorney, or by such other representative as is
permitted to practice before the Board, or you may present your position, arguments, or
contentions in writing. At the hearing you may also present evidence and examine witnesses
appearing for and against you.
Should you choose to request a hearing, please mail or deliver the request, in addition to any
other correspondence regarding this matter, to: Lisa Ferguson-Ramos, Compliance Unit
Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus OH
43215-7410, or to the email address.hearing@nursiug.ohio..g!!-v.
If the Board fails to receive a request for a hearing within thirty (30) days of the time of
mailing of this notice, the Board may, in your absence and upon consideration of the factual
and legal allegations set forth in this Notice of Opportunity for Hearing, deny, permanently
revoke, revoke, suspend or place restrictions on your license to practice nursing as a licensed
practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five
hundred dollars ($500.00) per violation.
Sincerely,
Judith A. Church, R.N., C.N.P.
Supervising Board Member
Certified Mail Receipt No. 7012 1010 0002 4257 4657
Attorney Certified Mail Receipt No. 70121010 0002 4257 4664
cc: Henry G. Appel, Assistant Attorney General
Kristopher Hill, Esq.
Case #12-001540
Ohio Board of Nursing www.nursing.ohio.gov
17 South High Street, Suite 400 Columbus, Ohio 43215-7410 (614) 466-3947
September 26, 2012
NOTICE OF IMMEDIATE SUSPENSION AND
OPPORTUNITY FOR HEARING
Jennifer Barr, L.PN.
8790 W. Bolsinger
Oak Harbor, Ohio 43449
Dear Ms. Barr:
In accordance with Sections 2929.42 and/or 3719.12 of the Ohio Revised Code (ORC), the
Ohio Board of Nursing (Board) has been notified that, on or about September 10, 2012, in
Ottawa County Court of Common Pleas Case Number 12 CR 048, you pled guilty to one (1)
amended count of 1llegal Possession of Dangerous Drugs, a felony of the fourth degree, in
violation of Section 2925.23(B)(I), ORC; and one (1) amended count of Attempted Deception
to Obtain Dangerous Drugs, a felouy of the fourth degree, in violation of Section 2923.02 and
2925.22(A), ORC, and were found eligible for Intervention in Lieu of Conviction.
Section 3719.121(C), ORC, states in pertinent part as follows:
On receiving notification pursuant to Section 2929.42 or 3719.12 of the
Revised Code, the board under which a person has been issued a
license, certificate or evidence of registration immediately shall
suspend the license, certificate, or registration of that person on a plea
of gnilty to, a finding by a jury or court of the person's guilt of, or
conviction of a felony drug abuse offense; a finding by a court of the
person's eligibility for intervention in lieu of conviction; a plea of guilty
to, or a finding by a jury or court of the person's guilt of, or the person's
conviction of an offense in another jurisdiction that is essentially the
same as a felony drug abuse offense; or a finding by a court of the
person's eligibility for treatment or intervention in lieu of conviction in
another jurisdiction.
1llegal Possession of Dangerous Drugs, a felony of the fourth degree, in violation of Section
2925.23(B)(I), ORC; and Attempted Deception to Obtain Dangerous Drugs, a felony of the
fourth degree, in violation of Section 2923.02 and 2925.22(A), ORC, constitute "felony drug
abuse offenses" as defined in Section 2925.01, ORC.
WHEREFORE, PURSUANT TO SECTION 3719.121(C), ORC, YOU ARE HEREBY
NOTIFIED THAT YOUR LICENSE TO PRACTICE NURSING AS A LICENSED
PRACTICAL NURSE, PN-133599, IS HEREBY SUSPENDED. Continued practice after
Jennifer Barr, L.P.N.
Page 2
receipt of this notice of suspension shall be considered engaging in the practice of nursing
without a current, valid license, which is a violation of Section 4723.03(B), ORC.
In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a
hearing in this matter. If you wish to request such hearing, the request must be made in
writing and must be received in the Board office within thirty (:50) days of the time of mailing
of this notice. As required by Section 3719.l21(C), ORC, the suspeusion ordered herein shall
remain in effect until this healing is held.
You are hereby further informed that, if you timely request a hearing, you are entitled to
appear at such hearing in person, by your attorney, or by such other representative as is
permitted to practice before the Board, or you may present your position, arguments, or
contentions in writing. At the hearing you may also present evidence and examine witnesses
appearing for and against yon.
Should you choose to request a hearing, please mail or deliver the request, in addition to any
other correspondence regarding this matter, to: Lisa Ferguson-Ramos, Compliance
Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, Ohio
43215-7410, or to the e-mail
If the Board fails to receive a request for a hearing within thirty (30) days of the time of
mailing of this notice, the Board may, in your absence and upon consideration of the factual
and legal allegations set forth in this Notice of Immediate Suspension and Opportunity for
Hearing, deny, permanently revoke, revoke, suspend or place restrictions on your license to
practice nursing as a licensed practical nurse; reprimand or otherwise discipline you; or
impose a fine of not more than five hundred dollars ($500.00) per violation.
Sincerely,
Judith A. Church, R.N., C.N.P.
Supervising Board Member
Certified Mail Receipt No. 7012 1010 0002 4257 0666
Attorney Certified Mail Receipt 70121010 0002 4257 0673
cc: Henry G. Appel, Assistant Attorney General
Kristopher Hill, Esq.
Case #11-003460
Ohio Board ofNursing www.nursing.ohio.gov
17 South High Street, Suite 400 Columbus, Ohio 43215-74100 (614) 466-3947
November 16,2012
NOTICE OF OPPORTUNITY FOR HEARING
Amy Marie Beckler, R.N.
2560 Key Street, #5N
Toledo, Ohio 43614
Dear Ms. Beckler:
In accordance with Chapter 119, Ohio Revised Code (ORC), you are hereby notified that the
Ohio Board of Nursing (Board) proposes under authority of Section 4723.28 ORC, to deny,
revoke, permanently revoke, suspend or place restrictions on your license to practice nursing as a
registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five
hundred dollars ($500.00) per violationfor the following reasons:
1. As set forth in Attachment A, while working as a registered nurse at Arbors at
Waterville, in Waterville, Ohio (Arbors at Waterville), you failed to accurately
account for the administration of narcotics and failed to administer medication as
directed in physician orders.
During an interview with a Board Compliance Agent, on or about September 23,
2011, you stated that, while working as a registered nurse at Arbors at Waterville, in
Waterville, Ohio, you probably did not consistently document medication
administration and were "a stronger patient advocate than doing paperwork."
Section 4723.28(B)(19), ORC, authorizes the Board to discipline a licensee for failure to practice
in accordance with acceptable and prevailing standards of safe nursing. care. Section
4723.28(B)(16), ORC, authorizes the Board to discipline a licensee for violation of Chapter
4723, ORC, or any rules adopted under it. Specifically, Rule 4723-4-03(B), Ohio Administrative
Code (OAC), states that a registered nurse shall maintain current knowledge of fhe duties,
responsibilities, and accountabilities for safe nursing practice. Rule 4723-4-06(E), OAC, states
that a licensed nurse shall, in a complete, accurate, and timely manner, report and document
nursing assessments or observations, the care provided by the nurse for the client, and the client's
response to that care. .
2. While working as a registered nurse at Arbors at Waterville, you withdrew
medication without or in excess of physician orders with respect to a withdrawal of
Percocet (Oxycodone) for Patient # 9 on or about May 8, 2011, at 10:00 p.m. and on
or about May 9, 2011, at 5:00 a.m.
r
Amy Marie Beckler, R.N.
Page 2
Section 4723.28(B)(19), ORC, authorizes the Board to discipline a licensee for failure to practice
in accordance with acceptable and prevailing standards of safe nursing care. Section
4723.28(B)(l6), ORC, authorizes the Board to discipline a licensee for violation of Chapter
4723, ORC, or any rules adopted under it. Specifically, Section 4723.28(B)(20), ORC, authorizes
the Board to discipline a licensee for, in the case of a registered nurse, engaging in activities that
exceed the practice of nursing as a registered nurse.
Accordingly, the Board is authorized to impose one or more of the sanctions cited in Section
4723.28,ORC.
In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing
in this matter. If you wish to request such hearing, the request must be made in writing and must
be received in the Board office within thirty (30) days of the time of mailing of this notice.
You are hereby further informed that, if you timely request a hearing, you are entitled to appear
at such hearing in person, by your attorney, or by such other representative as is permitted to
practice before the Board, or yon may present your position, arguments, or contentions in
writing. At the hearing, you may also present evidence and examine witnesses appearing for and
against you.
Should you choose to request a hearing, please mail or deliver the request, in addition to any
other correspondence regarding this matter, to Lisa Ferguson-Ramos, Compliance Unit
Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbns, Ohio 43215-
7410 or to the email address, ..
If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing
of this notice, the Board may, in your absence and upon consideration of the factual and legal
allegations set forth in this Notice of Opportunity for Hearing, deny, revoke, permanently
revoke, suspend, or place restrictions on your license to practice nursing as a registered nurse;
reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars
($500.00) per violation.
Sincerely,
Judith A. Church, R.N., C.N.P.
Supervising Board Member
Certified Mail Receipt No. 7012 1010 0002 4257 4305
cc: Henry G. Appel, Assistant Attorney General
Amy Marie Beckler, R.N.
Page 3
ATTACHMENT A
PATIENT
Physician Order
MEDICATION MAR Comments
#
WITHDRAWN
..
Patient Hydrocodone two Hydrocodone, Documented as Inaccurate record/date.
#1 (Vicodin) 5/500, 2 5/24/10 [sic] @ 4 am two administered Withdrawal and
every 8 hours as 5/23111 administration do not match.
needed.
two Hydrocodone, None No record of administration.
5/26/2011 @ 9 pm
Patient Percocet, 5/325, one one Percocet, 5/20/11, Yes, but Inaccurate record/date.
#2 every 6 hours as @4am documented as Withdrawal and
needed. one administered administration do not match.
on 5/19 at 4am
Patient Percocet two, 5/9/11, @ 1:30am None No record of administration.
#3 (Oxycodone),5/325,
1 to 2 tablets every 4- two, 5/14/11, @ 4 pm None No record ofadministration.
6 hours as needed
Patient Percocet two, 5/8/11 @7 am None No record of administration.
#4 (Oxycodone)
5/325,2 tablets every
4 hours as needed.
Patient Percocet one, 5/26/11 @ 7:30 pm None No record of administration.
#5 (Oxycodone) 5/325,
1 every 4 hours as one, 5/26/11 @ 11:30 None No record of administration.
needed. pm
Patient Percocet two, 5/6/11 @ 4 am None No record of administration.
#6 (Oxycodone), 5mg, 1
or 2 tablets every 4 two, 5/7/11 @ 8 pm None No record of administration.
hours as needed.
two, 5/8/11 @ 12 am None No record of administration.
two, 5/8/11 @ 7 am None No record of administration.
two, 5/9/11 @ 5 am None No record of administration.
two, 5/14111 @ 4:30 pm None No record of administration.
two, 5/20/11 @ 4 am None No record of administration.
Amy Marie Beckler, R.N.
Page 4
Patient Percocet two, 5/5/11, @ 8 pm None No record of administration.
#7 (Oxycodone),
5/325, 1 to 2 every 4 two,5/6/11,@ 1 am None No record of administration.
hours as needed.
Patient Percocet two, 5/5/11 @ 10 pm None No record of administration.
#8 (Oxycodone),
5/325,2 every 4 two, 5/6/11 @ 4:30 am None No record of administration.
hours as needed.
two, 5/7/11 @ 8 am None No record of administration.
two, 5/8/11 @ 4 am None No record of administration.
two, 5/9/11 @ 10 pm None No record of administration.
two, 5/27/11 @ 4 am None No record of administration.
Cases #12-004033; 10-0561
Ohi.o Board of Nursing www.nursing.ohio.gov
17 South HighStreet, Suite 400- Columbus, Ohio 43215-7410 - (614) 466-3947
November 16,2012
NOTICE OF OPPORTUNITY FOR HEARING
Joseph Gerard Bellian, Jr., R.N.
2524 Milford Rd.
University Heights, Ohio 44118
Dear Mr. Bellian:
In accordance with Chapter 119, Ohio Revised Code ("ORC"), you are hereby notified that
the Ohio Board of Nursing ("Board") proposes under authority of Section 4723.28, ORC,
to deny, permanently revoke', revoke, suspend or place restrictions on your license to
practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a
fine of not more than five hundred dollars ($500.00) per violation for the following
reasons:
1. You were licensed to practice as a registered nurse by the Board in June 2005.
On or about January 23,2010, while working as a nurse at the Cleveland Clinic
Foundation, you administered a dose of Vancomycin to Patient #1 [see attached
Patient Key - to remain confidential and not subject to public disclosure] with a
high pre-Vancomycin Blood level of 36.1. You did not check the test results prior
to administering the dose of Vancomycin and did not notify the physician of the
high Vancomycin level. In a written statement to the Board you stated that you did
not remember to check the test results.
2. On or about January 22,2010, you admitted Patient #2 to your unit with an
oxygen saturation level of 88% at approximately 11:00 prn., while on 5
liters per minute (LPM) of oxygen via nasal cannula. You notified the
respiratory therapist who placed an oxygen mask on the patient. You
documented the patient was administered oxygen at 5LPM. The respiratory
therapy staff member documented the oxygen being administered at
IOLPM. At or about 12:20 A.M. on January 23,2010, you documented that
Patient #2 had an oxygen saturation level of 56% on room air. You placed
the patient back on oxygen but did not notify the physician. You did not
obtain further oxygen saturation levels until twenty-three minutes after
administering the oxygen and at that time documented Patient #2' s oxygen
saturation was 94% on oxygen at 5LPM, when the flow rate was 10LPM.
Following your shift, on or about January 23, 2010 at 8:00 A.M., Patient #2
was transferred to the ICU. Throughout your shift, you did not notify the
physician regarding the change in Patient #2's respiratory status, nor did you
Joseph Gerard Bellian, Jr., R.N.
Page 2
notify the cardiac emergency response team per facility policy when Patient
#2' s oxygen saturation was 56%.
Section 4723.28(B)(I9), ORC, authorizes the Board to discipline a licensee for failure to
practice in accordance with acceptable and prevailing standards of safe nursing care.
Section 4723.28(B)(16), ORC, authorizes the Board to discipline a licensee for violation of
Chapter 4723, ORC, or any rules adopted under it. Specifically, Rule 4723-4-03(C), Ohio
Administrative Code, states that a registered nurse shall demonstrate competence and
accountability in all areas of practice in which the nurse is engaged which includes, but is
not limited to, the following: (I) Consistent performance of all aspects of nursing care; and
(2) Appropriate recognition, referral or consultation, and intervention, when a complication
arises.
3. On or about January 24, 2011, you entered into the Board's Practice
Intervention and Improvement Program (PlIP), stipulating that you had identified
practice deficiencies, and wished to correct the deficiencies without being subject to
disciplinary action. Under the terms and conditions of the PlIP Participatory
Agreement (Agreement), you were required to comply with the terms of the
Agreement (Agreement, page 6.)
a. Item 1. of the Agreement states that you shall obey all federal, state and local
laws, and all laws and rules governing the practice of nursing in Ohio.
i. Despite this provision, on or about November 18, 2011 at 8:00 AM, while
working as a nurse at Regency Hospital Cleveland East (RHC), Patient #3's pulse
oximetry was 88%. Despite Patient #3's decreased pulse oximetry reading, you
administered Morphine 3mg. and Ativan (Lorazepam) 1 mg., which could cause
further respiratory depression. At 8:18 AM you called for a Rapid Response Team
because Patient #3 was experiencing labored, shallow breathing and was non-
responsive. You were observed standing by the bedside watching Patient #3 and
had to be told twice to manually ventilate Patient #3. You were unable to recall
how much pain medication Patient #3 had received.
Section 4723.28(B)(I9), ORC, authorizes the Board to discipline a licensee for failure to
practice in accordance with acceptable and prevailing standards of safe nursing care.
Section 4723.28(B)(16), ORC, authorizes the Board to discipline a licensee for violation of
Chapter 4723, ORC, or any rules adopted under it. Specifically, Rule 4723-4-03(C), OAC,
states that a registered nurse shall demonstrate competence and accountability in all areas
of practice in which the nurse is engaged which includes, but is not limited to, the
following: (1) Consistent performance of all aspects of nursing care; and (2) Appropriate
recognition, referral or consultation, and intervention, when a complication arises. Rule
4723-4-06(H), OAC, states that a licensed nurse shall implement measures to promote a
safe environment for each client.
Joseph Gerard Bellian, Jr., R.N.
Page 3
ii. On or about December 25, 2011, yon were observed administering PEG
medications to Patient #4 while she was lying flat, when the head of the bed should
have been elevated. You had to be told by a family member to put the head of the
bed up.
Section 4723.28(B)(l9), ORC, authorizes the Board to discipline a licensee for failure to
practice in accordance with acceptable and prevailing standards of safe nursing care.
Section 4723.28(B)(16), ORC, authorizes the Board to discipline a licensee for violation of
Chapter 4723, ORC, or any rules adopted under it. Specifically, Rule 4723-4-03(C), OAC,
states that a registered nurse shall demonstrate competence and accountability in all areas
of practice in which the nurse is engaged which includes, but is not limited to, the
following: (l) Consistent performance of all aspects of nursing care.
b. Item 13. of the Agreement states that you shall successfully complete the period
of Workplace Monitoring. For purposes of meeting this requirement, your
successful completion must be verified by the Workplace Monitor (WPM) in a
written statement, submitted to the Board or its designee, indicating that your
nursing practice with respect to the identified deficiencies meets the standards of
safe care established in rules adopted by the Board, as set forth in Rule 4723-18-
09(B)(2),OAC.
i. Despite this provision, on or about October 7, 2011, your WPM reported to the
Board that you continue to struggle with establishing a routine conducive to
flexibility and allowing for changes in patient condition. You were reported to be
frustrated at times when patients' condition deteriorates due to a lack of
organizational skills and ability to think critically.
ii. Despite this provision, on or about November 28, 2011, the RHC Clinical
Dietitian reported to your WPM that you failed to implement her request to measure
Patient #5's weight.
iii. Despite this provision, on or about January 5,2012, your WPM indicated that
you continue to face challenges with interpersonal skills, clinical ability, awareness
of patients' needs, and recognition of changes in patient condition. Your WPM
states that you have not been receptive to feedback and deny responsibility for
issues with your performance.
c. On April 5,2012, you were terminated from PUP for non-compliance with the
terms and conditions of the Agreement as referenced in paragraph 3 a. and b. of this
Notice of Opportunity for Hearing.
Section 4723.28(B)(26), ORC, authorizes the Board to discipline a licensee for failure to
comply with the terms and conditions required under the practice intervention and
improvement program.
Joseph Gerard BeJlian, Jr., R.N.
Page 4
Accordingly, the Board is anthorized to impose one or more of the sanctions as cited in
Section 4723.28 ORC.
In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a
hearing in this matter. If you wish to request such hearing, the request must be made in
writing and must be received in the Board office within thirty (30) days of the time of
mailing of this notice.
You are hereby further informed that, if you timely request a hearing, you are entitled to
appear at such hearing in person, by your attorney, or by such other representative as is
permitted to practice before the Board, or you may present your position, arguments, or
contentions in writing. At the hearing you may also present evidence and examine
witnesses appearing for and against yon.
Should you choose to request a hearing, please mail or deliver the request, in addition to
any other correspondence regarding this matter, to Lisa Ferguson-Ramos, Compliance
Unit Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus,
Ohio 43215-7410 or to theemaiI address, hearing@nursing.ohio.gQY.
If the Board fails to receive a request for a hearing within thirty (30) days of the time of
mailing of this notice, the Board may; in your absence and upon consideration of the
factual and legal allegations set forth in this Notice of Opportunity for Hearing, deny,
permanently revoke, revoke, suspend or place restrictions on your license to practice
nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of
not more than five hundred dollars ($500.00) per violation.
Sincerely,
Judith A. Church, R.N., C.N.P.
Supervising Board Member
Certified Mail Receipt No. 7012 1010 0002 4257 4299
cc: Henry G. Appel, Assistant Attorney General
Case #12-003257
Ohio Board of Nursing www.nursing.ohio.gov
17SouthHigh Street, Suite 400 Columbus, Ohio 43215-7410 (614) 466-3947
November 16,2012
NOTICE OF OPPORTUNITY FOR HEARING
Yvonnie Booth, L.P.N.
6808 Kristi Lynne LN
Toledo, Ohio 43617
Dear Ms. Booth:
In accordance with Chapter 119. of the Ohio Revised Code (aRC), you are hereby notified that
the Ohio Board of Nursing (Board) proposes under the authority of Section 4723.28, aRC, to
deny, permanently revoke, revoke, suspend or place restrictions on your license to practice
nursing as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of
not more than five hundred dollars ($500.00) per violation for the following reasons:
1. On or about April 30,2012, in Franklin County Court of Common Pleas Case
Number llCR 09 5019, you pled guilty to and were subsequently convicted
of one (1) count of Theft by Deception, a fourth-degree felony, in violation of
Section 2913.02, ORe. The acts underlying your conviction occurred from on
or aboutJanuary 1,2008 to on or about February 10,2010, and consist of you,
while working as an independent provider nurse, billing for services that you
did not provide.
Section 4723.28(B)(4), aRC, authorizes the Board to discipline a licensee for conviction of, a
plea of guilty to, a judicial finding of guilt of, a judicial finding of guilt resulting from a plea of
no contest to, or a judicial finding of eligibility for intervention in lieu of conviction for, any
felony or of any crime involving gross immorality or moral turpitude.
Accordingly, the Board is authorized to impose one or more of the sanctions cited in Section
4723.28, aRC.
In accordance with Chapter 119, aRC, you are hereby informed that you are entitled to a hearing
in this matter. If you wish to request such hearing, the request must be made in writing and must
be received in the Board office within thirty (30) days of the time of mailing of this notice. You
are hereby further informed that, if you timely request a hearing, you are entitled to appear at
such hearing in person, by your attorney, or by such other representative as is permitted to
practice before the Board, or you may present your position, arguments, or contentions in
writing. At the hearing you may also present evidence and examine witnesses appearing for and
against you.
Yvonnie Booth, L.P.N.
Page 2
Should you choose to request a hearing, please mail or deliver the request, in addition to any
other correspondence regarding this matter, to Lisa Ferguson-Ramos, Compliauce Unit
Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus OH 43215-
7410, or to the email address, hearing@nursing.ohio.gQY.
If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing
of this notice, the Board may, in your absence and upon consideration of the factual and legal
allegations set forth in this Notice of Opportunity for Hearing, to deny, permanently revoke,
revoke, suspend or place restrictions on your license to practice nursing as a licensed practical
nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred
dollars ($500.00) per violation.
Sincerely,
Judith A. Church, R.N., C.N.P.
Supervising Board Member
Certified Mail Receipt No. 7012 1010 0002 42573704
cc: Henry G. Appel, Assistant Attorney General
Case #12-003073
Ohio Boa.rd of Nursing www.nursing.ohio.gov
17 South HighStreet, Suite400 Columbus, Ohio 43215-7410 (614) 466-3947
November 16,2012
NOTICE OF IMMEDIATE SUSPENSION AND
OPPORTUNITY FOR HEARING
Jessica Jolene Bowman, L.P.N.
8 Montgomery Way #10
Amelia, Ohio 45102
Dear Ms. Bowman:
In accordance with Sections 2929.42 and/or 3719.12 of the Ohio Revised Code (ORC), the
Ohio Board of Nursing (Board) has been notified that, on or about October 11, 2011, in
Morrow County Court of Common Pleas Case Number 201O-CR-0022, you pled guilty to and
were found guilty of one (1) count of Possession of Drugs, a felony of the fifth degree, in
violation of Section 2925.11, ORC; and on or about April 29,2009, in Richland County Court
of Common Pleas Case Number 2008 CR 0448 H, you pled no contest to and were
subsequently found guilty of one (1) connt of Possession of Heroin, a felony of the fifth
degree, in violation of Section 2925.11(A), ORC.
Section 3719.121(C), ORC, states in pertinent part as follows:
On receiving notification pursuant to Section 2929.42 or 3719.12 of the
Revised Code, the board under which a person has been issued a
license, certificate or evidence of registration immediately shall
suspend the license, certificate, or registration of that person on a plea
of guilty to, a finding by a jury or court of the person's guilt of, or
conviction of a felony drug abuse offense; a finding by a court of the
person's eligibility for intervention in lieu of conviction; a plea of guilty
to, or a finding by a jury or court of the person's guilt of, or the person's
conviction of an offense in another jurisdiction that is essentially the
same as a felony drug abuse offense; or a finding by a court of the
person's eligibility for treatment or intervention in lieu of conviction in
another jurisdiction.
Possession of Drugs, a felony of the fifth degree, in violation of Section 2925.11, ORC; and
Possession of Heroin, a felony of the fifth degree, in violation of Section 2925. 11(A), ORC
constitute "felony drug abuse offenses" as defined in Section 2925.01, ORC.
WHEREFORE, PURSUANT TO SECTION 3719.121(C), ORC, YOU ARE HEREBY
NOTIFIED THAT YOUR LICENSE TO PRACTICE NURSING AS A LICENSED
PRACTICAL NURSE, PN-117743, IS HEREBY SUSPENDED. Continued practice after
Jessica Jolene Bowman, L.P.N.
Page 2
receipt of this notice of suspension shall be considered engaging in the practice of nursing
without a current, valid license, which is a violation of Section 4723.03(B), ORC.
You are further notified that in accordance with Chapter 119, ORC, the Board proposes under
authority of Section 4723.28, ORC, to deny, permanently revoke, revoke, suspend or place
restrictions on your license to practice as a licensed practical nurse; reprimand or otherwise
discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation
for the following reasons:
1a. On or about October 11, 2011, in Morrow County Court of Common
Pleas Case Number 201O-CR-0022, you pled guilty to and were found
guilty of one (1) count of Possession of Drugs, a felony of the fifth
degree, in violation of Section 2925.11, ORC.
The acts underlying this case occurred on or about June 12, 2009, and
involve you obtaining, possessing, or using Heroin.
lb. On or about April 29, 2009, in Richland County Court of Common
Pleas Case Number 2008 CR 0448 H, you pled no contest to and were
subsequently found guilty of one (1) count of Possession of Heroin, a
felony of the fifth degree, in violation of Section 2925.11(A), ORC.
The acts underlying this case occurred on or about July 5, 2007, and
involve you obtaining, possessing, or using Heroin.
Section 4723.28(B)(4), ORC, authorizes the Board to discipline a licensee for conviction of, a
plea of guilty to, a judicial finding of guilt of, a judicial finding of guilt resulting from a plea
of no contest to, or a judicial finding of eligibility for intervention in lieu of conviction for,
any felony. Section 4723.28(B)(5), ORC, authorizes the Board to discipline a licensee for
conviction .of, a plea of guilty to, a judicial finding of guilt of, a judicial finding of guilt
resulting from a plea of no contest to, or a judicial finding of eligibility for intervention in lieu
of conviction for, violating any municipal, state, county, or federal drug law.
Accordingly, the Board is authorized to impose one or more of the sanctions as cited in
Section 4723.28, ORC.
In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a
hearing in this matter. If you wish to request such hearing, the request mnst be made in
writing and must be received in the Board office within thirty (30) days of the time of mailing
of this notice. As required by Section 3719.121(C), ORC, the suspension ordered herein shall
remain in effect until this hearing is held.
You are hereby further informed that, if you timely request a hearing, you are entitled to
appear at such hearing in person, by your attorney, or by such other representative as is
permitted to practice before the Board, or you may present your position, arguments, or
Jessica Jolene Bowman, L.P.N.
Page 3
contentions in writing. At the hearing you may also present evidence and examine witnesses
appearing for and against you.
Should you choose to request a hearing, please mail or deliver the request, in addition to any
other correspondence regarding this matter, to: Lisa Ferguson-Ramos, Compliance Unit
Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus OH
43215-7410, or to the email address, hearing@nursing.ohio.go,\,.
If the Board fails to receive a request for a hearing within thirty (30) days of the time of
mailing of this notice, the Board may, in your absence and upon consideration of the factual
and legal allegations set forth in this Notice of Immediate Suspension and Opportunity for
Hearing, deny, permanently revoke, revoke, suspend or place restrictions on your license to
practice nursing asa licensed practical nurse; reprimand or otherwise discipline you; or
impose a fine of not more than five hundred dollars ($500.00) per violation.
Sincerely,
Judith A. Church,RN., CN.P.
Supervising Board Member
Certified Mail Receipt No. 7012 1010000242574428
cc: Henry G. Appel, Assistant Attorney General
Case #11-002799
Ohio Board of Nursing www.nursing.ohio.gov
17 South HighStreet, Suite400 Columbus, Ohio 43215-7410 (614) 466-3947
November 16,2012
NOTICE OF IMMEDIATE SUSPENSION AND
OPPORTUNITY FOR HEARING
Robin Lyn Bufwack (aka "Robin 1. Fankhauser-Bufwack"), R.N.
333 S. Leavitt Rd
Leavittsburg, OH 44430
Dear Ms. Bufwack:
In accordance with Sections 2929.42 and/or 3719.12 of the Ohio Revised Code (ORC), the
Ohio Board of Nursing (Board) has been notified that, on or about September 21, 2012, in
Columbiana County Court of Common Pleas Case Number 2012-CR-52, you pled guilty to
one (1) count of Theft to wit: Dilaudid, Morphine, and other dangerous drugs, a felony of the
fourth degree, in violation of Section 2913.02(A)(2), ORC; one (1) count of Deception to
Obtain a Dangerous Drug, a felony of the fourth degree, in violation of Section 2925.22(A),
ORC; and one (1) count of Illegal Processing of Drug Documents, a felony of the fourth
degree, in violation of Section 2925.23(B)(3), ORC, and were found eligible for Intervention
in Lieu of Conviction.
Section 3719.121(C), ORC, states in pertinent part as follows:
On receiving notification pursuant to Section 2929.42 or 3719.12 of the
Revised Code, the board under which a person has been issued a
license, certificate or evidence of registration immediately shall
suspend the license, certificate, or registration of that person on a plea
of guilty to, a finding by a jury or court of the person's guilt of, or
conviction of a felony drug abuse offense; a finding by a court of the
person's eligibility for intervention in lieu of conviction; a plea of guilty
to, or a finding by a jury or court of the person's guilt of, or the person's
conviction of an offense in another jurisdiction that is essentially the
same as a felony drug abuse offense; or a finding by a court of the
person's eligibility for treatment or intervention in lieu of conviction in
another jurisdiction.
theft to wit: Dilaudid, Morphine, and other dangerous drugs, a felony of the fourth degree, in
violation of Section2913.02(A)(2), ORC; Deception to Obtain a Dangerous Drug, a felony of
the fourth degree, in violation of Section 2925.22(A), ORC; and Illegal Processing of Drug
Documents, a felony of the fourth degree, in violation of Section 2925.23(B)(3), ORC,
constitute "felony drug abuse offenses" as defined in Section 2925.01, ORC.
Robin Lyn Bufwack (aka Robin L. Fankhauser-Bufwack"), R.N.
Page 2
WHEREFORE, PURSUANT TO SECTION 3719.121(C), ORC, YOU ARE IJEREBY
NOTIFIED THAT YOUR LICENSE TO PRACTICE NURSING AS A REGISTERED
NURSE, RN-347207, IS HEREBY SUSPENDED. Continued practice after receipt of this
notice of suspension shall be considered engaging in the practice of nursing without a current,
valid license, which is a violation of Section 4723.03(A), ORC.
You are further notified that in accordance with Chapter 119, ORC, the Board proposes under
authority of Section 4723.28, ORC, to deny, permanently revoke, revoke, suspend or place
restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise
discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation
for the following reasons:
1. On or about September 21, 2012, in Columbiana County Court of
Common Pleas Case Number 20l2-CR-52, you pled guilty to one (1)
count of Theft to wit: Dilaudid, Morphine, and other dangerous drugs, a
felony of the fourth degree, in violation of Section 2913.02(A)(2),
ORC; one (1) count of Deception to Obtain a Dangerous Drug, a felony
of the fourth degree, in violation of Section 2925.22(A), ORC; and one
(1) count of Illegal Processing of Drug Documents, a felony of the
fourth degree, in violation of Section 2925.23(B)(3), ORC, and were
found eligible for Intervention in Lieu of Conviction.
The acts underlying this case occurred on or about March 2011 through
July 1, 2011, and involve you obtaining or exerting control over
Dilaudid, Morphine, and other dangerous drugs beyond the scope of
consent of Salem Community Hospital. Further acts underlying this
case involve you using deception to procure the administration of, or
the dispensing of Morphine and Dilaudid. Further acts underlying this
case involve you making or uttering a false or forged official written
order for the dispensing of Morphine and Dilaudid.
Section 4723.28(B)(4), ORC, authorizes the Board to discipline a licensee. forconviction of, a
plea of guilty to, a judicial finding of guilt of, a judicial finding of guilt resulting from a plea
of no contest to, or a judicial finding of eligibility for intervention in lieu of conviction for,
any felony. Section 4723.28(B)(5), ORC, authorizes the Board to discipline a licensee for
conviction of, a plea of guilty to, a judicial finding of guilt of, a judicial finding of guilt
resulting from a plea of no contest to, or a judicial finding of eligibility for intervention in lieu
of conviction for, violating any municipal, state, county, or federal drug law.
2. On or about July 1,2011, you submitted a specimen for drug testing.
The specimen that you submitted tested positive for Opiates.
On or about July 19, 2011, you admitted to a Board Compliance Agent
that you did hot have any prescriptions for Dilaudid, Morphine, or any
other narcotic. You admitted that during the prior three (3) months, on
daily basis, you diverted Dilaudid and Morphine from Salem
Robin Lyn Bufwack (aka Robin L. Fankhauser-Bufwack"), R.N.
Page 3
Community Hospital where you worked as a nurse. You admitted that
you self-administered the diverted Dilaudid and Morphine by injecting
it intramuscularly to help you sleep. You admitted that you frequently
falsified patient medical records including Emergency Department
records to show that patients had orders for Dilaudid and Morphine
when you had' not received these orders from a physician. You
admitted that you falsified patient records by documenting
administration of Dilaudid and Morphine when you did not administer
these drugs to the patient. You admitted that you also diverted residual
doses of Dilaudid and Morphine that you should have wasted.
Section 4723.28(B)(8), ORC, authorizes the Board to discipline a licensee for self-
administering or otherwise taking into the body any dangerous drug, as defined in Section
4729.01, ORC, in any way not in accordance with a legal, valid prescription issued for that
individual. Section 4723.28(B)(13), ORC, authorizes the Board to discipline a licensee for
obtaining or attempting to obtain money or anything of value by intentional misrepresentation
or material deception in the course of practice. Section 4723.28(B)(16), ORC, authorizes the
Board to discipline a licensee for violation of Chapter 4723, ORC, or any rules adopted under
it. Specifically, Rule 4723-4-06(G), Ohio Administrative Code, states that a licensed nurse
shall not falsify any client record or any other document prepared or utilized in the course of,
or in conjunction with, nursing practice. This includes, but is not limited to, case management
documents or reports or time records, reports, and other documents related to billing for
nursing services.
Accordingly, the Board is authorized to impose one or more of the sanctions as cited in
Section 4723.28, ORC.
In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a
hearing in this matter. If you wish to request such hearing, the request must be made in
writing and must be received in the Board office within thirty (30) days of the time of mailing
of this notice. As required by Section 3719.121(C), ORC, the suspension ordered herein shall
remain in effect until this hearing is held.
Yon are hereby further informed that, if you timely request a hearing, you are entitled to
appear at such hearing in person, by your attorney, or by such other representative as is
permitted to practice before the Board, or you may present your position, arguments, or
contentions in writing. At the hearing you may also present evidence and examine witnesses
appearing for and against you.
Should you choose to request a hearing, please mail or deliver the request, in addition to any
other correspondence regarding this matter, to: Lisa Ferguson-Ramos, Compliance Unit
Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus OH
43215-7410, or to the email address, hearing@nursing.ohio.gov.
If the Board fails to receive a request for a hearing within thirty (30) days of the time of
mailing of this notice, the Board may, in your absence and upon consideration of the factual
Robin Lyn Bufwack (aka Robin L. Fankhauser-Bufwack"), R.N.
Page 4
and legal allegations set forth in this Notice of Immediate Suspension and Opportunity for
Hearing, deny, permanently revoke, revoke, suspend or place restrictions on your license to
practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine
of not more than five hundred dollars ($500.00) per violation.
Sincerely,
Judith A. Church, R.N., C.N.P.
Supervising Board Member
Certified Mail Receipt No. 7012 1010 0002 4257 4381
cc: Henry G. Appel, Assistant Attorney General
Case #12-002245
Ohio Board of Nursing www.nursing.ohio.gov
17SouthHigh Street. Suite400 COIWJlbus. Ohio 43215-7410 (614) 466-3947
November 16,2012
NOTICE OF OPPORTUNITY FOR HEARING
Tracey Lane Campbell, L.P.N.
3486 Scottwood Rd
Columbus, Ohio 43227
and
6505 Creon Dr
Reynoldsburg, Ohio 43068
Dear Ms. Campbell:
In accordance with Chapter 119 Ohio Revised Code (ORC), you are hereby notified that the
Ohio Board of Nursing (Board) proposes under authority of Section 4723.28, ORC, to deny,
revoke, permanently revoke, suspend or place restrictions on your license to practice nursing as a
licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more
than five hundred dollars ($500.00) per violation for the following reasons:
I. On or about July 31, 2012, in Franklin County Court of Common Pleas Case No.
12CR-05-2453, you pled guilty to and were subsequently convicted of one (1)
count of Theft, a first-degree misdemeanor, in violation of Section 2913.02, ORC.
The events underlying your conviction noted above occurred from on or about
July 28, 2009 to on or about August 27, 2009, and consist of you, while working
as a home health aide, submitting false billing information regarding the hours of
services provided. Specifically, you submitted timesheets for services you did not
render. On or about February 10, 2012, you met with special agents from the
Ohio Attorney General, Medicaid Fraud Control Unit and admitted that while you
were attending school, you did not work all of the seven (7) hours each day that
you billed for.
Section 4723.28(B)(4), ORC, authorizes the Board to discipline a licensee for conviction of, a
plea of guilty to, a judicial finding of guilt of, a judicial finding of guilt resulting from a plea of
no contest to, or a judicial finding of eligibility for intervention in lieu of conviction for, any
felony or of any crime involving gross immorality or moral turpitude.
Tracey Lane Campbell, L.P.N.
Page 2
Accordingly, the Board is authorized to impose one or more of the sanctions as cited in Section
4723.280RC.
In accordance with Chapter Il9, ORC,you are hereby informed that you are entitled to a hearing
on this matter. If you wish to request such hearing, the request must be made in writing and
must be received in the Board office within thirty (30) days of the time of mailing this notice.
You are hereby further informed that if you timely request a hearing, you are entitled to appear at
such hearing in person, by your attorney, or by such other representative as is permitted to
practice before the Board, or you may present you position, argument, or contentions in writing.
At the hearing you may also present evidence and examine witnesses appearing for and against
you.
Should you choose to request a hearing, please mail or deliver the request, in addition to any
other correspondence regarding this matter to: Lisa Ferguson-Ramos, Compliance Unit
Manager, 17 South High Street, Suite 400, Columbus, OH 43215-7410, or to the email
address,
If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing
of this notice, the Board may, in your absence and upon consideration of the factual and legal
allegations set forth in the Notice of Opportunity for Hearing, deny, revoke, permanently revoke,
suspend or place restrictions on your license to practice nursing as a licensed practical nurse;
reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars
($500.00) per violation.
Sincerely,
Judith A. Church, R.N., CN.P.
Supervising Board Member
Certified Mail Receipt No. 7012 1010 0002 42573711
Second Address Certified Mail Receipt No. 7012 1010 0002 42573728
cc: Henry G. Appel, Assistant Attorney General
Case #2012-002211
Ohio Board of Nursing www.nursing.ohio.gov
17 South High Street, Suite400 Columbus, Ohio 43215-7410 (614) 466-3947
November 16,2012
NOTICE OF OPPORTUNITY FOR HEARING
Cheryl A. Cannon, R.N.
1130 Stambaugh Avenue
Sharon, Pennsylvania 16146
Dear Ms. Cannon:
In accordance with Chapter 119, Ohio Revised Code (ORC), you are hereby notified that the
Ohio Board of Nursing (Board) proposes under authority of Section 4723.28, ORC, to deny or
permanently deny your request for application to reactivate or reinstate a license to practice, in
Ohio, as a registered nurse; revoke, permanently revoke, suspend or place restrictions on your
license to practice nursiug as a registered nurse; reprimand or otherwise discipline you; or
impose a fine of not more than five hundred dollars ($500.00) per violation for the following
reasons:
1. Your license to practice as a registered nursing in Ohio lapsed on September
1, 2009. On or about August 6, 2012, you submitted a Request for
Application to reactivate or reinstate your license to practice nursing as a
registered nurse in Ohio to the Board.
a) On or about November 20, 2009, the Commonwealth of Pennsylvania
Board of Professional Affairs, State Board of Nursing (Pennsylvania
Board) issued a Second Amended Notice with Order of Automatic
Suspension in which your license to practice nursing as a registered
nurse was automatically suspended for a total offive (5) years. A copy
of the November 2009 Order, including Attachment A, are attached
and incorporated herein.
b) On and about January 12, 2010, the Pennsylvania Board entered a
Consent Agreement and Order in which your license to practice as a
registered nursing was placed on probation for a period of not less than
five (5) years, subject to restrictions and conditions. A copy of the
January 2010 Consent Agreement and Order, including Attachments
are attached hereto and incorporated herein.
c) On or about December 2, 2011, the Pennsylvania Board issued a
Preliminary Order in which your license to practice nursing. as . a
registered nurse was indefinitely suspended for no less than three (3)
Cheryl A. Cannon, R.N.
Page 2
years. A certified copy of the Preliminary Order is attached hereto
and incorporated herein.
Section 4723.28(B)(1), ORC, authorizes the Board to deny a license or otherwise discipline a
licensee for denial, revocation, suspension, or restriction of authority to practice a health cafe
occupation, including nursing, for any reason other than a failure to renew, in Ohio or another
state or jurisdiction.
Accordingly, the Board is authorized to impose one or more of the sanctions as cited in Section
4723.280RC.
You are hereby further informed that, if you timely request a hearing, you are entitled to appear
at such hearing in person, by your attorney, or by such other representative as is permitted to
practice before the Board, or you may present your position, arguments, or contentions in
writing. At the hearing you .may also present evidence and examine witnesses appearing for and
against you.
Should you choose to request a hearing, please mail or deliver the request, in addition to any
other correspondence regarding this matter, to: Lisa Ferguson-Ramos, Compliance Unit
Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, OH 43215-
7410, or to the email address,
If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing
of this notice, the Board may, in your absence and upon consideration of the factual and legal
allegations set forth in this Notice of Opportunity for Hearing, deny or permanently deny your
request to reactivate or reinstate a license to practice in Ohio as a registered nurse; revoke,
permanently revoke, snspend or place restrictions on your license to practice nursing as a
registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five
hundred dollars ($500.00) per violation.
Sincerely,
Judith A. Church, R.N., C.N.P.
Supervising Board Member
Certified Mail Receipt No. 7012 1010 000242574763
cc: Henry G. Appel, Assistant Attorney General
COpy
COMMONWEAlLm OF PENNSYJLVANJIA
DEPARTMENT OF STATE
BEJFORETHESTATE BOARIl OF NU]:{SJrNG
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,-
File No. @9-51-01835
-0
g ::0
.b . 9
'?: :k
...-, ( .
. Docket No.. 2051-51-09 '6)' 0 "'5'
(5
OJ :::-I

.
. '. : 00 N (')
SECOND AMENDED NOTICE AND ORJ)ER OF AUTOMAnc :.
'WHEREAS, the records the State Board of Nursing (Board) reflect that A: .
.' . . z r-o
Cannon, RN, (Respondent), is the holder of alicense to practice professional nUrsing'\h tff.?
In theMatter of the Automatic
Suspension of the License to
Practice Professional Nursing of
Cheryl Ann Cannon, RN,
. License No. JflN-538084
Commonwealth of Pennsylvania, license number and
WlflEREAS, the prosecuting attorney for the Commonwealth has filed a petition for
automatic suspension "A"), including copies of records certified by the Court of.
Common Pleas of Mercer County, Pennsylvania, in the case of Commonwealth of Pennsylvania
, .
v. Cheryl Ann Cannon (Respondent), which relate the following:
L On August 22, 2000, at criminal action number 327 CR 2000, Respondent
pleaded guilty to possession of drug paraphernalia, a misdemeanor, in violation of section
13(a)(32) of the Controlled Substance, Drug, Device and Cosmetic Act (Drug Act),' 35 P'S,
780-l13(a)(32);
2. On April 9,. 2001, at CR-453-00, Respondent pled guilty to possession of
paraphernalia, amisdemeanor, in violation of section 13(a)(32) of the Drug Act, 35 P.S. 780-
3. On March 17, 2003, at 780 CR 2002, Respondent pled guilty to criminal
conspiracy to possess a controlled substance in violation of the Drug Act, 35 P .8. 780-
. __...' Act.ofApi:iU4, 19n.cPJ., 2,3, p.$. 780- seq.
1
'.. '.. " .... pY'" ........
mUE N'lP. CORRECT COCORD
CEflTI\".lED FROMJ!ijf.:.: .D
. r: 'IHI\. Of. .""'.
.
Sl1JrIfl+., -
. . ...
* * * '
113(a)(16);
4. On October 7, 2003, at 697 CR 2003, Respondent pled guilty to possession of a
controlled substancein violation of the Drug Act, 35 P.S. 780-113(a)(16); and
5. On June 28, 2006, at CR-305-06, Respondent pled guilt)' to possession of drug
paraphernalia, a misdemeanor, in violation of the Drug Act, 35 P.S. 780-113(a)(32).
WHEREAS, sections 13(a)(16) and (32) of the Drug Act, 35 P.S. 780-113(a)(16),
(32), provide:
(a) The following acts and the causing thereof within the are hereby
prohibited:
(16) Knowingly .or intentionally possessing a controlled or
counterfeit substance by a person not registered under this act, or a
practitioner not registered under this act, or a practitioner not
registered or licensed by the appropriate State board, unless the
substance was obtained directly from, or pursuant to, a valid
prescription order or order of a practitioner, or exceptas otherwise
authorizedby this act.
* * *
(32) The use of, or possession with intent to use, drug
paraphernalia for the purpose of planning, propagating, cultivating,
growing, 'harvesting, manufacturing, compounding, converting,
producing, processing, preparing, testing, analyzing, packing,
repacking, storing, containing, concealing, injecting, ingesting,
inhaling, or otherwise introducing into the human body a
controlledsubstance in violation of this act.
WlB!EREAS, section 113(b) of the Drug Act, 35 P.S. 780-113(b), classifies
violations of section 113(a)(16) of the Drug Act as a misdemeanor.
WlHIERJEAS, 113(i) of the Drug Act, 35 P.S. 780-113(i), classifies violations of
section 113(a)(32)ofthe Drug Act as a misdemeanor.
WlHIERJEAS, section 23(c) of the Drug Act, 35 P.S. 780-123(c), provides:
(c) The appropriate licensing boards in the Department of State shall
automatically suspend, for a period not to exceed one year, the registration or
2
license of any practitioner when the person has pleaded guilty or nolo contendere '
or has been convicted of a misdemeanor under this act. The district attorney of
each county shall immediately notify the appropriate State licensing board of
practitioners subject to the provisions of this section. .However, the provisions of
such automatic suspensionmay be stayed by the appropriate State licensing board
in those cases where a practitioner has violated the provisions of this act only for
the personal use of controlled substances by the practitioner and the practitioner
participates in the impaired professional program approved by the appropriate
State licensing board for a period of between three and five years, as directed by
the appropriate licensing board. If the practitioner fails to comply in all respects
with the standards of such a program, the appropriate licensing board shall
immediately vacate the stay of the enforcement of the suspension provided for
herein. Automatic suspension shall not be stayed pending any appeal of a
conviction. Restoration of such license shall be made as in the case of. a
suspensionoflicense.
NOW THEREFORE, the Board concludes that the offenses to which Respondent were
convicted are misdemeanors under the Drug Act, and that the license to practice professional
nursing issued to Cheryl Ann Cannon, RN, license number RN-289734-L,shall be
AUTOMATICALLY SUSPENDED for one year for each of the five offenses listed above,
which suspensions shall run consecutively, thereby AUTOMATICALLY SUSPENDING
RESPONDENT'S LICENSE !i'OR A TOTAL OF FIVE YEARS, under the authority of
section 23(c) of the Drug Act, effective immediately.
Should Respondent choose to file an answer to the petition and a request for a hearing,
Respondent must do so by December )0,2009,20 days after the mailing date of this order.
If Respondent files an answer and request for hearing, the suspension of Respondent's license
shall remain in effect until a final order.is issued addressingthe issues raised in the answer.
Respondent may also petition for a stay of the suspension, in accordance with the
attachednoticepertainingto personal use of controlledsubstances. A stay will be granted only if
Respondent does not contest the fact of the convictions and meets the requirements set forth in .
the attached notice, established in section 23(0) of the Dreg Act, 35 P.S. 780-123(c} If
3
Respondent files a request for stay, Respondent's license will remain suspended until the Board
determines whether a stay of the suspension is appropriate.
identified in the petition at the address set forth below..
Answers to the petition, requests for hearing; and petitions for stay shall be filed with
Prothonotary, Department of State, 2601 North Third Street, Harrisburg, PA 17105. A copy of
. any answer, request for hearing or petition for stay shall be served on the prosecuting attorney
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BYORJ)ER:
. STATE BOARD OFNURS1fNG BUREAU OF PROFJIWSIONAL AND
OCClUPATIONAL AFFAIRS
Any hearing in connection with this matter shall be scheduled within 30 days of receipt
of the request for a hearing. Continuances will only be granted for good cause.
. BASIL L. MERENDA,
.COMMISSIONER
Respondent's address: CheryI AnnCannon, RN
1130 Stambaugh Ave.
Sharon, PA 16146
Prosecuting attorney: Monty 1. Batson, Esquire
Board counsel: Beth Sender Michlovitz, Esquire
Date of mailing:
4
NonCE
Respondent may request that this suspension be stayed ifthe conviction involved only the
personal use of controlledsubstances and if Respondent is acceptedinto the Professional Health
Monitoring Program (PHJ.Y1P) of the Bureau of Professional and Occupational Affairs.
Respondent is required to participate in PHMP for a period of between three and five years.
If the conviction was for personal use of a drug orily and Respondent desires to enter the
PHMP, Respondent must file a request to stay this suspension. Any request to stay this
suspension shall be filed 'in writing with both the Board's counsel and the Prothonotary of the
Department of State (see addresses below). After a determination as to Whether Respondent is
eligible for the PHMP, the Board will determine, following'S: hearing, whether a stay of this
order is appropriate. Respondent's license shall remain suspended until the Board determines a
stay is appropriate.
, Prothonotary
Department of State
2601 North Third Street
Harrisburg, PA 17i 10
Beth Sender Michlovitz, Counsel
State Board ofNursing
Bureau of Professional and Occupational Affairs
P.O. Box 2649
Harrisburg, PA, 17105-2649
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ATTACHMENT A.
COMMONWEALrn OF PEN]\!SYLVANJIA
J1)EPAR'f:t'\1IJEl\IT OF STATiE .
BEFORE THE STATEJB:OAJRD OF NURSING
In the Matter of the. Automatic
Suspension of the License to
Practice-of Professional Nursing
Cheryl Ann Cannon.RiN.
-License No. RN- 289734"L
..
Docket No.:
File No.
. ~ , " C j
?i,
'".-'.
....-:
PEunON FOR AUTOMAnc Sll]SPENSION
AND NOW. the Commonwealth of Pennsylvania, by and through its duly authorized
prosecuting attorney, Monty J.l\atson, files the within Petition for Automatic Suspension, pursuant
. to the Controlled Substance, Drug, Device and Cosmetic Act (Drug Act) at 35 P.S. 780 . 123(c),
and. as grounds therefore, states as follows:
1. Cheryl Ann Cannon; R.N., (Respondent) is the holder of Pennsylvania professional
nurse license number RN289734-L issued by the State Board of Nursing (Board) en.September 4,
1987 authorizing the Respondent to practice professional nursing in the Commonwealth of
,Pennsylvania.
2. The Respondent's license is active through April 30, 201b, and may be renewed
. '.. I
continually upon the filing of the appropriate documentation and payment of the necessary fees.
3. At all- time pertinent to the allegations in this Petition, the Respondent has been
. "
licensed to practice professional nursing in the Commonwealth of Pennsylvania.
4. Respondent retains a property interest in his license until and unless it is revoked
by the Board..
. 5. The Respondent's registered address with the Boardis. 1130 Stambaugh Ave.Sharon,
PA 16146.
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6: Onor about January 20, 2000, a Criminal Complaint was filed in Magisterial District
35-2-02 in Mercer County, charging Respondent with possession of
. drug paraphernalia, a misdemeanor, in violation of 35 Pa, C.S.A. 780-113(a)(32) of the Act of
April Id, 1972 (P.L. 233, No, 64) known as The Controlled Substance, Drug, Device and Cosmetic
Act, (Drug Act), 35 P.S. 780-l01, et seo..
7. On or about March 29, 2000, a Criminal Information/Indictment was filed in Court
of Common Pleas of Mercer County, Pennsylvania No. 327 Criminal 2000, charging Respondent
with possession of drug paraphernalia, a misdemeanor, in violation of 35 Pa. C,S.A. 780-
113(a)(32) of the Act of Apl'i114, 1972 (P.L. 233, No. 64) known The Controlled Substance,
Drug, Device and Cosmetic Act, (Drug Act), 35 P.S. 780-101, et seq..
._ . 8. On or about August 22, 2000, Respondent pled/was found guilty/pled nolo'
contendere, etc. of possession of drug paraphernalia, a misdemeanor, in the criminal matter
referenced above.
9. On or about October 5, 2000, in the above-referenced criminal proceedings
Respondent was sentenced for the charge of possession ofdrugparaphernalia to pay the costs and be
placed on probation for a period of one year under the supervision of the Pennsylvania Board of
Probation and Parole. Respondent was ordered to under go a drug and alcohol evaluation, be subject
to random drug testing at aminimum twice a month, and perform fifty (50) hours of community
'service,
10. On"or about March 1,2001, Respondent was re-sentenced at docket number 327
Criminal 2000 for the aforementioned charge ofpossession of drug paraphernalia, to pay tbe costs, to .
undergo imprisonment in the Mercer County jail for a period of not less than twenty (20) days nor
2
more than one (1) year, to be subject to random drug testing at a minimum oftwice per month and to
successfully complete White Deer Run's short term residential program..
11. True and correct copies ofthe Criminal Complaint and Affidavit ofProbable Cause,
Criminal Information/Indictment, Guilty Plea/Verdict and Sentencing Order are collectively attached
and incorporated herein as Commonwealth ExJjibit A .
.,
12. On or about August19, 2000, a Criminal Complaint was illed in Magisterial District
35-2-02 in Mercer County, Pennsylvania, No.CR-453-00, charging Respondent with possession of .
drug paraphernalia, a misdemeanor, in violation of 35 Pa. C.SA 780-113(a)(32) of the Act of
April 14, 1972 (pl. 233, No. 64) known as The Controlled Substance, Drug, Device and Cosmetic
\
Act, (Drug Act), 35 P.S. 780-10l; et seq...
13. An undated Criminal Information/Indictment was filedin Court ofCommonPleas of
Mercer County, Pennsylvania No. 1365 Crimina12000, charging Respondent with possession of drug
paraphernalia, a rnisderneanor, in violation of35 Pa. C.SA 780-113(a)(32) ofthe Act ofApril 14,
1972 (P.1. 233, No. 64) known as The Controlled Substance, Drug, Device and Cosmetic Act, (Drug
Act), 35 P.S. 780-101, et seq..
14. Onor about April 9,2001, Respondent pled/was found guilty/pled nolo contendere,
etc. of possession of drug paraphernalia, a misdemeanor, in the criminal matter referenced above.
15. On or about May 2
nd
, i001, in the above-referenced Respondent
was sentenced on the charge of possession of drug paraphernalia to pay the costs and undergo
imprisonment in the Mercer County Jail for a period Of110t less than sixty (60) days nor more than
One(1) year and shall be randomly drug tested at. a minimum oftwice a month.
16. True and correct copies ofthe Criminal Complaint and Affidavit ofProbable Cause,
3
Criminal Information/Indictment, Guilty P1eaIVerdict and Sentencing Order are collectively attached
and incorporated herein as Commonwealth Exhibit JEl."
17. On or about March.l Z, 2003, Respondent pled guilty, inthe Court of Common Pleas
./ ' of Mercer County, Pennsylvania at docket number 780 Criminal 2002, to criminal conspiracy to
posses a controlled substance in violation of 18 Pa. C.S.A. 903(a)(1) and/or (2) and Section
13(a)(l6), 35 P.S. 780-113(a)(l6), of the Act of April J4, 1972 (P.L. 233, No. 64) bOWD as The.
Controlled Substance, Drug, Device and Cosmetic Act (Drug Act), 351'.8. 780-J O J , ~ ..
18. On or about May2, 2003, in the above-referencedcriminal proceedings, at docket 780
Criminal 2002, Respondent Was sentenced on the charge of criminal conspiracy to posses a
controlled substance to pay the costs and 'Undergo imprisonment in the Mercer County Jail for .a
period of not less than five (2) days nor more than one (1) year and was referred to the Mercer
County Day Reporting Treatment Program for the purpose of drug treatment and drug testing.
19. True and correct copies ofthe Criminal Complaint and Affidavit ofProbable Cause,
Crimina] Information/Indictment, Guilty Plea/Verdict and Sentencing Order are collectively attached
and incorporated herein as CommonwealthExllliNt C.
"' .. 20.' On or about October 7, 2003, Respondent pled guilty, in the Court ofCommon Pleas
of MercerCounty, Pennsylvania at docket number 697 Criminal 2003, to possession of a controlled
substance in violation of Section 13(a)(J 6), 35 P.S. 786-113(a)(16), of the Act of April 14, 1972
(1'.1.233, No. 64) known as The Controlled Substance, Drug, Device and Cosmetic Act (Drug Act),
,35 P.S. 780-}01, etseq..
21. On or about November 5, 2003, in the above-referenced criminal proceedings, at
docket 697 Criminal 2003, Respondent was sentenced on tile charge ofcriminal conspiracy to posses
4
a controlled substance to pay the costs and undergo imprisonment in the Mercer County Jail for a
period of not less than twenty (20) days.
22. True and correct copies ofthe Criminal Complaint and Affidavit ofProbable Cause,
Criminal Information/Indictment, GuiltyPlea/Verdict and Sentencing Order are collectively attached
and incorporated herein as Commonwealth E:l\!JIilOit D.
, 23. On or about June 28"', 20'06, Respondent pled guilty, in Magisterial District 35-2-02
in Mercer County, Pennsylvania, at docket number CR-305-06, charging Respondent with
, possession of drug paraphernalia, a misdemeanor, in violation of35 Pa, C.S.A. 780-113(a:)(32) of
the Act of April 14, 1972 (P.L. 233, No, 64) known as The Controlled Substance, Drug, Device and
Cosmetic Act, (Drug Act), 35 P.S. 780-10L et seq..
, 24. On or about June 28
th
, 2006, in the above-referenced criminal proceedings, at docket
~ R " 305-06 was sentenced on the charge of possession of drug paraphernaliato pay anne of$100.00
and court costs 0$145.00 and to one (1) year state supervised probation.
25. True and correct copies of the Criminal Complaint and Affidavit ofProbable Cause,
Guilty PleaNerdict and Sentencing Order are collectively attached and incorporated herein as
Commonwealth Exhibit E.
26. . The Drug Act at 35 p..s. 780-1l3(b) provides, ii1 pertinent part, "Any person who
violates any of the provisions or' clauses (1) through (1), (13) and (15) through (2'0) or (37) of
subsection (a) shall be guilty of a misdemeanor ... "
27. 111e Drug Act at 35 P.S. 780-1l3 (1) provides, in pertinent part, "Ar'lyperson who
violates clauses (32), (33), and (34) of subsection (a) is guilty ofa misdemeanor ... "
5
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28. Section 123(c) of the Drug Act, 35 P.:>. 780-123(c), provides in pertinent
part:
. : f h ~ appropriate licensing boardts) in the
Department of State shall automatically suspend, for a .
period of not to exceed one year, the registration or
license of any practitioner when the person has
pleaded guilty or nolo contendere or has been
convicted of a misdemeanor under this act. . . . . .. ..
WHEREFORE, based upon the Respondent's conviction as set forth above, the
Commonwealth petitions the Board to notify the Respondent that pursuant to the Controlled
Substance, Drug and Device ana Cosmetic Act at 35 P.S. 780-123(c), the Respondent's-license to
practice professional nursing in the Commonwealth ofPennsylvania has been AUTOMATliCALLY
SUSPENDED and it is ORDERED that the Respondent immediately surrender his licensure
documents and CEASE AND DESli'][ from the. practice of professional nursing in the
Commonwealth of Pennsylvania.
Respectfully submitted,
onty .
Pros eo Attorney
Commonwealth of Pennsylvania
Department of State.
DATE:
MJB/mb
6
- - - - - _ . _ ~ - . - ~ - - _ . - _ ..
VERllnCATION
1, Monty J. Batson, do verify that the facts. set forthin the foregoing Petition for Automatic
Suspensionaretrue and correctto the best of myknowledge, information andbelief. 1understand
that falsestatements hereinaremadesubjectto the penaltiesof18 Pa.C.S. 4904relatingto unsworn
falsificationto authorities.
*****k************************************************ ************************************
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF MERCER S
Y, Katl1leeHil M1. Kloos, Clerk of Common Pleas Court,
Crlmlna], in and for said county and state, do hereby certify that
the foregoing is a nul, true and correct copy of the following: '
1. Complaint
2. D.A. Information and Signed Plea
30 Sentence
4. Re-Seritence
5. Docket;
nn the case of Commonwealth v, Cheryl Ann Cannon
so full and entire as the same remains of record before the said Court at No, 327 Criminal 200l).
In Testin-:ony Whereof, I have hereunt,'o m hand and affixed the seal of said Court this
12th day of March, 2009 ;' , v/JO. )
;Ui!U __' _
, , Oed, of Common Pleas Court, Criminal
******************************************************************************************
J. -ddj;"",
Thomas R. j5fufson
Y, Thomas R. Dobson, a Judge ohlle 'JI'Jilkty-fiftful Judicial Distrlct, composed of the County of
'Mercer, do hereby certify that Kathleen M. Kloos by whom the annexed record, certificate and attestation was
made and given and who, in her own proper handwriting, thereunto subscribed her name 'and affixed the seal of
the said Court of Common Pleas of said County, was at the lime of so doing and now is Clerk of Common
Pleas Court in and for said County of Mercer, in the Commonwealth of Pennsylvaniaduly commissioned and
qualified, to all of whose acts as such full faith and credit are and ought to be given as well in courts of
judicature aselsewhere, and that thesaid record, certificate and attestation are in due form of law, and made by
the proper officer,

'-,
COMIMONWEALTH OF PENNSYLVANIA
COUNTY OF MERCER 53
Y, Kathleen M: Kloos, Clerk of Common ]pleas Court, Criminal, 'in and fOT said County, do certify
that the Honorable Thomas R, Dobson, by whom the foregoing attestation was made and who bas hereunto
subscribed his name, was at the time of making thereof and stilUs' a Judge of the Court of Common Pleas,
, 'Criminal, in and for said County duly commissioned and qualified, to an of whose acts as such full faith and
credit are and ought to be given as well in courts of judicature as elsewhere.
In Testimony Whereof, I have hereunto set y hand and affixed the seal of Clerk of Courts this
,12thday of!lia:r-;h, 2009, .
o.SUlCl Number 35 - 2 v 02
J
Oefr,>odanl'$ SID (StalaIdllnwlcatlon
OIlJllndllJll's Onvll/'s L,cnllSl't Nvrnoet
Sl:'lle


COMMONWEALTH OF PENNSYl.VANIA
Regl51rallon Slicker(MM}YVj
OMcndanl'S lie/HelD In(Qlm:luon
Plale Number sme
Q&fol1(iaJlI'S SIlX Oefllndnnl's 0 0 B
02/01/1960 J1.
Docket No'
Date Filed:
OTN: H
OolentlMt"s A K A (also MelVlI as)
OQIllntlanl's R:!.C111fElhmclly
o Wh!tc 0 As.an m
a Hlspalllc 0 NallY/J Am0,H93n 0 Unknown
<;OMMONWEALTH OF _VANIP,
\ COUNTY OF; lmlRCER
cmplallllllno!dclll Numbllr
00-00650
uc RS Code
District Attorney's Office OApproved 0 Disapproved because: . '.
(ThedIStrict attorney mayrequire jhartne complaint, arrest warrant antdavn. orboth be approved by me attorney for the Commonwealth pnor to fllJn9
PaFlCtP1Q7}
lOMe}
123
H5HlC!l( aaa.ge NumlXllJI 01
00-0.0650
PA 0430100
(Name 01A1lo1My lorC(lIIlmollweanl'l Plel)SePnnt01
Cpl. ANTHONY S. MASOTTO .
INllmoOfAl/lllnl aaase ?flnl or Typel
Southwest Mercer County Regional P.D.
{Il:lllnllly Oep!lflflllJl'\! or Agencyflep!I1S11nted and PaMtealSUlxlIV!$lOnJ
do hereby state: (check appropriate box)
1, 1lI!l' i accuse the above named defendant, who lives at the address set forth above
o I accuse the defendant whose name is unknown 10 me liut who is described _
0112012000 AT APPX. o117hrs, Mercer
o .1 accuse the defendant whose name and popular desiqnanor. or nrckname IS unknown to me and whom I have
therefore designated as John Doe 700 BLK OFIDAHOSTREET.
with violating tha penal laws of the Comrnonweaith of Pennsylvania ai ,-__. _-.====== _
FARRELL, PA16121
Particigants were; (If there were Qartloigants" place their names here, name of above defendant)
cHERYL A. CANNON, DOUULA" A. DAVJS, FRANK LAWLER JR.
,
2. The actscommneo by fhe accused were: . .
(Sel lorth-a, summary ofthetecta suffiC'ent toadvIse Ihe defendant of theeefure oftheoffense charged AcitatIon 10 allegedly violated.
withoutmore,ISncteuftcient Ina summary case,you must cite the speclftc section andeubsecticn oflhestatute or crdoence vroleted.)
THE CONTROLLED SUBSTANCE, DRUG,DEVICE AND COSMETIC ACT. ACT 64 13(A,32)
The use of, Or possession with intent to use, drug paraphernalia for the purpose of inhaling or otherwise
introducing into the human body a controlled substance in violation of this act.
AOPC 4\2A(4I99) , .''i-
Defendant's Name: CHERYL A. CANNON
Docket Number:
CR-48-00.
pOIUCIE
COMPlAKlMl'
9n January 20th,2000at apprcx, GUO hrs.ebove subject was a passenger of a Green'fGyota TrackbearingVA registrationfZC81,9C,
vehlclewas stoppedinthe760Blk. ofIdaho Street fora trafficviolation. ThisRIOalongwith OFe. Borton asked subject to exit tbe
vehicle end asked her if shebad 011 hertbatshe should not have.1fhesubjccithenpulled aNewportpack of efgaretse's from her
pocketand heMthe openendinfrollt of QL. Maaetto's facet in plainviewa straigb(shooter couldbe seenin the bottomof the pack. The
straightshooter wasa pipeepprox. 2
11
.leng burnt 011 oneendwith ascreeningmaterial intbesame ern'll, theseare cl)mmonly usedfor
inbling a controlledsubstance. '
(Section) (Sv1:>Gectlonl cPASlp(Ull.l') .(oounls)
,.
.".
(PA (coul1Is)
a QIme
tSeC!lClIl) (Soosecuonj tp/l.$lallllll)
Ollhll
ISeclllll'll \SVb$(!cllOl'l) ..llll \l:OllnISI
all of which were against Ihe peace and dignity ollhe Commonwealth 01 Pennsylvania and contrary to the Act
of Assembly, or in vioiation of 13" (a,32) ACT 64 1
altha -,=;::;-
SEAL 35-2-02
3. I ask tnat a warrant of arrest or a summons be Issued and that the defendant be reqUlfed fa answer the charges I have
made. (10 order for a warrant of arrest to issue, the attached affidavit ot probable cause must be completed
and sworn to belore the issuing authority.) . '"
4. I verily that (he facts set lorth in this comptamt are true and correct to the best o(my knowledqe or information
and belief. This verification is made subject 10 Ihe penallles 01 Section 490401 the.Crimes Code (18 PA. C.S.
4904) relating to unsworn lalslficafion to authontles.
January20tn, 2000 y/
ANDNOW, on thiSdals January 20, 2000 " I certily that the complaint has bean properly
completed and venfled. An alflcavl! 01 probable causa must be complete rder lor a warrant '10 Issue. .
AOPC 4','aSf6/99)
IN THE COURT OF COMMON
OF MERCER
of
vs. No. Criminal
r
2000'
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(-)
The Dis'trict At.torney of Mercer County, pennsylvania, by t.his
presents that on (or about) ShO
2000., at 700 Or ""-d-!\r\r,,p $"t'!il fIT . . I
f \\ , Mercer county, the defendant
did commit the of The Controlled Substance,
Drug
J
Device and Cosmetic Act (the
( ) 35 780-113 (a) (16) possession o a controlled
Substance
Defendant knowingly' 'or in:=entionally possessed a,
controlled or substance, to wit:
a Schedule , Drug, the said defendant not being
registered under- t'his act of tha'c of persons whose
profession, business, employment, occupation or' dut.ies are
permitted and allowed to have .i n their possession and
under their control such controlled eubs-bance , and the
substanc,e was not. obtained puz-s ua.nc to a vaid
35 Pa.C.S.A. 780-113'(a) (31) Amount of Marijuana
Defendant possessed less than 30 grams of a
Schedule I, Drug, the def endane no-t bei.nq registered
under this act or of- that c Las-s of: persons t.Jhose
profession" business, or occupation or duties
are and allowed to have in their possession such
controlled substance;
35 pa. C.S.A. 780-113 (a) (32)
used or poe s ess ed with intent. to use drug
paraphernalia for. the purpose ot p,lant.i.ng r propagat.ing, ,
cu Ltivating, growi'ng, harvesting, manufacturing,
compounding, converting, producing, pracessingr'preparing,
testing, enaLyz Lnq , packing I ,repac:r.ing, s ecc-Lnq ,
containing, concealing, injecting, ingesting; inhaling or
o1:herwis6 introducing into etie numan ' body a con't.z'c.Ll.ed
substance in violation of 'this in that defendant did
All of which is against. the Act of Assembly and the peace and
of the COIDm9nwealth of
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----.._-------------------
named I, C.h ee(/ Ill.')
in the within Information bgb
Y
enter a plea of Guilt;.y to
the charges of 1)[L, j cc, I! h
c
./a e t C-
. I
IN THE COURT OJ! COMMON PLEAS
OF
No. Criminal. 2Q.QQ
CQMM"OmmALTH OF PENNSYLVANIA
v.

(!5e-fendant: )
DATE, -00 :1:du1J,j
oetehaaoc ..-(f-
tJu(.q--
}.\ctorney for Coutlnonwealch
I N FOR MA rON
Ccunr;' __. ; eosseearon o[ ('1
Controlled Substance
,-
--X-
Count Possess a Smsll
Amount-of Mariju3na
ccooc L: possessten ,)f
Drug paraphernalia
iii C(JUHTY
L"a I,Pit -3 ,6,. q, Iq

INTHE COURT OF COMMON PLEAS OF MERCER COUNTY, PENNSYLVANIA
CRIMINAL
. COMMONWEALTH
vs.
CHERYL ANN CANNON
)
)
.) No. 327 Oiminal 2000
)
)
CHARGES: Unlawful Possession of Drug Paraphernalia
1
Counsel for Defendant: Randall Hetrick, Esquire
Matter is Before the Court on Plea of Guilty
AND NOW, this 5
th
day of October, 2000, It is the sentence of
this Court on the charge of unlawful possession of drug paraphernalia that
thedefendant pay the costs and be placed on probation for a period of
one year under the supervision of the Pennsylvania Board of Probation
and Parole SUbject to the following terms andconditions:
. 1. She shall report this date to the Mercer ~ f f i c e of the
Pennsylvania Board of Probation and Parole and enter into a contract for
her supervision. The terms of that contract are incorporated herein by
reference.
2. She shall obey the laws of any jurlsdictbn in which she may
be located.
.'
2
3. She shall not consume or possess any alcoholic beverages
or go Into any bar or tavern where they eiresold.
4. She shall undergo a drug and alcohol evaluation at an
entity. to be chosen by her probation agent and successfully complete
any treatment and any aftercare recommended.
5. She shall be subject to random drug testing at a minimum
of twice per month.
6. She sholl make her pest effort to obtain employment. She
. shall have a minimum of 10applications submitted per month and
provide written verificationfhereof on the lost day of each month to her
probation agent.
7. She shall perform 50 hours of community service. She shall
report this date to the Mercer County Community Service Coordinator for
implementation of this provision.
8. She shall pay her costs pursuant to an agreement to be
entered into with the Mercer County Cost Coordinator. She shall report
this date to the Cost Coordinator's Office for the purpose of entering into
said agreement. Upon itsentry, itsterms are Incorporated herein by
reference.
BY THE COURT:
bsh
Tomas R. Dobson
Judge
INTHE COURT OF COMMON PLEAS OF MERCER COUNTY, PENNSYLVANIA
CRIMINAL
COMMONWEALTH
VS. \ No. 327 Criminal 2000
CHERYL ANN CANNON
, Charges:
Counsel for the Defendant:
Matter is Before the Court on a PleEl of G\.!i1ty
, /'.
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AND NOW, this 1'1 day of March, 2001, IT'ISTHE SENTENCE OF
THIS COURT on the charge of unlawful possession of drug paraphernalia,
the defendant pay the costs: that she undergo imprisonment in the
Mercer County Jail for a period of not less than 20 days nor more than one
year. She shall receive credit for time served, being 20 days, from August
18
1h
, 2000, through August 22
nd
, 2000, and from January 11
1h
, 2001, through
January 26
th,
2001. In that she has served her minimum sentence, she is
released this date and placed on parole for the balance of her term
under the supervision of the Pennsylvania B.oard of Probation and Parole,
subject to the follOWing terms and conditions:
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1. She shall report this date to the Mercer Office of the Board
and enter into a contract for supervision. 1he terms of that contract are
. .'
incorpordted herein by reference.
2. She shall obey the Idws of any jurisdiction In which she may
be locoted.
3. She shall not consume or possess any alcohoiic beverages or
go into any bar or tavern where they are sold.
,
4. 'She shall be subject to random drug testing a minimum of
twice 'per month.
5. She shell enroll In and successfully complete White Deer Run's
short term residential program. She shall report this date to Cynthia
McDonaid, a representative of the Behavioral Health Commission, who
shall arrange for defendant's admission into said program. She shali
execute any releases in favor of her parole agent for her parole agent to ..
monitor her compliance with this provision.
6. Upon defendant's release from the inpatient program, she
sholl obtain employment within 60 days of the date of her release. If she is.
unable to do so, she Is referred to the Mercer County Job Partnership
Program.
7. She sholl pay her costs pursuant to the payment plan
previouslv entered into with the Mercer County Cost Coordinator. The
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terms of that plan are incorporated herein by reference.
BY THE COUR1:
Thomas R: Dobson, Judge
kako
COURT Of COMMON PLEAS OIF MERCIER COUNTY
[)Il{)CI{El
Page 1of 10

CRIMINAL DOCKET
Ca]S!?I
Commonwealth of Pennsylvania
v.
Ann Cannon Cheryl"
CASEilMfORMA-nON
Date Filed: 02/29/2000 Initialion Date: 02/29/2000
Lower Court Docket No: CR-0000048-00
Final Issuing Authority: Henry J Russo
Arresting Officer: MasoUo, Anthony Stanley'
Case Local Number(s\
CR 0000048 00,
2000-327
Judge Assigned: Dobson, Thomas R
OTN: 'H1351862
Initial Issuing Authority: Henry J Russo
Arresting Agency: SW Mercer .Regional Police Dept
CllJre..bocgl Number Type(s)
Criminal 10#
Legacy Docket Number
Case Status: Closed
Status Date
08/22/2000
02/29/2000
Processing Status
Migrated Final Disposition
Migrated Case
Arrest Date: 01/20/2000
Complaint Date: 01/20/2000
Date Of Birth: 02/0111961
DEFENDANT iNFORMATIOI'JJ
CltylState/Zip: Erie, PA 16504
Alias Name
Cannon; Cheryl
Participant Type
Defendant
CASE
Name
Cannon, Cheryl Ann
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AOPC9.o.a2 Q3I12.12Q09 . Prlnted; 03112/200
Recent entrl'e:s made inthe court filing offices maynotbe immediately reflected onthesedocket sheets. thecourt; Ihe judicial
System oftheCommonwealth of Pennsylvania northe AdmlmstrativeOffice of Pennsylvania Courts assume any llabilUy for inaccurateor delayed
data, errors Of omissions onthese reports, Docket Sheetluformatlon should notbe used inplace of a crhnjnal history check which can
only beprovided bythePennsylvania SlatePolice. Moreover anemployerwho doesnotcomply with the, prcvtslons of theOrirntnel.History Record
. , Information Act maybesubject tocfvllliabillty as set forth.in 18Pa,C.S-.Section 9183.
COURT OIF COMMON PLEAS OIF MERCIER COUNTY
DOCi<\E1'

CRIMiNAllOOCIKET
COllin
Commonwealth of Pennsylvania
v.
Ann Cannon Cheryl
BAil
Page2 of 10
Cann061, CI1<a&y1 Ann
Bail Action
Set
Bail TVPe
01/18/2001 Monetary
Percentage Amount
Bail Posting Status Posting Data
$5,000.00
CHARGES
Posted 02/29/2000.
Disposition Date Final Disposition
Offense Disposition section
Sentence Date. . Credit For Time Served
Incarceration/Diversionary Period Start Date
. M 35 780113 A3; UselPoss Of Drug Paraph
Ori
a
Seg. Statute
1
Disposition
Case Event
Seguence/Description
Sentencing JUdge
SentencelDiversioo Program Tvpe
Sentence Conditions
Linked Offense: Sentence
Migrated Dlspcsjtlon
Migrated Dispositional Event
1 / Use/Poss Of Drug Paraph
Dobson, Thomas R
Confinement
Financial Assessments
Statute Description
\,.ink Tvpe
08/2212000
GUilty Plea
08122/2000 '.
Min of 20.00 Days
Max of 1.00 Years
Min of 20.00 Days
Max of 1.00 Years
Offense ' 'OTN
Date'
0112012000 H1351862
. Linked Docket Number
Final Disposition
35780-113A32
10105/2000
10105/2000
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AOPC 9082- Rey0;311;:/7,P9$. . ':'ril'l\ed: 03112/2"009
Recent entries made Inthecourt filing Offices maynot be immediately reflected onthesedocket sheets, Neitherthe courts of the Unified judicial
System of the Commonwealth of Pennsylvania nor the Office of Pennsylvania Courts assume anyllabllily forInaccurate or delayed
data, errors oromissions onthesereports. Docket Sheetrntcenatten should notbe usedinplaceof a criminal ntstorvbaCkgrOUnd checkwhich can
only beprovided by the Pennsylvania SlatePolice. Moreover an employer whodoesnotcomply with !heprcvierons of lhe Criminal History Record
. Information Act may subject tocivil liability asset fOrlh In18 Pa.C.S.Section 9183.
COURT OF rcOMMONll?lEAS.OW:: MERCER COUNTY'


CRiMiNALDOCKET
C\lrt COlS!!
Commonwealth of Pennsylvania
v.
Ann Cannon Cheryl
COMMONWEALTH !NFOIRMATiO!'! AnOlRlI!lEY nos
Page 3 of -10
. Name: James Peter Epstein, Esq:
District Attorney
Supreme Court No: 021859
Phone Number(sl:
(724) 662-3800 (Phone)
(724) 662-0807 (Fax)
Address:
Mercer County District Attorney's Office
Courthouse 5te 209
Mercer PA 18137
\
Supreme COUl1 No'
fullb Status:
Phone Number(s)'
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Aope 9Q82" Rev P.rinled: 03/12/2009 ,
aecent entries made In thecourt flUng offices maynotbe immediately reflected 011 these docket sheets, Neither thecourts of the Unified Judicial
System oftheCommonwealth of Pennsylvania northeAdministrative Officeof Pennsylvania Courts assume any liability forlnaccurate'or delayed
data,errors oromissions on thesereports. Docket Sheet informationshould not beused inplace of a criminal history background check which Cal)
only be: provided bythePennsy'varuaStatePonce. Moreovel' anemployer whodoesnot comply with the provisions ofthe Criminal History Record
Information Actmaybe sublect tocivilllabniiy as setforth in18Pa.C.S. Section 9183: '
COURT OF COMMON PLEAS OF MERCER COUNTY

Docket Numb<er: iCP-43-CR-i)l)@@3212\i11@@
DOCKET

CP Filed Dati;
0112012000
Sequence Numillli
1
COMPLAINT FILED
COMPLAINT FILED
Commonwealth of Pennsylvania
v,
Ann Cannon Cheryl

DOCument Date
Migrated, Filer
'Page 4of 10
-_.' ,-- --- ..._. ---_. -,- -_._. --- ---_. -" ... - .. _... "",": .-._.. ,._,-" .... -
'j 0212912000
Original Papers Received from Lower Court
Unknown, Filer
' ' ri ....,., "J..
1 0212912000
TRANSCRIPT TRANSFERRED FROM AOPC SYSTEM
TRANSCRIPT TRANSFERRED FROM AQPC SYSTEM
M,igrated, Filer
1 0410312000
INFORMATION FILED BY DISTRICT ATTORNEY'S
INFORMATiON FILED BY DISTRICT ATTORNEY'S OFFICE
Migrated, Filer
2 0410312000
MOTION FOR PRETRIAL DISCOVERY FILED
MOTiON FOR PRETRIAL DISCOVERY FILED BY DA
Migrated, Filer
.. , __ ...,- v. __ _, .. _''''_ , v _ri _,_ _'''''' _ ..
1 04105/2000
ORD'ER DATED'
ORDER (DATED 4+00) PO IS APPT'D TO,REPRESENT DFMDTIN CONNECTION WITH CHARC?ES AT ABOVE
TERM AND NUMBER. DOBSON J, 2 COPIES DA; COpy DFNDT AND PO
Migrated, Flier
1 0511212000
MOTION TO WITHDRAW AS COUNS FILED BY
MOTION TO WITHDRAW AS COUNSEL & ORDER DATED 511-00 FILED, POIS WITHDRAWNAS COUNSEL AND
RANDALL HETRICK, ESQUIRE IS APprO CRT APprD 'COUNSEL. WHERRY J, 2 COPIES DA;COPY, PO AND
ATTY HETRICK
Migrated, Filer
'n__' ._ _ __ M _. "'_-'" _ v _.__ _. , __ __ .:..- ,_
AOPC 9082 "Rev 03112/2009. .' Printed: OSf1212009
Recententries made'ln the court t1ling offices:may not be lmmedlately reflectedonthese docket sheets, the courts of the Unified Juolclal
Systemof the Commonwealth of Pennsylvaniano, theAdministrative Office of Pennsylvania Courts assume any liability for lnaccurateor delayed
data, errorsor omissionson thesereports, Docket Sheet informationshould not be usedInplace of a C(jlninal hlsiory background checkwhich cart
only be provided bythe Pennsylvania Slate Police, Mcrecver an employer who does not comply with the provisions of the Cnmlnat History Record
Information Aci 'maybe subject to civil liability as set forthln 18 Pa.C.s. Section 9183'
COURT Of COMMON PLEA,SOf MERCER COUNTY
[lOCKE1f
i'IllJlil11bew:
CR!MiNAl DOCKET
court Clilse
Commonwealth of Pennsylvania
v,
Ann Cannon Cheryl
IENTRnIES
Page5 of 10
'-"'- .._- - ...,"-
Sequence Numb", CP Flied Date Document Date
1 0611312000
CONTIN ORDER FILED DATED
CONTINUANCE ORDER FILED DATED 6-12-00, MAT'TER IS CONTINUED TO JULY 2000 TRIAL TERM FOR
PURPOSE OF PERMITTING DEFENSE COUNSEL TO FURTHER INVESTIGATE MATTER, DEFENSE COUNSEL
HAVING JUST BEEN APPTD DOBSON J, 2 COPIES DA AND COPY ATTY HETRICK
Migrated, Filer
1 0712112000
ORDER DATED
ORDER - (DATED 7120100)-UPON QRAL MOTION OF COUNS FORTHE DEF-THE ABOVE CAPTIONED MATTER IS
CONTINUED TO THE AUGUST TERM OF CT-RULE 1100 TIME IS ALLOCATED TO THE DEFENSE-WHERRY J-2
COPIES DA-1 COPY ATTY HETRICK
Migrated, Filet'
1, 0810912000
BENCH WARRANT DATED
B,ENCH WARRANT DATED 818100-CALL LIST-DOBSON J-2 COPIES(1CC) TO DA;1 TO ATTY HETRiCK
Migr"ted, Filer
--- -_._-- -_. --..- - -.
1 0812212000
RETURN ON WARRANT FiLED-DEF LODGED IN
RETURN ON WARRANT FILED-DEF LODGED IN MCJ ON 8119100 BY ?-COPY TO DA
Migrated, Filer
1 0812212000
Migrated Disposition
Migrated Automatic Registry Entry (Disposition) Text
Migrated, Filer
2 0812212000
BENCH WARRANT "VACATE" ORDER DATED
BENCHWARRANT"VACATE'* ORDER DATED 8/22100-BWPREV ENTEREDISVACATEDAND BOND REINST AS
EXIST PRIORTO ENTRY OF BW-FURTHER ORODEF REL'D FROM MCJ FORTHWITH-FURTHER ORO DEF'S ADD
SHALL BE LISTED AT 4558 LESLIE ST-SHARON-PA-16147-DOBSON J-2 COPIES TO DA;1-ATTY HETRICK;1-MC
Migrated, Filer
. .-_" ,_ ....... -v _... :.._ .."._ _._ .. ...:.._. :-_._" '_'_" ... ,__._
AOPC9082- Rev031:\212009 PJinted,: J:l;3;!1.2(2Q09
Recententnes made Inthe court filing offices maynotbe immediately reflected onthesedocket sheets. Nellher the courts of theUnified Judicial
System of theCommonwealth 01 Pennsytvania'nor theAdministrative Office of Pennsylvania Courts aasume.enyliability forInaccurateor delayed
data,errors Of omissions on these reports. Docket Sheet information should not be usedinplace of a cf.lmlnal history background checkwhichcan
be provided by the Pennsylvania State Pofce. anemployer whodoesnot comply with theprovisions of the Criminal History Record
lnformatlonAct maybe subject 10civilliap1lily as set forth In18 Pa,CS. Section 9183.
, \
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I
C uar OF COMMON PLEAS OF MEiR.CElR COIlJNTY
DOCKET
i'!Q.Ilm!bew:
CiR.!MiNAl DOCKET
Coa,qrtCase
I Sequence Number
2
Migrated Sentence
Migrated Sentence
CP Filed Date
08/22/2000
Commonwealth of Pennsylvania
v.
Ann Cannon Cheryl
ENTRiES
Document Date
Migrated, Filer
Page6 of 10
3 08/22/2000
PLEA ENTERED
PLEA ENTERED (DOBSON) PER CC LIST. PLEA ENTERED TO DRUG PARAPHERNALIA
Migrated, Filer
1 10/1112000
SENTENCE: (DATED:
SENTENC'E: (DATED: 1015/00)ON CHARGE Of UNLAWFUL POSS OF DRUG PARA, PAY COSTS & PLACED ON 1
YEAR PROBATION SUBJECT TO TERMS & CON- DITIONS. DOBSON,J 2 COPIES DA;1 ATTY HETRICK
. . Migrated, Filer
1 10123/2000
PA SEf'IT GUIDELINES FILED
PA SENT GUIDELINES FILED
Migrated, Filer
.2 10123/2000
INITIAL LETTER W/STATEMENT OF COSTS
INITIAL LETTER W/STATJ;MENT OF COSTS MAILED TO DEFENDANT
Migrated, Filer
1 01/11/2001
DEOTAINER ORDER FILED-MCJ TO DETAIN TILL
DETAINER ORDER FILED-MCJ TO DETAIN TILL PBPP CAN FILE PET/REV AND HRG HELD - (ORDER DATED:
1-11-01)-DOBSON J. 2 COPIES DA; COpy AnY HETRICK;PBPP AND JAIL
. Migrated, Filer
.".- .... .... _.' -- - ----" _._.' .... - .... , - .. ." _....__ ..
Aope 9082 Rev03{12/2009. Printed: Q3/1212Q09
R;cent'entries madeIn the court filing offices may not be Immediatelyreflectedon thesedocket sheets. Neitherthe courts of the Un\ftedJudicial
System of theCommcnweahhof Pennsylvanianor theAdrnlnlstretlveorscect PennsylvaniaCourtsassume any liabilityfor inaccurateor delayed
data,errorsoromisslone on these reports. Docket Sheet Intormetlonshould not be used inplace of a criminal historybackground check Which can
onlybe provided by the Penreylvenia Stale Pollee. Moreoveran employer who does net comply with the provrsrcnsof the Criminal Hlstory Record
InformationAct may be SUbject to civll jiabillty as set forthIn 18 Pa.C.S. Section9183.
[)eket Nknmlb>elt: Cp43-CR-OO!:l1l32/-21!J@1,l
CRiMINAL DOCKET
ccurt C:1lIse
Commonwealth of Pennsylvania
v.
Ann Cannon Cheryl
ENTlRilE$ .
Page 7 of 10
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Sequence Number CP Filed D a \ ~
01/19/2001
Document Date
Migrated, Filer
01/2612001
Migrated, Filer
ORDER DATED
ORDER -' (DATED 1118/01) DEF IN VIOLATiON OF PROBATION, PROBATION REVOKED, BENCH
WARRANT/DETAINER PREVIOUSLY ENTERED IS VACATED, RE-SENTENCING ON 3/1101 AT 9:00'AMIN CR#3.
BOND IS SET AT $5,000DEF UNDERGO DRUG & ALC EVAL WHILE IN MCJAIL AND COMPLETE ANY TREAT-
MENT. DRUGAND ALC EVAL is ACONDITION OF BOND. DOBSON, J 2 COPIES TO DA, 1 TO ATTY HETRICK, 1
TO MERCER CO JAIL, 1 TO DEF.
1 01/22/2001
APPLICATiON FOR ASSIGNMENT OF LEGAL
APPliCATION FOR ASSIGNMENT OF LEGAL COUNSEL - ORDER DATED 1119/01- PD APPTD COUNS-DOBSON .
J-1 COPYPD
Migrated, Filer
1
BOND
BOND" SURETY - IN AMOUNT OF $5,000. POSTED BY BAIL USA, DOUG GREENFIELD, AGENT, SENECA
INSURANCE CO., 157 MAIN ST., GREENVILLE, PA 16125.
Migrated, Filer
1 03105/2001 .
RESENTENCING(ORDER DATED:
RESENTENCING(ORDER DATED: 3/1/01) PAY COSTS, IMPRISONMENT MCJ FOR 20 DAYS TO 1 YR. RECEIVE
CR'EDIT FOR 20 DAYS, FROM 8/18/00 TO 8122/ 00 & FROM 1111/01 THROUGH 1/26101. HAViNG SERVED
MINIMUM, RELEASED. THIS DATE & PLACED ON PAROLE FOR BALANCE'OF TERM SUBJECT TO TERMS &
CONDITIONSWHICH iNCLUDES ENROLL iN &SUCCESSFULLY COMPLETEWHITE DEER RUN'S SHORT TERM
RESIDENTIAL PROGRAM,.. DOBSON,J 2 COPIES DA;2 PD;1CC JAIL
1 03106/2001 .
STATEMENTOF COSTS ISSUED
STATEMENTOF COSTS ISSUED - END OF WEEK
Migrated, Filer
2 0310612001
FILETAGGED FOR AOPC 3-SHEET ELECTRONIC
FILETAGGED FOR AOPC 3-SHEET ELECTRONIC TRANSMISSION,
AOBC9082 Rev03112/2009 . Printed: 03n 2/2009.
Recent entries made j ~ thecourt filing offices maynotbe immediately reflected onthese docket sheets, Neither the courts ofthe Unified JudicIal
System of the Commonwealth of Pennsylvania northeAdministrative Office of Pennsylvania courts assume anyliabUlty forlnaccurale or delayed
data, errors oromissions onthese reports. Docket Sheet information should notbe used inplace of a criminal history background check which can
only beprovided bythePennsylvania St,ale POllee. Moreover anemployer who doesnot comply with the prcvlslons of the Criminal History Record
tnfcrmaticn Actmaybe subject tocivil liability asset forth in 18 Ps.C.S. Section 9183.
COIlJRT Of CDMMOINI IPIlJEAS Of MERCER COIlJINITY
IDOCKlEiJ
ber: Cp43-CfRl)iI)@@3272@@!ll
CRI!MllNIAl DOCKET'
Sequence Number CPFiled Date.
Commonwealth of Pennsylvania
v,
Ann Cannon Cheryl
ENTRiES
Document Date
Migrated, Filer
Page8 of 10
1 03/09/2001
. PA SENT GUIDELINES FILED
PA SENT GUIDELINES FILED'
1 03/12/2001
ACT 84 PACKET ISSUED
ACT 84 PACKET ISSUED
Migrated, Filer
Migrated, Filer
1 03/20/2091
NOTE-30 DAY APPEAL PERIOD FROM SENT
. NOTE-30 DAY APPEAL PERiOD FROM SENT PASTPD/CTAPPT'D COUNSELNO LONGERCOUNSEL OF REC AS
PER RULE 316(C)(III} - PAW .
Migrated, Filer
1 06/22/2001
NONCOMPLIANCE HEARING HELD (ORDER DATED:
NONCOMPLIANCE Hr;:ARiNGHELD (ORDER DATED: 6/21/01)NONCOMPLIANCE HRG ISCONTD FOR A PERIOD
OF 90 DAYS. DOBSON :1-2 COPIES DA-1 COpy DEF- PBPP-COST COLL
Migrated, Filer
1 11/14/2001
DETAINER ORDER FILED-MCJ TO DETAIN TILL
DETAINER ORDER FiLED-MCJ TO DETAIN TILL PBPP CAN FILE PETIREV AND HRG HELD - (ORDER DATED:
1113,01}-DOBSON J. 2 COPIES DA;COPY DFNDT @ MCJ;PBPP AND JAIL
. Migrated, Filer
.. _."." .. " .....",,_ ._. _ _. ,_,._. .. __" __ "_" ....,....:.- .._. w.__ _._.
1 11/21/2001
GAGNON ORDER DATED
GAGNON ORDERDATED 11-21-01 FILED. DFNDTVIOLATEDTERMSOF PAROLE. PAROLE ISREVOKED-BENCH
WARRANTIDETAINER ARE VACATED. DFNDT IS RELEASED THIS DATE FROM MCJ AND PLACED ON HOUSE
ARREST FOR BALANCE OF HER SENTENCE UNDER SUPERVISiON OF IPP. SHE SHALL HAVE WiNDOWS FOR
COUNSELING AND FOR CARING FOR HER MOTHER-iN-LAW WHO is SUFFERING FROM ALZHEIMER'S.
WINDOWS SHALL BE GENEROUSLY GRANTED. CRT ALSO. RELIEVES IPP FROM DOING ANY DRUG TESTING.
DOBSON J. 2 COPIES DA;COPY DFNDT;PBPP AND JAIL
Mi rated Filer
AQPC. 9082. Re,v. .o;:;112i2QPS PrlO{\'J:l;1; q3f1;U2009
entries made inthe oeurt filing offices maynotbe Immediately reflected onthese docket sheets. Neither courts of the Unified JUdicial
System of the Commonwealth of Pennsylvania northeAdministrative Office of Pennsylvania COllrl"S assume anyliability forinaccurate or delayed
data.errors OJ omtseione onthesereports. DocketSheet information should notbeused inplaceof a crimina,l history bacKground' check which can
only be provided by thePennsylvania State Pollee, Moreover an employer who does n01 com.ply with the'provtstcns of the Criminal History Record
Information Act be subject \0 clvilliabiUly asset in18 Pa,C,S. Section9183.
COURT OIF. OF MERCiER
IDOClKlEr
\\jJllImibJer: cp<\l3,.GIR0l11ll0ll1321211)@O
DOCKET'
Sequence NUQJber CP Filed Date
Commonwealth of Pennsylvania
v.
Ann Cannon Cheryl
.
Document Date
Page9af 10
Migrated, Filer
2 1"112112001
APPLlCA,10N FOR ASSIGNMENT OF LEGAL
APPLICATIONFORASSIGNMENT OFLEGALCOUNSEL -ORDER DATED11121i01-PDAPPT'D COUNS-FORNELLI
PJ-1 COPY PD
Migrated, Filer
1 0111512002
NOTICEOF VIOLATION FILED BY IPP
NOTICE OF VIOLATION FILED BY IPP
Migrated, Filer
1 0210812002
NOTE-30 DAY APPEAL PERIOD FROM SENT
DAYAPPEAL PERIODFROM SENTPASTPD/CTAPPT'D COUNSEL NOLONQER COUNSEL OF REC AS
PERRULE 316(C)(III) LM
2 0210812002
ORDERDATED
ORDER - (DATED 2-7-02)- DFNDT IS RELEASED FROM HOUSE ARRESTTHIS DATE AND pLACED ON
UNSUPERVISED PAROLE FOR BALANCE OF HER SENTENCE. DOBSON J. 2 COPIES DA; COpy DFNDT;PBPP
AND JAIL
Migrated, Filer
Aope 9Q62 Rev. . Printed: 03/1212009
Recent entries madeinthecourt filing offices may notbe lmmedlately reflected onthese docket sheets. Neitherthe courts of tne Unified Judicial
System oftheCommonwealth of Pennsylvania northeAdministrative Office of Pennsylvania Courtsassume anyliability for lneccurete or delayed
data, errors 0( omissions onthese reports. Docket Sheetinformation should notbe usedinplaceof a criminal history background check whIch can.
only be provided by the Pennsylvania State Pollee. Moreover an employer whodoes notcomply with theprovisions of the Criminal History Record
lntcrrnation Act maybe cMlliabillty as set forth in18 Pa.C.S. Section 9183:.
COIIJRT OF COMMON iPllEAS OF MERCER COUNTY
DOCKlEl'
NlUlml:lr: CP4l3CIR@lJJ@@3212(1)(j11\l
DOCKET
COMnit Case
Commonwealth of Pennsylvania
v.
Ann Cannon Cheryl
CASE FINANC!Al non
Page10of 10
Last Payment Date: Total of Last Payment: $0.00
Carmon, Cileryl Arm Assessment Payments Adjustments Non Monetary Total
Defendant Payments
Costs/Fees
County Court Costs (Act 204 of 1976) $98.40 $0.00 -$98.40 $0.00 $0.00
State Court Cost (Act 204 of 1976) $8.40 $0.00 -$8.40 $0.00 $0.00
Commonwealth Cost - H8627 (Act 16: $7.20 $0.00 -$7.20 $900
'$0.00
of 1992)
Domestic Violence Compensation (Ac'
$10.00. $0.00 -$10.00
. $0.00
$0.00
44 of 1988)
. Crime Victims Compensation (Act 96
$15.00 $0,00 -$15.00 $0.00 $0.00
'of 1984)
Crimes Commission Cost (Act 96 of
$15.00 $0.00 -$15.00 $0.00 $0.00
1984)
JCP
$1,50 $0.00 -$1.50 $0.00 $0.00
Firearm Education and Training Fund
$5.00 $0.00
-$5.00 .
$0.00 $0.00
(158 of 1994)'
AutoTr"ck Fee (Mercer) $3.00 $0,00 -$3.00 $0.00 $0.00
Act 84 (Mercer) $5.00 $0.00 -$5.00 $0.00 $0.00
Costs/Fees Totals: $168,50 $0.00 -$168.50 $0.00 $0.00
Grand Totals:
$168.50 $0.00 -$168.50 $0.00 $0.00
.. - Indicates assessment is subrogated
AOPC 9082 Etev.o3f12/2009 Prloled: 0311212009"
Re.cent entries madeinthe court filing offices maynotbe immediately reflected on these docket sheets. Neither thecourts of the Unified Judicia!
System oftl1e Commonwealth cf Pennsylvania northeAdministrative Office of Pennsylvania Courts assume anyliability for inaccurate or delayed
data, errors' orcmisslcns on these reports, Docket Sheet Information'. should not beused in place of a criminal history backqround check Which can
only. be provided bythePennsylvania State Police Moreover.ari employer whodoesnotcomply withtheprovisfons of the Cnmins! History Record
Information Act may be'subject tocivl! llablllty as set forth 1018 Pa.C,S. secttcn 91'83. .
******************************************************************************************
3 .. ' Sentence
4. Docken
2. D.A. and
in the case of Commonwealth v. Cheryl Ann Cannon
S5
I, KllllMeeii M. Kloos, Cllerk of Common Pleas Court,
Criminal, in and for said county and state, do hereby' certify that
the foregoing is a full, true and correct copy of the following:
1. Complaint
COMMONWEAL1!'1810F JP'ENNSYLVANlA
COUNTY OF MERCER
so full and entire as the same remainsof record before the said Court atNo. 1365 20qO.
In Testimony Whereof, 1have hereunto set my hand and affixed the seal of said Court this
12th dayof March,2009 . . _
Clerk of ommon Pleas Court, Criminal
***************************************************************k**************************
___,J.
.
Thomas R Dobson
X, Thomas R. Dobson, a Judge of the Thirty-fifth Judicial tlistrict, composed of the of
Mercer, do hereby certify that Kathleen M. Kloos by whomthe annexed record, certifioate and attestation was
made and given and who, in her own proper handwriting, thereunto subscribed her name and affixed the seal of
the said Court of Common Pleas of said County, was at the time of so doing and now is Clell'kof Common
Pleas Court in and for said County of Mercer, in the' Commonwealth of Pennsylvania, duly commissioned and
qualified, 10 all of whose acts as such full faith and credit are arid ought to be gi-ven as well in courts of
judicature as elsewhere, and that the said record, certificate and attestation. are in due form of law, and made by
the proper officer.
*****************'**********************************************k**************************
COMMONWEALTH: OF lPiENNSYLVANIA
COUNTY OF MERCER 58
X, Kathleen M,. Kloos, Clerk of Common Pleas Court, Criminal, in and for said County, do certify
that the Honorable Thomas R.:Dobson, by whom the foregoing attestation was made and who has hereunto
subscribed his name, was at the time of making thereof and still is a Judge of the Court of Common Pleas,
Criminal, in and for said County duly commissioned and qualified, to all of whose acts as such full faith and
credit are and ought to be given aswell in courts ofjudicature as elsewhere,
In Testimony Whereof, I have hereunto set 111 hand and affixed the seal of Clerk of Courts this
J.1.!;h
da
y of MaTch, 2009 .in
EXHIBIT of Common Pleas Court, Crimina!

COMMONWEALTHOF PENN .VANIA
COtJNTY OF, JMJJmiCER
J
SID {Sllt1a Idal1lJheallon NumbQr)

ClFliMU!I!IAl COMIii'lA8!1!11i
COMMONWEALTH OF PENNSYLVANIA
''0milml'lUl '$ n0 e
02,01,61
, oeereenre Vaillclo lnlotlllaHon .
PlalcN".mb/lr srae
o<tiilli.oiu.
,Bit..
q Mala
0",,," JU'lIl.wml1"" J. RUSSO
Add"" 1119 gReER
I)mmiiITAGE, PA
Docket No'
Date Filed:
OTN:
06randanfs A K A {alSQ kOt)Wfl as)
Del"ndll.nl'g. Raceteltlmcrly .
o WillIe 0 -1m alael<
Cl !11sparnc 0 Nalll/o Amllncan lJ Unknown
umbor
00,8918
Comptamv[nCl(l,ml Numaf1-f II 011101 UCRtNlBFlS Code
Olstnct Attorney's Office DApproved DOisapproved because' __-:c-"._-"._-:-::--::-__-:c__-::-__
(Thedlstnct attorney mayrequire tharihe complaint. arrest werrant affldavd, orbplh be approved by lheattorney fortheCommonwealth pnor 10 111mg
PaRCrP 107)
(Ollllll
123
{Ollicor 0 PA0430100
lSlgoaMeoj AltO/My lorComtnQnwealth)
I
., REGIONAL POLICE DEPARTMENT
ol..,=====".",==;;;;r;'===;;;- -..=="""== '-;===""""""'="""""
do hereby state: (check appropriatebox)
1. 1iliJ'''t accuse the above named defendant, .who lives at hi addressset forth above
o I accuse the defendant whose nameis unknown to me but who is described as, _
o I accuse the defendant whose name and popular deslgnallon or nickname IS unknown to me and whornl have
.therefore designated as John Doe ,500ROEMER 'l3LVD INTHE .CITY
with Violating the penal laws of the Commonwealth of Pennsylvaniaat .-;;;;=====,.- _
OF FARRELL PA,
MERCeR AUGUSt i9,2000.@0;30SHkS
In -'-__------ County on or about -=--'- _
place their names here, repealing the name of above defendant)
2. The acts cornmmed by the accused were:
(Set fortha summary 01 thefaCls sufllctent toadvee Ihe'delenctant oj the oatu(e of theoffen'Se- charged ACItation to lhe statute allegedly VIolated,
Without more,isnot sufflClent Inasummary case, youmust cite the specillc secucoandsubeecucn of the statute 01 ordInance allagedly vloialed.}
THE CONTROLLED SUBSTANCE, DRUG, DEVIc::EAND COSMETIC ACT. (ACT 64) .
SS13 PROHIBITED ACTS; (A)(32) ,POSSESSION OF DRUG PARAPHERNALIA.
AOPC 412A-/4/99) 1 3
I
I
Defendant's Name: CHERYLANN CANNON
Docket Number: CR-453-00

CRIMilMAl COMlfllAUlMif
ONSATURDAY AUGUST 19,2000 AT0248HRS THE DEFENPANT CHERYL ANN CANNON WAS
ARRESTED INTHE500 BlK OFIDAHO ST ON.A WARRANT FROM THE DA'SOFFICE;THEDEFENDANT
WASTHENTRANSPORTED TOTHEREGIONAL LOCKUP AT 500 ROEMER BLVD. AF.TER THE DEFENDAN
WAS BOOKEDA STRIPSEARCH WASCONDUCTED BYTHEFEMALE LOCKUP ATTENDANT,KATHY
WHITEMAN. DURING THESEARCH A 41NCH GLASS STRAIGHT SHOOTER WASFOUND HIDDEN INTHE
DEFENDANT'S BRA. THIS.GLASS STRAIGHT SHOOTER WASBRUNT ONBOTH ENDSANDHAD
SCREENING MATERIAL INONEEND. THISITEM ISUSED TO INHALE CRACK COCAINE INTOTHE HUMM
BODY.
all of which were against the peace and dlgnily of the Commonwealth 'of Pennsylvania and contrary to the Act
of Assembly, or in violailon 01
i
i
I
I
1
I
1
SEAl..
OI!M
iSeeuon) ". {SlJbwCllOrll (PI>. Slal,Ule) lroun(s)
of 1M
ISlIClllln) (Sub$ElCllOnl (pAStamt1l") . !eoUnls}
olttl&
ISoos&ClIOnJ \Pl\$lalul.q) '!eooola)
011110
(Sf.'l:itonj lPA$laltM) lcoumSI
35-3-01
3. i ask that a warrant 01arrest or a summons beissued and that the defendant be rsqured to answer the charges I have
made. (II' order lor a warrant 01 arrest to Issue, lha atlaohad affidavit 01probable cause must be completed
and sworn 10before Iha issuing autho'ity.j. .
4. I verify thai the facts set forth in this cornplamt are irueand correct to the best of my knowledge or Information
and belief. This verification is made subieat to the penalties of Section !he Crimes Code (18 PA. C.S.
4904) rela1lng to unsworn falsification to aumontiss. . B "-
AUGUST 19 . Ave. )"\ 2000 / J --"."...-
tSJgnalulQ 01",Ulanl'
AND NOW, on ttusdate Augus t. 19 2000, I certily.tlm!- a complaint has been properly
.completed and venfied. An atnoavu 01 probable cause musl be completed inorder lor a warrant 10 Issue: ..

AOPC 412B(6/99)
IN THE COURT OF COMMON
OF MeRCER COUNTY, PENNSYLVANIA
of Pennsylvania
VS,
No, !!/oS' Criminal,
,(+-)
The District Attorney bf Mercer pennsylvania
r
by this
information presents that on about) \9
zo eD, at .g?() 'll!,\oe.\< Or lRoaVM,1B:, .&u.I... \\....1SA ,
'E \ \ t Mercer Pennsyl'V'ania, the defendant
did commit the following.;iolation(s) of The
Drug! Device Cosmetie {the Act) :
( > 35 (a) (16) ofa

Defendant knowingly or intentionally possessed a
controlled or counterfeit substance, to wit:
a , Drug I the said defendant not being
registered under this act or of of persons whose
profession, business, employment, occupation or duties are
permitted and allowed t? have in their poes e s s Lcn and
under their control such controlled subs-cance, and the
substance wee not obtained pursuant. to a vaid prescriptioni
( __) 35 g (a) (31) Small 'Amount of Marijuana
nefendanb possessed Les s than 30 'grams of Na r Lj uana , a
Schedule :r f Drug, the defendant not being
under this act or of that of persons whose
profession, business, employment or, occupation or dutIes
are-permitted and al19wed to have in their
substance;
35 Pa. C.S.A. 780-113 (a). (32) Drug paraphernalia
"
used or with intent to use drug
pe r aphez-na Lke for bhe purpose of plani:.i.ng f propagat.ing!
cultivating, growing, harvesting,
converting, producing, processing, preparing,
testing, apalyzing, packing, s+:oring,
co nca LnLuq , concealing, injecting, ingesting
l
in-paling. or
oehe rwi.a e intro-ducing into the human body a cfoni::rol'led
substance in violation of this act in that defehdant did
possess ('l)\!!Iel.v>
rNLh'" *"&f,\cl\\lf\,. ;
All of is against. e he Act of AssemblY'. and ehe- peace and
dignity of the Commonwealth of Pennsylvania.
..
'Z) , Att.orney
Attorney for the Commonwealth
\
,
j
I,
(3
IN 'THE COURT OF COMMON PLEAS
OF mrnCER
No. Criminal,-
COMMONWEALTH OF l?Em:i;3YLV.lUUA
-v ,

. CD endantl
I N FOR MAT ION
Count : Possession of a
Controlled
e!Awf A-AA., rJw, , ""fandant named
the w1thin Information hexeby encer a'plea of to
the char,ges of ' 1> RMAFwv"t:.,
A
DATE, q, 1-'0\
_ . neeen ant

xe eocney for commonweafth .....
.x
Possess a Small
Amount of
PosseSSiof.l at
Drug ?araphernalia
f
I;,! rn GOt!;(lY'
/fi!ll1!'O'! -b i', II' 21
. ;',H f'l. :{'
';':'
INTHE COURT OF COMMON PLEAS OF MERCER COUNTY, PENNSYLVANIA
CRIMINAL
COMMONWEALTH
vs.
CHERYL ANNCANNON
No. 1365Criminal 2000
CHARGES:, Unlawful Possession of Drug paraphernalia
AND NOW. this 2
nd
day of May. 2001, it is the sentence of this
Court on the charge of unlawful possession of drug paraphernalia the
Counsel for Defendant: James Goodwin, Esquire
Matter is Before the Court on Plea of Guilty
-'
i
,[
I
I
I
I
/
defendant pay the costs. and undergo imprisonment inthe Mercer
County' Jail for a period of not less than 60 days nor more than one year.
She shall receive credit for time served In the sum of26 dovs. being from
August 19,2000 through August 22, 2000. and from January 11.2001
,through January 26. 2001.
If the defendant does not violate any of the rules and
regulations of the Mercer County Jail, she shall be released at the
conclusion of her minimum sentence without further order of court and
2
placed on parole for the balance of her term under the supervision of the
Pennsylvania Board of Probation and Parole subject to the following terms
and conditions:
1. She shall report within 72 hours of the date of her release
from her minimum sentence to the Mercer Office of the Pennsylvania
Board of Probation and Parole and enter into a contract for her
supervision. The terms of that contract eireIncorporated herein by
reference;
2. -She shall obey the laws of any jurisdiction in Which she may
be located.
3. Sheshall not consume or possess any alcoholic beverages
or go into any bar or tavern where they are sold.
4, She shall be randomly drug tested at a minimum of twice
per momh,
5. If she has not obtolned full time employment within 60 days,
of the date of her reiease, full time employment being defined as a
minimum of 20 hours per week, then she shall perform community service
at the rate of 10hours per week. She shall report on September 4, 2001 to . .
the Mercer County Community Service Coordinator to verify her
employment status and if not employed, to commence community
service. If she is employed, she shall report on the first day of business of
I
I
I
3
each month to the Community Service Coordinator to verify her
employment status.
6. She shall pay her costs pursuant to an agreement to be
entered into with the Mercer County Cost Coordinator. She shall report to
the Cost Coordinator's office within 72 hours of the date of her release
from her minimum sentence for the purpose of entering into said
agreement. Upon entry, its terms and conditions are incorporated herein
by reterence.
.BY THE COURT:
/fA J,tL-.
bsh
Thomas R. Dobson
Judge
COURT OF COMMOINJ IPlIEJ\S OF MERCERCOUNTY
DOClKlEl
D<l:lcki i\IIlJJmiblew:
CRIMiNAL DOCKET
Page 1 of,11
"Commonwealth of Pennsylvania
v.
Ann Cannon Charyl
CME INIFOIF!.MATiOI\!
Date Filed: 0910612000 Initiation Date: 0910612000
Lower Court Docket No: CR0000453-00
Final Issuing Authority: Henry J Russo
Arresting Officer: Masotto, Anthony Stanley,
Case Local Number(s)
CR 0000453 00
2000-1365
Judge Assigned: Dobson, Thomas R.
OTN: H1872566
Inltlallssuina Authority: Ruth M French
Arresting Agency: SW Mercer Regional Police Dept
Case Local Number Type(s)
Criminal 10#
Legacy Docket Number
STATUS
Case,Statys: Closed
StatysDate
0410912001 '
0910612000
processing Status
Migrated Final Disposition
Migrated Case'
Arrest Date: 0811912000
Complaint pate: 0811912000
Date Of Birth: 0210111961
DEFENDANT TiOINl
CltylStatelZip: Erie, PA 16504
Alias Name
Cannon, Cheryl
Participant TyPSl
Defendant
CASE I"ARTICBPANTS
l:J!i.IrJe.
Cannon, Cheryl Ann
AOPC9082 RevQ311212009 Printed: 0311212009
Recent entries made inthecourt filing offices maynotbe lrnmedlatefyreflectad onthese docket sheets. Nelther (hecourts of the Unified Judicial
System of the Commonwealth of Pennsylvania northeAdministrative Office of Pennsylvania courts assume anyJlability tor inaccurate ordelayed ,
data. errors or omissions on thesereports. Docket Sheet Informationshould notbe usedtn place of a criminal history bacKground c;heql, which can
only beprovided bythePennsylvania Stete'Police. Moreover anemployer who doesnotcomply with the provisions of lheCriminal History Record
Information Actmaybe subject to civllliebillly as set forth in 18 Pa.C.S. Section $183.
cousr Of PLEAS Of M RCER couerrv
lOOC1I(!El
31!li$-2til@(jI .
DOCKET
Commonwealth of Pennsylvania
v.
Ann Cannon Cheryl
. BAil Bli'!fORMJIITIOIIIJ
Page2of11
Cannon, Chevy! Ann
Bail Action
Set
Bail Tvpe
0'1125/2001 ROR
Percentage Amount
$0.00
Bail Posting Status Posting DatE;
Orig Seq. Statut" Offense
bate
08/19/2000 H1872566
1 .
M
Statute Description
35 780113 UselPoss Of Drug Paraph
Posted 09/06/2000
I
I
Disposition Dgte Final Disposition
Offense Disposition Section
Sentence Date Credit For Time Served
Incarceration/Diversionary Period Start Date .
Disposition
'Case Event
Sequence/Description
Sentencing Judge
SentencelDlversion ProgramType
Sentence Conditions
Linked Offense: sentimce
Mignted Disposition
. Migrated Dispositional Event
1 / Use/Pass Of Drug Paraph
Dobson, :rhomas R.
Confinement
Financial Assessments
Link Type
04/09/2001
Guilty Plea
04109/2001
Minof 2.00 Months
Max of 1.00 Years
Min of 2.00 Months
Max of 1.00 Years
Linked Docket Number
Final Disposition
35780-113A32
05/02/2001
05/02/2001
I
AOPC9082 Rev03l12f200e Printed: 0311212009
e'ntri'es' 10-the courtfiiing offices' may notbe immediately ori' theSe' docket sheets. thecourts' ct the Unified .. - .
System oftheCommonwealth ofPennsylvania northeAdministrative Office of Pennsylvania Courts assumeany liability for inaccurate or delayed
data. errors or omtsstone onthese reports. DOI;I<et Sheet information should not be used inplace of a criminal history beckqround check Which an
only beprovided bythe Pennsylvania State Pollee. Moreover. anemployer whodoes notcomply wltl1 theprovisions of theCriminal Histofy Record .
. Information Ay! maybesubject tc c.ivn lla.bilit}/ asset forth in18 Pa.C.$. Section 9183.
-
COIUlRT Of COMM INI PllEAS Of MIERCIERCOUI\Il1'Y
IOOCI{E'f
lDioc!{et CP43CR..@1(l1lJ1365-20Ilij
CRiMiNAlllJOCKIET
Commonwealth of Pennsylvania
v.
Ann Cannon Cheryl
COMMONWEALllll ii'4IFORMATiON ATTOIRINlIEViIllIFO!':fillfiATllOINl
Page 30t 11
Name: . James Peter Epstein, Esq.
District Attorney .
Supreme Court No: 021859
phone Number(s);
(724) 6623800 (Phone)
(724)B62-0807 (Fax)
Address;
Mercer County District Attorney's Office
Courthouse Ste.209
Mercer PA 16137
Supreme Court No:
Rep Status;
Phona Number(s);
AO?C,9082 Rev03/12/2009 Printed: 03'11212009
Recent entries madein the court-filingoffices may not be immediatelyreflected on these docketsheets. Neitherthe courts of the Unified JUdicia"j
System of the Commonwealth of Pennsylvanianor theAdministrativeOffice of PennsylvaniaCourts assumeany liability for inaccurate or delayed
data errorsor omissions on thesereports. Docket Sheet informationshould not be used in place of a criminal history backqround check which can
onlybe provided.by the PennsylvaniaStatePollee. Moreoveran employer who does not comply with the provisions'of the Crlminal History Record
Information Acl may be subject 10civilliabilltyas set forth in 18 Pa,C,S. Section 9183..
COURT Of COMMON PLEAS Of eousrv

[j@<l:!<I:<!lt i\lJlllmlbJew: CiP'-43CR@@1(l136!i;l;ilI@@
CRIMINAL DeicKET
court Case
CP FiledDate
08/19/2000
SeauenceNumber
1
COMPLAINT FILED
COMPLAINTFILED
Commonwealth of Pennsylvania
V(
Ann Cannon Cheryl
ENTR!ES
Document Date
Migrated, Filer
Pege 4 on1
1 08/22/2000
ORDERDATED
ORDER" (DATED8122/00) (HANDWRITTEN) BONDISROR. DOBSON, J. BOND-ROR - SIGNED ,BYDEF.
Migrated, Flier
1 09/06/2000
Original Papers ReceivedfromLower Court
1 09/06/2000
TRANSCRIPT TRANSFERRED FROMAOPC SYSTEM
TRANSCRIPT TRANSFERRED FROM AOPC SYSTEM
, Unknown l=i1er '
Migrated, Filer
-,-_ * __ - ...... __ __ ..._._ ._._ .... w.. . .... "
1 10/10/2000
INITIAL LETTERWISTATEMENTOF COSTS
INITIAL LETTER W/STATEMENT OF COSTS MAiLEDTO
\\!Ilgrated, Filer
1 11/06/2000
INFORMATION FILEDBY DISTRICTATTORNEY'S
INFORMATION FILEDBY DISTRICTATTORNEY'SOFFICE
Migrated, Filer
_"., ......M "'M" _.,.. __ ... .. .w _,, __, ._ .._.. ._
, 2 11/06/2000
MOTION FORPRE-TRIALDiSCOVERYFILED
MOTIONFORPRE-TRIAL DISCOVERYFILEDBY DA
/
"., o. "" ,._" _." ..... ''- __
Migrated, Filer
1 11/14/2000
BENCH WARRANTDATED
BENCHWARRANTDATED11/14JOO-FAIL APPEAR2NDARRAIGN-DOBSONJ-2 COPIES(1CC) TO DA;1-DEF
AOPC 9082 Rev 03/12/2009 PrInted: 03/1212009
Recent entries made in the 90Uft filing offices may not be lmmedlately reflected on these docket sheets, Neither the courts of the Unlfled judicial
System of the Commonwealth of Pennsylvania nor the Administrative Office of Pennsylvania Courts essume any liability for inaccurate or delayed'
cata. errors or omissions on these reports. Docket sneer information should not be used in place of a criminal history background check whfcltcan
only.be provided by the Pennsytvanla ,Slate Pollee, Moreover an employer whp does not comply with the orcvretcre of the Onminal History Record
Information Act may be subject 10clvllllablllly as set forth In 18 Ps.C.S. Seclion Si8S.
COURT Of COMMON filllEAS Of MIERCIER COUNTY"
:OOCKE'f
:Ml!S.:l;@@l)
.
clliS$
Sequence Number CP Filed Date
Commonwealth of Pennsylvania
v.
Ann Cannon Cheryl
EN1IRiES
Document Date
Migrated, Filer
Page5 of 11
1 01/16/2001
. RETURN ON WARRANT FILED-DEF LODGED IN
RETURN ON WARRANT FllED-DEF LODGED IN MCJ ON 1/10101 BY DEP'SHERIFF D DEVENNEY-COPY TO DA
Migrated, Filer
. _._ ... __ '--. .__ - - _. _.__ - - . - ,,__ ._ ,_. __. w.
2 01/16/2001
ORDER DATED
ORDER - (DATED 1116/01)-IT IS DIRECTED THAT A PD IS APPT'D TO REPRESENT THE DEF IN THE
ABOVE-CAPTIONED CASE. FORNElL! PJ-2 COPIES DA-1 COpy PDt COpy DEF
. Migrated, Filer
3 01/1612001
BENCH WARRANT '''VACATE'' ORDER DATED
. BENCH WARRANT "VACATE*' ORDER DATED 1/16/01-BW ISSUED 11114/00 IS VACATED-FaRNELL! PJ-2
COPIES TO DA;1-PD;1-MCJ
Migrated, Filer
'1 01122/2001
APPLICATION FOR ASSIGNMENT OF lEGAL
APPLICATION FORASSIGNMENT OF LEGAL COUNSEL - ORDER DATED 1/18101- PO APPT'D COUNS-WHERRY
J-1 COpy PD
Migrated, Filer .
1 . 01/24/2001
MOTION
MOTION TO REINSTATE BOND AND ORDER DATED 1/23/01-RULE RETURNABLE 1/25/011:15 PM-CR #3.
DOBSON J-2 COPIES'DA-1 COpy PD
Migratad, Filer
2 01/24/2001
MOTION FOR PRE-TRIAL DISCOVERY AND INSPECTION
MOTION FOR PRE-TRIAL DiSCOVERY AND INSPECTION FilED BY P.D.
Migrated, Filer
_...,...... -- - -- -_. .._- . ._---- ---- .-- ----
AOPC9082- Rev03/1'2J2009 Printed: 03l1Z12009
Recent entries madeinthecourt filing offices maynotbelm"medlately reflected onthese docketsheets. Neitherthe courts of theUnified Judicial
System of theCcrnmonweatttrot Pennsylvania northeAdministrative Office of Pennsylvania Courtsassume anyliability forinaccurate or delayed
data, errors or omissions on these reports. Docket Sheet information shoutd notbeused Inplaceof a criminal history backqrcurrd cneck which can
only beprovided bythePennsylvania Stale Moreover anemployer who does notcomply with theprovistcne oftheCrIminal History Record
. Information Act maybesubject tocivil liability as set forth in18 Pa:C.S. Section 9183.
COURT Of iCOMMONPlEAS Of MERCER iCOUNTY
DOCKET
CIF'-43C\RIQl01365-2i1JJ@1[))
iCRiMii'lllAl DOCtl<ET
'Comrnonwealth of Pennsylvania
v.
Ann Cannon Cheryl

Page6 of 11
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CONTIN ORDER FILED' DATED
CONTINUANCE ORDER FILEDDATED 3/12101-THIS MATTER IS CONTD UNTIL THE APRIL-2001 ,CRIM TERM OF
CRT-RULE 1100 ALLOCATED TO THEDEFENSE- WHERRY J-2 COPIES WI1 COpy PD
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Documenf pate CP Filed D"ie
01/26/2001
Sequence Number
1
ORDER DATED
ORDER - (DATED 1/25/01) BAiL is SET AT ROR.
PREVIOUSLY SIGNED ROR BOND)
1 04/09i2001
PLEA ENTERED .
PLEA ENTERED 4109/01 CHARGE BEFORE JUDGE DOBSON TO POSSESSION DRUG PARA. PER CT. CRIER
LIST
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Migrated Automatic Registry Entry (Disposition) Text
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SENTENCE: (DATED:
. SENTENCE: (DATED: 512101) PAY COSTS & IMPRISONMENT MCJ FOR60 DAYS TO 1 YR. RECEIVE CREDIT FOR
26 DAYS BEING 8/19/00 THROUGH 8122100 & FROM 1/11/01 THROUGH 1/26/01. TO BE .RELEASED @
CONCLUSION OF MIN W/O FU'RTHER ORDER OF CRT & PLACED ON PAROLE FOR BALANCE OF TERM
SUBJECT TO TERMS & CONDITIONS. DOBSON,J 2 COPIES DA;2 PD;1CC JAIL
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.. . ._._ - -r-- , - _.__._ __ _. - - - - __ ., __W". r-:-:
Acpe 9082 n sev Q'3f121200a Prlnled; 03/1212009
Recent entries madeInthecourt flUng offices maynotbe lrnmedietelyreflected onthese docket sheets. Neitherthe courts of the" Unified JUdiclal
System ofthe Commonwealth of Pennsylvania northeAdministrative Office of Pennsylvania Courts assume anyliability for Inaccurate Of delayed
data, errors oromtsetcns 00 these reports Docket Sheetmfcrrnatlonshould not be.used inplace of a cnmlnat hlstcry background check whichcan
only beprovided bythePel)nsylvania State Perce. -Moreover an employer who doesnot comply with the provisions of the Criminal HIstory Record
Information Actmay. besubject tocivilliabillty asset forth in18PaC.S. Section 9183,
COURT Of COMIMilOINl PLEAS) Of MERCER COUNTY
DOCIKIeT
fl)Qckret HIlllLlmlblrer: CIP'43C!R.@III.1l13$521111i)@
CRiMDINlAl DOCK,ET
COlin Case
Sequence Number CP Filed Date
1 05/08/2001
PA SENT GUIDELINES FILED
PA SEN1 GUIDELINES FILED
Commonwealth of Pennsylvania
v,
Ann Cannon Cheryl

Document Date
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1 05/09/2001
STATEMEN1 OF COSTS ISSUED
STATEMENT OF COSTS ISSUED; ENDOF WEEK
, 2 05/09/2001
ACT 84 PACKET ISSUED
ACT 84 PACKET ISSUED
3 , 05/09/2001
FILE TAGGED FOR AOPC 3-SHEET ELECTRONiC
FILE TAGGED FOR AOPC S,SHEEI ELECTRONIC TRANSMISSION"
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1 05/11/2001
TRANS ORDER OF COURT DATED
TRANS ORDER OF COURT DATED 511112001 BY lHE SHERIFF TO LAWRENCE CO, JAIL DUE TO
OVERCROWDING,..WHERRY J - 2 C,C JAIL; iDA; 1 PD
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1 . 06/22/2001
NOTE-30DAY APPEAL PERIODFROM SENT
NOTESODAY APPEAL PERIODFROM SENT PAST-PD/CT APPT'D COUNSEL NOLONGER COUNSEL OF REC AS
PER RULE 316(C)(III) - KMK
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NONCOMPLIANCEHEARING HELD (ORDER DATED:
NONCOMPliANCE HEARINGHELD (ORDER DATED: 6/21/01).NONCQMPLIANCE HRG IS'CONT'D,FORA PERiOD
OF 90 DAYS, DOSSON J-2 COPiES DA-1 COPY DEF-PBPP-COSTCOLL
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,."W .,"_ .': __ w._. __....__. .._, .'_." . .,._._ .._....
AOPC9082 Prlnled: 03f12f2009
Recent entrles made Inthecourt filing offlces notbe reflected onthese docket sheets. Neither the courts of the Unified JUdicial
System ofthe Commonwealth of Pennsylvania northe Administrative Office of Pennsylvania Courts assume anyliability for lnaccurate Or delayed
data, erroreoromissions onthesereports. Docket Sheetinformation should notbe used inplace of a criminal hIstory background checkwhich can
only beprovided bythe Pennsylvania 'Slate Police. Moreover an employer wlioDoes nol comply with theprovisions of the Criminal History Record
. Information Act maybe subject toc:vn liability asset forth in18Pa.C.S. Section 9183.
-r-------cooRlof cOM-MoN PlEA$-oi--iffiERICei!icouNT-------!
I [)JOCKET c
i'lh\llmlbev: CIP-43-CR.@({))1())'l3iG5-Z@@@
CR!!\,IUNAl DOICKlEl'
COiUlvt COlS!:!
Commonwealth of Pennsylvania
v.
Ann Cannon Cheryl
E!II1'R!1E3
Page 8 of 11
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1 . 11/14/2001
DETAINER ORDER FllED-MCJ TO DETAiN Till
DETAiNER ORDER FllED-MCJ TO DETAIN Till PBPP CAN FilE PET/REV AND HRG HELD - (ORDER DATED:
11-13-01)-DOBSON J. 2 COPIES DA;COPY DFNDT'@ MCJ;PBPPAND JAil
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GAGNON ORDER DATED
GAGNONORDERDATED11-21-01FilED. DFNDTVIOlATED.TERMSOF PAROLE PAROLE IS REVOKED-BENCH
WARRANT/DETAINER ARE VAGATED-DFNDT is RELEAsED THIS DATE FROM MCJ AND PLACED ON HOUSE
ARREST FOR BALANCEOF HER SENTENCE UNDER SUPERVISIONOF IPP. SHE SHALL HAVE WINDOWS FOR
COUNSELING AND FOR CARING FOR HER MOTHER-IN-lAW WHO IS SUFFERING FROM ALZHEIMER'S.
WINDOWS SHAll BEGENEROUSLY GRANTED. CRT ALSO RELIEVESIPP FROM DOING ANy DRUG TESTING.
DOBSON J. 2 COPiES DA;COPY DFNDT;PBPP AND JAil
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2 11/21/2001 .
APPLICATION FOR I\SSIGNMENT OF LEGAL
APPLICATIONFORASSIGNMENTOFlEGALCOUN$EL -ORDER DATED 11/21/01- POAPpTDCOUNS-FORNELLI
PJ-1 COPY PO
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NOTiCE OF VIOLATION FILED BY IPP
NOTICE OF VIOLATION FILED BY IPP
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NOTE-30 DAYAPPEAL PERIODFROM SENT
NOTE30 DAYAPPEALPERIODFROMSENT PAST-PD/CT APPTD COUNSEL NO lONGER COUNSELOF REC AS
PER RULE 316(C)(III) LM
2 02/08/2002
ORDER DATED
ORDER - (DATED 2-7-02)- DFNDT IS RELEASED FROM HOUSE ARREST THIS DATE AND PLACED ON
UNSUPERVISED PAROLE FOR BALANCE OF HER SENTENCE. DOBSON J..2 COPIES DA;COPY DFNDT;PBPP
AND JAIL
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AOPC. S0.8,2R.el? .Q;3;/12f2.QQf,l" Prlnted: Q311Z(4009
Recent entries madeInthecourt filing offices maynotbe immediately reflected onfhese docket sheets. Neither the courts ot the Unified-JudiCial
System of the Oomrncnwealth of Pennsylvania northeAdmlnlstrative Officeof Pennsylvania Courts assumeany liability forinaccurateordelayed
data, errors or omissions onthese reports. Docket Sheet information should notbe used inplaceofe criminalhistory background oheckwhich can
only be provided bythePennsylvania.State Pcjce.. Moreover an employer whodoesnotcomply with tne provlelcns of tlte Criminal History Record
Information Act maybe SUbject 10 clvil"liabiUty as set forth In18 Pa.C,S, Section 9183. '.
COURT Of COMMON Of MERCIER COUNTY
oocxsr
lliurm!lier: CP-4l3-CR(j@@i316lS-20(l1[l
CRiMiNAL DOCKET
Court Case
Sequence Number CP Filed Date
Commonwealth of Pennsylvania
v.
Ann Cannon Cheryl
ENTRiEiS
Document Date
Page 9 of 11
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ORDER DATED
ORDER - (DATED 2/7102)-THEDEFT SHALL PAY THE SUM OF $100.00TWD HER OUTSTANDING COSTS THIS
DATE & SHALL PAY THE BAL WIIN 30 DAYS OF TODAY'S DATE. DOBSON J-2COPIES DA-1 COpy DEFT-1 COST
COLL(S)
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NONCOMPLIANCE HEARING HELD (ORDER DATED:
NONCOMPLIANCE HEARINGHELD (ORDER DATED: 8/22/02)-THEDEFT SHALL PAYTHESUM OF $1OOTWDTHE;
ARREARAGES IN THIS MATTER WlIN 30 DAYS-IF SHE FAILS TO DO SO-THIS MATTER SHALL BE REFERRED
TO THE MCDA'S OFFICE FOR THE PURPOSE OF FILING AN INDIRECT CIVIL CONTEMPT PET. DOBSON .
COPIES DA-1 COPY DEFT-1 COpy PBPP
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'. 1 11125/2002
ORDER DATED
ORDER DATED 11121102-DEFT SHALL PAY THE SUM OF $100 TWD HER OUT- STANDING FINES-COSTS s
RESTIT WIIN60 DAYS OFTODMS DATE-IF SHE FAILS TO DO SO-THIS MATTER SHALL BE REFERRED TO THE
MC DA'S OFFICE FOR THE PURPOSE OF FILING OF INDIRECT CIVIL CONTEMPT. DOBSON J- 2 COPIES DA-1
COpy DEFH COpy PBPP
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ORDER DATED
ORDER DATED 3:13-03 FILED. MATTER IS REFERRED TO DA'S OFFICE FORPURPOSE OF FILING AN INDIRECT
CIVIL CONTEMPT PETITION. DOBSON J. 2 COPIES DA AND COPY DFNDT
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MOTION FOR IND CIVIL CONT FILED BY DA-RULE
MOTION FOR INDCIVIL CaNT FILED BY DA-RULE DATED 3/21103-RULERETURNABLE ON 4/30103-AT 3:10 PM-IN
CR# 3. DOBS.ON J-2 COPIES DA-1 COpy DEFT-1 COpy PBPP
AOPC 9062" 8,ev:.03112/2009 Printed: 0311212.00,9
Recententries madeinthecourt filing offices maynotbe lrnmedlately reflected on these docket sheets. Neitherthe courts of theUnitled judicial
System oftheCommonwealth of Pennsylvania northeAdministrative Office of Pennsylvania Courts assume anyli.abillty forinaccurate or delayed
data. errors or omissions onthese reports. Docket Sheet Infcrmatron should notbe used Inplace 01 a criminal .history background check which can
only be provided bythePennsylvania StatePollee, Moreover an employer who doesnotcomply with the provisions of theCriminal History Record
InformatIon Actmaybesubject 10 civilliabmty asset forth in 18Pa:C's. Section 9183.
COURT Of COMMON IPllEAS 0 MIERCIER COUNTY
DOCKET
--I

CRIMINAL DOCKIET
Commonwealth of Pennsylvania
v.
Ann Cannon Cheryl
ENTRIES
Page 10of 11
Sequence Number CP Filed Dale Document Date
1 0510512003
ORDERWARRANT SHALL ISSUE DATED
ORDERWARHANTSHALL ISSUE DATED4130/03BEFORECT FORICCFIND OF CT DEF INCONTEMPT OF SENT
ORDORD OF CT DEF SHALL BE INCARC INMCJ NOT TO EXCEED 15 DAYS ORPAYS $210.14FURTH ORD'D BW
ISS-UPON APPRE HENSION SHALL BE DET'D IN MCJ PEND COMP WI THIS' SENT ORD-SAID BW SHALL
CONTAIN NOTATION "THiS IS NOT AN EXTRADITABLE OFFENSE." DOBSON J2 COPIES TO
DA;1DEF; 1MCJ; 1PBPP
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BENCHWARRANT DATED
BENCH WARRANT DATED 4130/03-FAIL APPEAR
DA;1DEF;1MCJ;1PBPP
ICC HRGDOBSON J2 COPIES (NO CCIMM VAC)TO
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BENCHWARRANT *"VACATE"" ORDER DATED .
BENCH WARRANT "VACATE- ORDER DATED 5/2103BW PREV ENTRED IS VAC- SENT IMPOSED 4/30103 IS
REAFFIRMED, TOWIT: DEF SHALL UNDERGO 1M PRISONMENT MCJ 15 DAYS OR UNTIL SHE PAYS
$210.14-DOBSON J-2 COPIES TO DA;1DEF;1.MCJ;1-PBPP
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ORDER DATED
ORDER DATED 5/2103:DEF. HAVING POCOSTS IN FULL SHE IS RELEASED FROM MCJDOBSON J2 COPIES TO
DA;1DEF; 1MCJ;1PBPP
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AOPC9062 Rev. l3/121200s .' . Prlnted: 0311.2/2009
Recent entries made inthecourt filing offices maynotbe immediately reflected onthese docket sheets. Neither the-courts of theUnified Judicial
System of theCommonwealth of Pennsylvania nor theAdministrative Office of Pennsylvania Courts assume anyliability for Inaccurate ordelayed
data, errors or omissions onthese reports. Docket Sheetinformation shol.!ld notbeusedinplace ofa criminal histoi'Y backgrol,lI1dcheck Which can
only beprovided bythe Pennsylvania State Police. .Moreover an employer who doesnot'comply with theprovislcns of the CriminaI History Record
Information Act may besubject toclvllliability as set forth ln i8 Pa.C.S. Sectloo9183. f
COlOR Of CO MOINl IPlEAS. Of MERCER COUNTY
DOCKET
. CIP43CR@((!iOIi
CIFUMiNAl DOCKET
COllwt C<lse
Commonwealth of Pennsylvania
v.
AnnCannon Cheryl
FliIDANCiAl.II\IIFORMAT10iID
Page 110f-11
Total of Last Payment $0.00
Payments . Adjusiments Non Monetary Total
. Payments
$146.40 $0.00 -$146.40 $0.00 .$0.00
$8.40 $0.00 -$8.40 $000 $0.00
$7.20 $0.00 -$7.20 $0.00 $0.00
$10.00 $0.00 -$10.00
$0.00 .
$0.00
$15.00 $0.00 -$15.00 $0.00 $0.00
$15.00 $0.00 -$15.00 $0.00 $0.00
$1.50 $0.00 -$1.50 $0.00 $0.00
$5.00 $0.00 -$5.00 $0.00 $0.00
$3.00 $0.00 -$3.00 $0.00 $0,00
$5,00 $0.00 -$5.00 $0.00 $0.00
$5.00 $0.00 -$5.00 $0.00 $0.00
$54.64 $0.00 -$54.64 $0.00 $0.00
$650.00 $0.00 -$650.00 $0.00 $0.00
$926.14 $0.00 -$926,14 $0.00 $0.00
$926.14 $0.00 -$926.14 $0.00 $0.00'
Costs/Fees Totals:
Grand Totals:
arm Education and Training Fund
s ot 1994)
) Track Fee (Mercer)
84 (Mercer)
ornation Fee (Mercer)
,riff's Costs (Mercer)
Fee (Mercer)
Last Pay'ment Date:
111081, Cheryl Aro" Assessment
'efendant
Coels/fees'
mty Court Costs (Act 204 of 1976)
:e Court Cost (Act 204 of 1976)
nmonwealth Cost -HB627 (Act 16',
992)
nestic Violence Compensation (Ac'
)f 1988)
ne Victims Compensation (Act 96
984)
nes Commission Cost (Act 98 of
4)
, - Indicates assessment Is SUbrogated
)82 RevO;y12f2009 Printed: 03/12/2009
:ententries madeInthecourt filing offices maynotbelmmediately reflected on these docket sheets. Neitherthe courts of the.Unified Judicial
.emoftheCommonwealth of Pennsylvania ncr theAdministrative Office of Pennsylvania cccrts assume anyliability for inaccurate or delayed
errors ororruesicns onthese reports. Docket Sheet irrtormanon should notbe usedIn place 01 a criminal history background check which can
be provloedbythePennsylvania State sojce, Moreover en employer whodoesnotcomply wIththe provisions. of the Criminai History Record
lraormation Act maybesubject tooivilliability as.eet.forth ,in :1.8 P.a,c,.s..S.ectlop.91.B3. .
******************************************************************************************
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20 D.A. and Slgned Plea
3,. Sentence
4. Docket
in tile case of Commonwealth v, Cheryl Ann Cannon
SS
I, KatllleeUl M. KllliOS, <Clerk of Common Pleas Court,
Criminal; in and for said county and state, do hereby certify that
the foregoing is a full, true and correct copy of the following:
1. Complaint
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF MERCER
so full and entire as the same remains of record before the said Court at No. 7&0 C:t:imi-nal 2002.
. . .
In Testimony Whereof, i have hereunto set my hand and affixed the seal of said Court this
12th day of March, 2009 A )
of

I, R. Dobson, a JUdge of the Thirty-fifth Judicial Distriet, composed of the County of
Mercer, do hereby certify .that Kathleen M. Kloos by whom-the annexed record, certificate and attestation was
made and given and who, in her own proper handwriting, thereunto subscribed her name and affixed the seal of
the said Court of Common Pleas of said! County, was at the time of so doing and now is Clerk of Common
Pleas Court in and for said County of Mercer, in the Commonwealth of Pennsylvania, duly commissioned and
qualified, to all of whose acts as such full faith and creditare and ought to be given as well in courts of
judicature as elsewhere, and that the said record, certificate and attestation are in due form of law, and made by
.the proper officer, .
1I4Js-. J.
Thomas R. Dobson

COMMONWEALTH OF PENNSYLVANIA
COUNTY OF MERCIER SS
1, Kathleen M. Kloos; Clerk 0>1' Common Pleas Court, Criminal, in and for said County, do certify
that the Honorable Thomas R. Dobson, by whom the foregoing attestation was made and who has hereunto
subscribed his name, was at the time of making thereof and still is a Judge of the Court of Common Pleas,
Criminal, in and for said County duly commissioned and qualified, toall of whose acts as such full faith and
credit are and ought to be given as well in courts ofjudicature as elsewhere. '
In Testimony Whereof; I have hereunto set my hand and affixed the seal of Clerk of Courts this
12thduyof.March, 2009 '.
IEXlHti$O"ij' Cler of Common Pleas Court, Crimina]
C
NAMEendADDRESS
COMMONWEALTli OF PENNSYLVANIA
YS.
DEFENDANT:
I'
Magisterial Oiwicl Number,
35-2-01
DisUcal JU$uce NarM: Hem.
James E. McMahon
Addu,,:;rt 1217 Hall av.
Sharon, Pa. 16146
CUMMONWEALTH OF
COUNTY OF:MERCER
T'''ph"" (724)346-6541
Docket No."
Date Filed: March 10, 2002
.,
OTN: H 551770-2
Cheryl Ann Cannon
302 Bud st.
Sharon, Pa. 16146
L --l
Race/5thnlcily Defendant's sex Oelendanl's 00,13,
o WIllie Black 181 Female
o Asian 0 NativeArne/lean 0 Male 2/1/61
tJ Hispanic 0 Unknown
De:lendanFs AKA. (also knownas) Defendant'sVehiclehl/Otmation
PlateNllmbel Slate
Oefell<lant's &,Ictal&!cl,Ir!lyNomber De/and'!,",!'s SID (Slate ldanml,catlon Number)
oercn anrs Driver's License Number
Reglstrallon Sltcker (1v,1MfYY) S1.3te
Complainllincideni Numbet UveSaanTl:leking NI.ll'll al UCRtt;lIBRS Code
02-00216
District Attomey's-Offlce 0 Approved 0 Disapproved because: .
(Thedlslrlol allorneY,may requtre mar .the c:ompltdnl, arrest warrant affidavit, or both beapproved :C;c::'-om:::m=on=w:::e::.'::;":::p::,;:,o:",'::o';m:::'n::g-.::P-,:::R:::.C;:'.::P":. 5::0::7"'.)---
(Name01 Attomey {Of Gommonw/;laHnPlease PontOf type} (Slgnaluleof AllomeyIQrCornmollweallh} (Date)
I,
THQMAS MACK
of Sharon Police Department PA0430600 02-00216
(policeAgenoy0/ ORl Number) {Orlgln$l1ng AgencyCase Number (OCA)l
do hereby state: (check. appropriate' box)
1. lSI I' accuse the above named defendant who lives at the address set forth above
o I accuse the defendant whose name is unknown to me but who Is descrtbed as
o i accuse the defendant whose name and popular designation or nickname is unknown to me and whom I
have therefore designated as John Doe .
wllh violating the penal laws of the Commonwealth of Pennsylvania at -" _
Sharon, Pa.
in MERCER County on or about 03-10-02 appx. 0033 hrs.
Participants were: Df there were participants, place' their names here, repeating the name of the above defendant)
.
Cheryl Ann cannon
Wolf"" oannon
, .
Docket Number:
2. The acts committed by the accused were: .
forth a summaryoltha (acts su(flciant toad\liaG lhedefend;:ml of the nature of thecrreose charged. Acilauc>nlo 1I\estatute aliegadlYviolaled, ... ,Unout mora,
isnet eumcteot. Ina summary oeee, you mustcite Iheepecmc eecucn andsubsection of [heslaluleorcrdlnance allegedly violated.). - .
903(a)(1)(2)Criminal consolracy-to commit title 35 780-113(A)(30) Possesion with the intent to deliver a
controlled SUbstance (crack cocaine) (Felony)The above named cer, did agree with another and/or did aid
another person to engage in conduct which constitutes a crime. The above named del. did conspire with
Walter Cannon and did invite another person into a residence owned by her for the purpose of selling a
controlled substance, being crack cocaine, not being licensed or registered to do so.
Title 35 780-113(a)(16) Possession of a controlled substance (crack cocaine) (Mlsdemeanor)--The above
named det. did have in her possession Inside her residence, 302 Bud st. Sharon. Pa., a smail plastic baqqle
eontalnlng a substance of suspected crack cocaine, not being licensed or registered to do so under this act.
This substance of suspected crack cocaine was recovered Inside a laundry basket, inside the livingroom of
the defendant's residence, upon an execution of a search warrant of said residence.
Tltie 35 780-1 t 3(a)(32).Possession of drug paraphernalia (Mlsdemeanor)--The above named def. did have in
her possession, inside her residence, several dr.ug paraphernalia devtces which were recovered as a result of
an execution of a search warrant of her resldence, 302 Bud St. Sharon, Pa. These drug paraphernalia
devices included: Straight Shooters (devices used for the purpose of Inhaling or introducing into the human
body a controlled substance). cleaning rods, screens, containers (used fOFstoring a controlled substance
and/or packaging materials 'for packing or storing controlled substances) and a digitai scale (used for
preparing, processing and/or weighing a controlled substance) all In violation to posess under this aCL .
ali of which were against the peace and dignity of the Commonwealth of Pennsylvania and contrary to the Act of
Assembly, or in violation of
I
,
I
I
I
I
I
I
I
, (SlgnBll,lfe Affiant)
3,
4.
I ask that a warrant of arrest or a summons be issued and thai the defendant be required to answer the charges I
have made. (in order lor III warrant 01 arrest to iasue, the amdllV;! prob'lbie cause be
completed and sworn to belore the issuing autnority.)
i verify that the facts set torth in this complaint are true and correct to the best of my knowledge or information and
belief. This verification is made subject to the penalties of Section 4904 of the Crimes Code (18 PAC.S.4904)
reiating to unsworn falsification to authorities.
MARCH 10TH 2002
(Data)
AND NOW, on this date, MARCH lOTH 2002 I .certlfy that the complaint has bee roperly oompieted and verified. An
aifidavi! of probable cause must be completed in order lor a warrant to issue.
. . '-
35-2-01
(MagislerlalDlslrlet)
AQPC 4128', '(8100)
tlv INrue COURT OF COMMON PLEAS
OF M.EHCER COUNTY, Jl'JENNSYLVANJIA
Commoriwealth of Pennsylvania
VS,
Cheryl AnnCannon
No. 780 Crimlnal 2002
The District Attorney of'Mercer County, Pennsylvania, by this Information presents that on (or
about) March 10,2002 ..
with the intent of prornotlnq or the commission of the crime Of Possession of a
Controlled Substance With the Intent to Deliver, defendant did conspire with Walter Cannon
and agreewith himto commitsaid crimeor agree to aid him'In the planning or commission of
the crime and in furtherance of said conspiracy, did do an overt act, to wit one and/or both did
arrange for and facilitate inviting another person into her residence for the purpose of selling
crack cocaine to that person, said incident occurring at 302 Bud Street, in the Cityof Sharon,
Mercer County, Pennsylvania,
in violationof18 Pa. C.SA 903 (a) (1) and/or (2)
all of which. js against the Act cf Assembly and the peace .and dignity of the Commonwealth of
Pennsylvania.
The District Attorneyof Mercer County,Pennsylvania, by thisInformation presents that on (or
about) March to, 2002
at 302 Bud Street, in the City of Sharon, Mercer County, Pennsylvania, detendant, above
named, did knowinqly or intentionalfy possess or have under her control, a controlled or
counterfeit substance, to-wit: Crack Cocaine, a Schedule lI'drug, the said defendant not being
registered under this act or of that class of persons whose profession, buslness, employment.
occupation or duties are permitted and allowed to have in their possession and under their
control such controlled substance. arid the substancewas n6t obtained pursuant to a valid
prescription,
, 'h"
in violationof 35 Pa, C.SA 780 -113 (a) (16)
al] 'of whj.ph isagainst the Act of Assembly and the peace and dignity of the Commonwealth of
'. .
"'.:
...
District Attorneyof'Mercer County, Pennsylvania, by thisInformation presents that on (or
about) March 10, 2002
at 302 Bud Street, in the City of Sharon, Mercer County, Pennsylvania, defendant did
knowingly or intentionally possess with intent to use, dru9 paraphernalia for the purpose of
planting, propagating, cultivating, growing, halVssting,. manufacturing, compounding,'
converting, produolng, processing, preparing, testing, analyzing, packing, repacking, storing,
containing, ccncsallnq, injecting, ingesting, inhaling or otherwise introducing into the human
body a controlled substance in violation of this act in that defendant did possess various items
including straight shooters commonly used for inhaling and/or ingesting crack cocaine;
cleaning rods, screens, containers and/or a scale commonly used for processing and/or
preparing crack cocaine;
in viclatlcnof35 Pa. C.S.A. 780-113 (il) (32)
all of which is against the Act of Assembly and the peace and dignity of the Commonwealth of.
Pennsylvania'
@
-,------------
j
,
.. ......-
ru.to iH l,jERCER COUHTY
,
lU03 MAY -b' A ll: 53
. ilAJHLEEN M.i-lLOOS
CLERII AND REGISTEr<
IN THE COURT OF COMMON PLEAS OF MERCER COUNn, PENNSYLVANIA
CRIMINAL
'COMMONWEALTH
versus
CHERYL ANN CANNON
780 CRIMINAL 2002
CHARGE:
COUNSEL:
Lr-i.iJlinaJ_J:.o.ns.p.:Lr.aJ:.Y__ ..to..P-O.S.s,e.5_S.:.S_Q_ca.tn_e
Randail Hetrick, Esquire
123 N. Diamond Street
Mercer, Pennsylvania 16137
SENTENCE
AND NOW, thi s 2nd day of May 2003, IT IS THE
SENTENCE OF THIS COURT on the charge of Criminal Conspiracy
to Possess Cocaine thctt the Defendant pay the costs; the
Court noting that for purposes of Act 198, the imposition
of additional costs would create an undue hardship; and
that she undergo an in the Mercer County Jail
for not less than five (5) days nor more than one-ye e r .
The Defendant shall receive credit for time served,
the sum of five (5) days, being from March 10, 2002 to
I
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'-"- ..-. -----------------1
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March 14, 2002.
In that she has served her mlnimum sentence, she is'
released thls date from the Mercer County Jall and placed
, .
on parole for the balance of her term, under the
supervlslon of the Pennsylvania Board of Probation and
Parole, subject to the following terms and cond t t t ons :
1. She'will report this date to the Mercer office of
the Board and enter lnto a contract for supervision; the
terms of that contract are incorporated herein by
reference.
2: She shall obey the laws of.any jurisdicti.on in
which she may be located.
3. She. shall not consume or possess any alcoholic
bever aqes or go into any bars or taverns where they are
so1d..
4. She is referred to t he Mercer County Day
'Reporting Treatment Program for the purpose of drug
treatment and drug testing, She shall report .t o the Day
Reporting Treatment Program within 72 hours of the date'of
her released from incarceration.
5. She shall pay her costs and restitution pursuant
to a payment plan to be entered into with the Mercer County
Cost Coordinator. She shall report to the Mercer County
Co's t Coordinator's office within 72 hours from her release
from incarceration for the purpose of entering into said
I
plan. Upon entrance, the terms of said-plan are
incorporated herein by reference.
BY THE COURT
. , ~
Thomas R. Dobson, Judge
mrk
3
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COURT Of COMMON 'PlE Of MERCER COUNTY
DOCKEl
Page 1 of 12
Judge Assigned: Dobson, Thomas R.
OTN: H5517702
Initial Issuing Aythority: William L Fagley
Arresting Agency: Other
Case I Qcal NumberTvpeis)
Criminal 10#
Legacy Docket Number
[j}('Jclkt NlIlmli:lv:
CRiMiNAL DOCKET
Commonwealth ot Pennsylvania
v.
Ann Cannon Cheryt
CASE IIIIlFORftiliATRON
pate Filed: 04/12/2002 InitiatiQn Dale: 0411212002
Lower CQurt Docket No: CR-0000139-02
Final Issuing AuthQrlty: James E. McMahQn
Arresting Officer: Affiant
Case LQcal Numberis\
CR 0000083 02
2002-780
RELATEDCASES
. Related Docket No Related Case CaptiQn
Joined Codefendanl Cases
CP-43-CR-0000773-2002 Cornm. v, Carinon, Walter
CP-43-CR-0000775-2002 Comm. v. Cannon, Walter
Related Co"IJrt
CP-35-43-Crim
CP-35-43-Crim
Association Reason
Joined Codefendant Cases
Joined Codefendant Cases
81Arus !NFORMAliON
Case Status: Closed
Status Date
03117/2003
0411212002
Processing Status ..
Migrated Final Disposition
Migrated Case
Arrest Date:
Comolalnt Date'
0311012002 I
11
,I
03/1012002 i
I
I
Date Of Birth:
Alias Name
Cannon, Cheryl
Participant Tvoe-
Defendant
02/0111961
DEFENDANT iNFORMATIOINJ
City/State/Zip: Erie, PA 16504
CASE PARTICllPANTS
.tlern!l
Cannon, Cheryl Ann
AOflC9082- Rev03/12/2009 Printed: 0311212009
Recent entries made in thecourt fiUng offices maynotbeimmediately reflected on these docket sheets. Neitherthe courts of theUnified Judicial
System Qf theCommonwealth of Pennsylvania northe Office of Pennsylvania Courts assume anylIabil1ty for inaccurate or oelayes
data, errors or omissions on these reccrte. Docket Sheet lnformalion should notbe used inplaceof a criminal history background check w/lich can
only be provided bythePennsylvania StatePolice. Moreover-an employer whodoes net comply with theprovlarcos of theCriminal History Record
11lfbrmationAct maybesubject to civil liability asset forth in.18 Pa.C.S., Section 9183,
COURT Of COMM NPLEAS Of MERCIER COUNTY
[lOCKtET
!'ll!ml:li!lw: CP43GIR@@@@'I'1ll1l:l-2@@2
CRiMINAL DOCIKIET
coviwt Case
Commonwealth of Pennsylvania
v.
Ann Cannon Cheryl
Page2 of 12
QQ. Orig Seq Grade Statute Statute Pescrlptlgn Offense
QI!::J
Date
1 F 18 903 A1 Conspire ManUf/Deliposs/w Int Manuf Or 03/10/2002 H5517702
2 2 F
189,G3 A1
Conspire Manuf/Del/posslw Int Manur Or 03/10/2002 H5517702
3 3 M 35 780-113 A1t Int Poss Contr Subst By Per Not Reg 03/10/2002 . H5517702
4 4 M 35 780-113' Use/Pass Of Drug Paraph 03/10/2002 H5517702
5 5 M 18 903 A1 Criminal Conspiracy/Possession
03/10/2002 H5517702
(Cocaine)
AOPC 9082' 'Rev 0$/12/2009 Printed: 03'1212009
Recent entries made inthecourt filing offices maynotbe immediately reflected onthese docket sheets. Neitherthe courts of theUnified judicial
System of the Commonwealth of Pennsylvania northeAdministrative Office of Pennsylvania Courts assumeany liablllty for 'neccurate or delayed
data.errors oromissions onthese reports, Docket Sheet information should notbe used inplace of a crt minat his10ry background c.heck: which can
only beprovided by thePennsylvania StatePolice.. Moreoveran employer who does.not comply with theprovisions oftheCriminal HIstory Record
. Information Act maybe subject lo civilliabilily asset forth In18 Pa.C,$. Section 9183,
,,-.-
COURT OF !PlEAS OF MERCER COUINITV
DOCKET
Numli:lillW: .
DOCKET

\ Commonwealth of Pennsylvania
v.
Ann Cannon Cheryl
DiSPOSiTiON SlEIMTIEIMCiNG/PENAl11IES
Page 3 01 12
Disposition Date r Final Disposition
Offense Disposition Section
Sentence Date Credit For Time Served
Incarceration/Diversionary Period 8tert Date
Disposition
Case Event.
Sequence/Description
Sentencing Judge
SentenceJDiversion ProgramType
Sentence Conditions
Linked Offense =Sentence
Migrated Disposition
. Migrated Dispo.sitionarEvent
1 I Conspire Manuf/Del/poss/w Int Manul Or
Dobson, Thomas R
2 / Conspire Manuf/Del/poss/w Int Ma'nuf Or
Dobson, ThomasR.
3 lint Poss contr Subst By Per Neit Reg
Dobson, Thomas R
4 1Use/Poss Of Drug Paraph
Dobson, Thomas R.
5/ Criminal Conspiracy/Possession (Cocaine)
Dobson, Thomas R
Confinement
Financial Assessments
Link Type
03/17/2003
Withdrawn
03/1712003
Withdrawn'
03117/2003
Withdrawn
03/17/2003
Withdrawn
0311712003
. GUilty Plea
03/1712003
Min of 5.00 Days
Max of 1.00 Years
Min of5.00 Days
Max of 1.00 Years
Linked Docketr;,Jumber
Final Disposition
18903A1
18903A1
35780-113A16
35780-113A32
18903A1
05/02/2003
05/02/2003
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Recent entries madeinthecQurt.fillng offices maynot be Immediately reflected on thesedocket sheets, Neltherthe courts of the Unified Judicia!
SystemoftheCommonwealth of Pennsylvania northeAdministrative OffIce of Pennsylvania Courts assume anyliablllty forinaccurate or delayed
data, errors cr omissions onthese reports, Docket Sheet information should notbeusee inplace of a crlmlnet history backgrOUnd check wh!ch can
only beprovided bythePennsylvania State Pollee.. Moreover an employer who doesnot comply with theprovisions of theCrirnllial History Record
Information Act maybe subjectto civil.liability as set forth in18 PaC.S. Section 9183.
'MRCER-ci:iuNTY- -----.-----1
II)OiCKET
1J)>::l!<et tNJumfoor:
CRiMiNAL DOCKET
Court Case
Commonwealth of Pennsylvania..
v.
Ann Cannon Cileryl
COMMONWEALTH Al'TORlMlEY
Page 4 of 12
Name: James Peter Epstein, Esq.
District Attorney
Supreme Court No: 021859
Phone Number(s):
(724) 662,3800 (Phone)
(724) 662-0807 (Fax)
Address:
Mercer County District Attorney's Office
Courthouse Ste 209
MercerPA 16137
Supreme Court No:

Phone Number(sj: .
AOPO 9082< Rev 03/12/2009 printed:
Recent entries made in the court fiUngoffices may not be immediately reflected on these docket sheets. Neither the courts of the Unified JUdIcial
System of the Commonwealth of Pennsylvania nor the Administrative Office of Pennsylvania Courts assume any liability for inaccurate or delayed
data, errors or omissions on these reports, Docket Sheet information should not be used In place of a crtmlnat history background check. which can
only be provided by the Pennsylvania State Police. Moreover an employer who does not comply with the prOVisions of the Criminal History Record
lnfof"0alion Ad may be subject to civil liability as set forth in 18 Pa.C.S. Section 9183.
I
COURT OfF COMMOIi';g PLEAS OF MERCER COUIi';gTY
OOCI<!Ei
1'!1l.m'UIller:CP-43-CR-@lCllJ1:\1ll-21102
CRiMINAlll)OCKET
CO!JJrt Case
Sequence Number CP Filed Date
1 03/10/2002
COMPLAINT FILED
COMPLAINT FILED
Commonwealth of Pennsylvania
v.
Ann Cannon Cheryl
ENTRIES
Document Date
Migrated, Filer
Page 5 of 12
1 04/01/2002
APPLICATION FORASSIGNMENT OF LEGAL
. APPLICATiON FORASSIGNMENT OF LEGAL COUNSEL- ORDER DATED 3/28/2002 ATTY RANDALL T HETRICK
APPTD. FORNELLI,PJ ICOPY TO Any HETRICK
Migrated, Filer
._,,'." ,,',.,
Unknown Filer
1 04/12/2002
Orlglnal Papers Received from Lower
1 04112/2002
TRANSCRIPT TRANSFERRED FROM AOPC SYSTEM
TRANSCRIPT TRANSFERRED FROM AOPC SYSTEM
. .
_ ,w,"',' ' _,. __ _
1 07/0812'0'02
INFORMATIONFILED BY DISTRICT ATTORNEY'S
INFORMATiON FILED BY DISTRICT ATTORNEY'S OFFICE
2 07/08/2002
MOTION FORPRE-TRIAL DISCOVERY FILED
MOTION FOR PRE-TRIAL DISCOVERY FILED BY DA
Migrated, Filer
Migrated, Filer
._-- _._- .--- -_._-. _.. _.. - ".. .... _. .
Migrated, Filer
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1 99/09/2002
ORDER-WARRANTSHALL ISSUE DATED
ORDER-WARRANT SHALL ISSUE DATED 913102-CALL LIST-WHERRY J-2 COPIES TO DA;1-ATTY
HETRICK;1-MCJ;1-911
Migrated, Filer
-,- -,..._.- -,._. -- _._. ----, .._- ---
AOP-C 9082 Rev 03/.1 Zf2009 Prit11ect 03112/2009
Recententries made in, the court fHing offices ma)l not be ImmediC1ltely reflectedon thesedocket sheets. Neither the.courts of the Unified Judicial
System of the Commonwealth of Pennsylvanianor the.Aominlstretlve Officeof Pennsylvania courts assume any liability for inaccurate or delayed
data, errors Of omissions en these reports: Docket Sheet lnfometicn should not be used in place of a criminal history background check which can
onlybe providedby the Pennsylvania Slate Police. Moreover an employer who does"not comply with the provisions of the Criminal History Record
Information Acl may be subject to dvillial:Hlity as set forth in 18 Pa.C.$. Section 9183. .
CP-43-tCR..@@@11Ji"d'$il)).,1i!@:!
DOCKET
',=
COURT OIF COMMOINl Of MERCIER COUINlTY
DOtCI<ler
Commonwealth of Pennsylvania
v. .
Ann Cannon Cheryl

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Page6 of 12
Sequence Number .Cpo Filed Date Document Date
Migrated. Filer
2 09/09/2002
. BENCH WARRANT DATED
BENCH WARRANT DATED 913/02-CALLL1ST***BAIL TO BE DEMANDED: $5,000 -10%. CASH OK*'''WHERRY J2
COPIES (NO CC AS IMMVAC) TO DA;1ATTY HETRICK;1-MCJ;1-911
. . .
3 0910912002
BENCH WARRANT "VACATE*" ORDER DATED
BENCH WARRANT "VACATE'* ORDER DATED 9/3/02-BW ISS THIS DAY IS VAC- WHERRY J-2 COPIES TO
DA;1-ATTY HETRICK;1MCJ;1911
Migrated, Filer
4 09/0912002.
CONTJNORDER FILEDDATED
CONTINUANCE ORDER FILED DATED 9/3102THIS CS IS CONTD TO OCT TRIAL TERM AT REQUEST OF
DEFTRULE 600 TIME IS ALLOCATED TO. DEFT. WHERRY J-2 COPIES DA-1 COPY ATTY HETRICK
M.lgrated, Filer
5 09/09/2002
CONSOLIDATION ORDER DATED
. CONSOLIDATiON ORDERDATED9/3102-ABOYE-CAPTIONEDCASESARECONSOLIDASTED. WHERRY,J 201',;1
ATTY HETRICK'" CASE NOS. 780 CR 2002,773 CR 2002 & 781 CR 2002 "*
Migrated, Filer
1 11127/2002
MOTION FOR CONTIN FILED BY
MOTiON FOR CONTINUANCE & bRDE!" DATED 11f27102DEFTS MOT TO CONT THE ABOVE CAPTIONED CS
FROM DEC 2002 TRIAL TERM TO THE JAN. 2003 TRIAL TERM IS GRANTED IN THAT NO JURY TRIALS ARE
SCHEDULED DURINGTHEMONTHOF DEC-ANY DELAYCAUSED BYTHIS CONTINUANCE WILL BEl',TTRIBUTED
TO THE DEFT FOR RULE 600 PURPOSES. DOBSON J-2 COPIES DA 1 COpy ATTY HETRICK
Migrated, Filer .
1 0211412003
CONTIN ORDER FILED DATED
CONTINUANCE ORDER FILED DATED 2/12103-CS IS CONTD TOTHE MAR 2003 TERM OF CRT-UPON THE MOT
OF THE CRT. WHERRY J-2 COpiES DA1 COPY ATTY HETRICK
MIgrated, Filer
AQPC RElV Printed: 03112/2009
entries madeIn thecourt filing Offices maynotbe immediately reflectedonthesedocket sheets. Neither thecourts of the Unifieo' JUdicial
SYSlem of theCommonwealth ofPenneylvenie nor theAdmtnlslrativeOfficeof Pennsylvania Courts assume anyliablUty tor.inaccurate or delayed
data, errors oromissions onthese reports. Docket Sheet lntormauonsrould not beused inplaceofa criminal history background cnecx Which can
only be provided bythePennsylvania-Slate Pollee: Moreover an employer who does not comply withtheprovisions of Criminal HIstolYl3ecord
Information Act maybeSUbject 10 civil liability as set forth in18 Pa.C.s. Section 9183.'
:,'''''.. , ... _,' --'---- -
COURT Of COMMON PLEAS Of MERCER COUNTY
DOCl'(lEl
",
CIPti\3iCRl))OOi'Ji'8l!-2002
CRiMiNAL DOCKET
COlifl1 Case
Commonwealth of Pennsylvania
v.
Ann Cannon Cheryl
lEi\liI"RiES
Page7 oI 12
Migrated, F.iler
1 03/17/2003
Migrated Disposition
Migrated Automatic Registry Entry (Disposition) Text.
2 0311712003
PLEA ENTERED
PLEA ENTERED TO CONSPIRACY TO POSSESS A CONTROLLED SUBSTANCE .91 GRAMS CRACK COCAINE
AMMENDED 3117/03 TO ADD N.P. CTS 1,2,3
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Migrated, Flier
Document Date Sequence Number CP Flied Date
1 03/17/2003
AMENDED INFORMATION (ORDER DATED:
AME"NDED INFORMATION (ORDEROATED:3/17/2003) TO INCLUDE A CHARGE OF CRIMINAL CONSPIRACY TO
POSSESS COCAINE... J - 2 COPIES DA; 1 ATTY HETRICK
Migrated, Filer
..__ . ....... .."... --- ...._- -- - ..- -- --_., --- -_.. -_.. -- .__..,
2 03/1712003
Sentence
Migrated Sentence
Migreted, Flier
3 03/1712003
PARTIAL NOLLE PROSEQUI (DATED:
PARTIAL NOLLE PROSEQUI (DATED: 3/1712003) HAVING PLED TO CRIMINAL CONSPIRACY TO POSSESS
COCAINE THE BALANCE OF THE CHARGES ARE NOLLE PROSSED...DOBSON, J - 2 COPIES DA; 1 ATTY
HETRICK
Migrated, Flier
1 05/0612003
SENTENCE: (DATED:
SENTENCE: (DATED: 512103) ON CHG OF CRIM CONSPIRACY TO POS!3ESS COCAINE - PAY COSTS; CRT
NOTING THAT FOR PURPOSES OF ACT 198, IMPOSITION OF ADD'L COSTS WOULD CREATE UNHARDHSIP &
IMPRISONMENT IN MCJ FOR 5 DAYS TO 1 YR. RECEIVE CREDIT FOR 5 DAYS BEING 3110/02 TO 3/14102.
HAVING SERVED MINIMUM, RELEASED THIS DATE FROM MCJ & PLACED ON PAROLE FOR BALANCE OF
TERM SUBEJCT TO TERMS & CONDITIONS WHICH INCLUDE REFERRED TO DAY REPORTING TREATMENT
PROGRAM FOR PUR- POSES OF OM TESTING... OOBSON,J 2 OA;1 ATTY .
Migrated, Flier
AOPC .9082 Rev 0:3/12'20.0,9 . . ." '" . , Printed: _03.1121200$,
Recententries madein the court flling officesmaynot be immediately reflectedon these docket sheets. Neither the courts-of the Unified judiCIal
Systemof the Commonwealthof Pennsylvania nor the AdministrativeOffice of PennsylvaniaCourts assumeany liability for inaccurate or delayed
data, errors'oremtssrcns on these reports. Docket Sheet informationshould not be usedIn place of a criminal history background cbeckwhtch can
onlybe providedby the PennsylvaniaStatePolice.. Moreoveran employer who does not comply with the provisions ot tbe Criminal History Record.
, Information Act may be subject to civlllJabitifyas set forth in 18 Pa C.S. Section9183,
COURT OF COMMON IflillEAS OF MIERCIER COUNTY
100CIKIE1f
lCl<c>cket
CRIMiNAL DOCKIET
Court Case
Sequence Number CP Filed Date
1 0511212003
ABSTRACT(S) ISSUED
ABSTRACT(S) (1) ISSUED
1 0511412003
ACT 84 PACKET ISSUED
ACT 84 PACKET ISSUED
2 0511412003
PA SENT GUIDELINES FILED
PA SENT GUIDELINES FILED
Commonwealth of Pennsylvania
v.
Ann Cannon Cheryl
ENTRiES
Document pate' .
Migrated, Filer
Migrated, Filer
Migrated, Filer
Page 8 of 12
\
:I
1 0610612003
NOTICE OF VIOLATION FILED BY IPP
NOTICE OF VIOLATION FILED BY IPP .
1 0611712003
STATEMENT OF COSTS ISSUED
STATEMENT OF COSTS ISSUED
(
Migrated, Filer
Migrated, Filer
. I
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I
2 06/1712003
FILETAGGED FOR AOpe 3-SHEET ELECTRONIC
FILETAGGED FOR AOPC 3-SHEET ELECTRONIC TRANSMISSION.
Migrated, Filer
. ._M_' __._ ._M. __. --'__, . .
1 06/20/2003
ORDER DATED
ORDER DATED6119/03-THIS MATTER BEING BEFORE THE CRTTO REVIEW ALLEGED VIOLATIONS OF DEFT'S
INTERMEDIATE PUNISHMENT PROG-THE DEFT SHALL COMPLETE OUTPATIENT COURSE OF D & A
TREATMENT PRESCRIBED FOR HER ATTHE SHARON REG HLTH SYSTEM & THAT SHE SHALL BE ON HOUSE
ARREST WIWINDOWS FOR TREATMENT & ANY OTHER APPROP NECESSITIES-THE CRT WILL REVIEW THIS
HOUSE ARREST IN 3 WKS VIA A WRITTEN RPT FROM INTERMEDIATE PUNISHMENT PROG. DOBSON J-2
COPIES DA-1 COpy ATTY HETRICK-1 COpy IPP-1 COpy PBPP
AOPC9082. Rev 03fi2/2009 Printed: 0311212009
Recententriesmadein thecourt filing offices may-notbe immediatelyreflectedon these docket sheets. Neither the courts of the Unified Judlclat
System of the Commonwealth .ofPennsylvanianor the AdministrativeOffIceof PennsylvaniaCourts assume any liability for inaccurate or delayed
data,errorsor omissionson these reports. Docket Sheet informationshould no! be used in place of a criminal history background check which can
onlybe providedby the PennsylvaniaState Police. Moreover an employer who sees not comply with theprovisions of the Criminal History Recore
[ntormauon Act may be SUbject to civilliabillty as set forth in 1BPa.C,S, Section9183.
[lJocilet Nlllmlber:
CIR!MiNlAIL DOCKET
COllrt Calse
Sequence Number CP Filed Date
Commonwealth of Pennsylvania
v.
Ann Cannon Cheryl

Document Date
Migrated, Filer
Page 90! 12
1 06/23/2003
NOTICE OF VIOLATION FILED BY IPP
NOTICE OF VIOLATION FILED BY IPP
Migrated, Filer
... _- ._--- _.:... .,- -- --- ._- --- --, - --- -" .... .-- ---,. _.- .. ...
1 06/23/2003
NOTICE OF.VIOLATION FILED BY IPP
NOTICE OF VIOLATION FILED BY IPP
Migrated, Filer
1 06/25/2003
NOTICE OF VIOLATION FILED BY IPP
NOTICE OF VIOLATION FILED BY IPP
Migrated, Filer
1 07/03/2003
NOTICE OF VIOLATION FILED BY IPP
NOTICE OF VIOLATION FILED BY IPP
Migrated, Filer
... _. _ __ __ __ _. _ __' ,_ .__ _ __" ._. ._ __'n
1 07/15/2003
NOTICE OF VIOLATION FILED BY IPP
NOTICE OF VIOLATION FILED BY IPP
Migrated, Filer
..._; _ M , ._._ __
- -- ._.- ._- -- -'- ._. -_.- -'- --
. Migrated, Filer
2 07/15/2003
NOTE-30 DAY APPEAL PERIOD FROM SENT
NOTE-30 DAYAPPEAL PERIOD FROM SENT PAST-PDICTAPPTD COUNSEL NO LONGER COUNSEL OF REC AS
PER RULE 122(C)(3) LM
3 07/1512003
DETAINER ORDER FILEDMCJ TO DETAIN TILL
DETAINER ORDER FILED-MCJ TO DETAIN TILL PBPP 'CAN FILE PET/REV AND HRG HE.LDORDER DATED:
7-15-03-WHERRY J. FOR' DOBSON J. 2 COPIES DA; COpy DFNDT @ MCJ;PBPP AND JAIL .
Migrated, Filer
AOPC9082- Rev 03112/2009 Printed: O:.;f12{2D09
Recent entries made In the court:fIlingofflces may not be immediately reflected on: these docket sheets, Neither the courts of the Unified JudicJal
System of the Commonwealth of Pennsyrvanla nor the Adrntnlatrative Office of Pennsylvania Courts assume any liability for,inaccurate or delayed
data, errors or omissions on these reports Docket Sheet jnfcrrnatlon-should not be used in place of a criminal history background checkwhich can
only be provided by the pennsylvania Slate Police. Moreover an employer who does not comply with the provisions of the Criminal History, Record
Information Act may be subject to clvilllability as,set forth in,8 Pa.C.S. Section 9183. '
COUJIRT Of PLEAS Of MERCER
oocxsr

CRIMINAL DOCKET
court Case
Sequence Number CP Filed Date
Commonwealth of Pennsylvania
v.
Ann Cannon Cheryl

[Jocument Date
Page 10of 12
1 07/16/2003
NOTICE OF VIOLATiON FILED BY IPP .
NOTICE OF VIOLATION FILED BY IPP
Migrated, Filer
1 07i18/2003
TRANSPORT ORDER DATED:
TRANSPORT ORDER DATED: 71803 FILED. SHERIFF SHALL TRANSPORT DFNDT TO CLEARFIELD COUNTY
PRISON FOR OVERCROWDING. FORNELLI PJ. COPY DA; DFNDT @ MCJ AND 2 CC JAIL
Migrated, Filer
". "M ._,,'_'W ." .__ ' __ _._. w .,. __ .. _ _ ._..... "_w. ,..
1 08/11/2003
ORDER DATED
ORDER DATED 8703 FILED. DFNDT SHALL BE DETAINED IN MCJ UNTIL THE SUM OF $40 IS PAID TO IPP..
UPON RECEIPT OF PAYMENT,CRT WILL LIFT THE DETAINER. DOBSON J. 2 COPIES DA;COPY DFNDT @ MCJ
AND JAIL . . .
Migrated, Filer.
1 0'8/13/2003
ORDER DATED
ORDER DATED 8-12'03 FILED. DFNDT HAVING COMPLIED WITH CRT ORDER OF 8-7-03,THE DETAINER IN
MATTER IS LIFTED. DOBSON J. 2 COPIES DA;COPY DFNDT AND JAIL
Migrated, Filer
1 . 09/23/2003
APPLICATION FOR ASSIGNMENT OF LEGAL
. APPLICATION FOR ASSIGNMENT OF LEGAL COUNSEL -ORDER DATED 9122/03- POAPPT COUNS-DOBSON J-1
PD
Migrated, Filer.
1 10/17/2003
NONCOMPLIANCE HEARING HELD (ORDER DATED: ,
NONCOMPLIANCEHEARING HELD (ORDER DATED: 101 16/03)-MATTERREF TO MC DA'S OFFICE FOR PURP OF
FILING AN INDIRECT CIVIL CONTEMPT PET- CRT NOTES DEF OWES $739.87 & PAYM'T OF SAID SUM WILL
RESULT IN THE INDIRECT CIVIL CONTEMPT HRGBEING CANCELED. DOBSON J,2 COPIES DA-1 COpy PD-1
COpy PBPP
Migrated, Filer
;:'-OPC 9082 RI'll! Printed; 02[1212009 .
Recententries madeinthecourt fililiS offices-may notbeimmediately reflected on, these docket sheets. Neither the courts of theUnified Judicial
System 'of the Commonwealth of Pennsylvania northeAdministrative Office of Pennsylvania Courts assume any'liability for Inaccurate or delayed
oets. errors or omissions onthese reports DocketSheet information should notbe usedinplace ofa criminal history-background check which can
only be provided bythePennsylvanle State Police. Moreover anemployer whodoesnotcomply wlth the provisions of the Criminal History Record
, Information Act maybe subject to as set forll1 10.18 Pa.C,S Section 9183.
.-.. _,,' _., ,.... <- _.::..'-'.'
COURT Of COMMON PLEAS Of MERCER COUNTY
DOCIKIE1r
IDccij{a NI!.6(M(blew: CIP.43-CR.@If.i)Il()i/'$@-201.l2

CmmCase
Commonwealth of Pennsylvania
v.
Ann Cannon Cheryl
ENllRU?;
Page1'1 of 12
Sequence Number . CP Flied Date Document Date
1 10/24/2003
MOTION FOR IND CIVIL CONT FILED BY DA-RULE
. MOTION FOR IND CIVIL CONT FILED BY DA-RULE DATED 10/23/03-RULE RETURNABLE ON 12/17/03-AT 2:00
PM-IN CR# 3, DOBSON J-2 COPIES DA-1 COPY PD-1 COpy P8PP
Migrated, Flier
..-..-., ., -- --_. ._--
1 12119/2003
ORDER DATED
ORDER DATED 12/17/03-8EFORECRTON PET FORINDIRECT CIVIL CONTEMPT- THE DEF SHALL PAY THE SUM
OF $100 TWD HER OUTSTANDING ARREARAGES THIS DATE-THE 10TH OF EA MONTH COMMENCING 1110/04
SHE SHALL PAY $75 PER MONTH-IF SHE FAILS TO PAY TWO CONSECUTIVE MOS IN A ROW-A BW SHALL 8E .
ISSUED FOR HER ARREST-THE INDIRECT CIVIL CONTEMPT PET IS DISMISSED. D08S0N J-2 COPIES DA-1.
COpy PD-1 COPY P8PP
Migrated, Filer
1 04/29/2004
NOTE-30 DAY APPEAL PERIOD FROM SENT
NOTE-30 DAYAPPEAL PERIOD FROM SENT PAST-PD/CT APPT'D COUNSEL NOLONGER COUNSEL OF REOAS
PER RULE 122(C)(3) - LM
Migrated, Filer
2 04/29/2004
BENCH WARRANT DATED
BENCH WARRANT DATED 4/29/04-FAIL COMPWI CT'S ORO 1:2/17/03-8AIL: NONE-DOBSON J-2 COPIES(1 CC) TO
DA;1-DEF;1-MCJ;1-P8PP
Migrated, Flier
1 06/23/2004
BENCH WARRANT ORDER DATED
BENCH WARRANT"VACATE'* ORDER DATED 6/23/04-DEF HAS PO COSTS/REST IN FULL BW ISS 4/29104 IS
VAC-DOBSON J-2 COPIES TO DA;1-DEF;1-MCJ; 1-PBPP
Migrated, Flier .
AOPC 9082 Rev03/1212009' Prlnled:
Recent entries madeinthecourt filing offices may notbe immediately reflected on these docket sheets. Neither the courts of the Unified Judicial
System of the Commonwealth of Pennsylvania nor theAdrnlnistrativeOfflceof Pennsylvania Courts assume any liabil1ty for Inaccurate or delayed .
data, errors Of omissions on1!l8S8 reports. DocketSheet Information should notbe usedjnplaceof a criminal history background checkwhichcan
only be provided bythePennsylvania SlatePolice. Moreover anemployer whodoes not cornplywlth tne.crcvetons of the Criminall-tlstory Record
Information Act may be subject \0 chrllliabmty as set forth- in18 Pa.C.S. Sectlcn 9183.
!
I
I
COURT Of COMMON PLEAS Of MERCER COUNTY
I)OCIKIET
[i>oclkat ll\!Jllmbaw: '
CR!MINAL DOCKET
Case
i
-
Commonwealth of Pennsylvania'
,I
v, "
Page12of 12
Ann Cannon Cheryl
CASE FiMA!I!CiAllNfOFlMATiON
Last Payment Dale: Total of Last Payment: $0,00
cennon, Cheryl An" Assessment Payments Adjustments Non Monetarv Total
Defendant Payments
Costs/Fees
Domestic Violence Compensation (AC'
$10,00 $0,00 -$10,00 ;00,00 $0,00
I
44 of 1988)
Crime Victims compensation (Act 96
$16,00 $0,00 -$15,00 $0,00 $0,00
I
of 1984)
Crimes Commission Cost (Act 96 of $25,00 $0,00 -$25,00 $0,00 $0,00 '
I
1984)
Firearm Education and Training Fund $5,00 $0,00 -$5,00 $0,00 $0,00
(158 of 1994)
,
Auto Track Fee (Mercer) $3,00 $0,00 -$3,00 $0,00 $0,00
Act 84 (Mercer) $5,00 $0,00 -$5,00 $0,00 $0,00
Automation Fee (Mercer) $5,00 $0,00 -$5,00 $0,00 $0,00
CW, Elill (Mercer) $2,37 $0,00 -$2,37 $0,00 $0,00
,
County Court Costs (Act 204 of 1976) $147.D1 $0,00 -$147.Q1 $0,00 $0,00
l
I
State Court Cost (Act 204 of 1976) $8,61 $0,00 -$8,61 $0,00 $0.00
I
Commonwealth Cost - HB627 (Act 16:
$7,38 $0,00 -$7,38 $0,00 $0,00
,
I
of 199;2)
I
JCP $1,50 $0:00 -$1,50 $0,00 $0,00
IPP Fee (Mercer) $505,00 $0,00 -$505,00 $0,00 $0,00
"
IPP Fee (Mercer) $40,00 $0,00 -$40,00 $0,00 $0,00
Costs/Fees Totals: $779,87 $0,00 -$779,87 $0,00 $0,00
Grand Tctals:
$779,87 $0,00 4779,67 $0,00 $0,00
'., lndicstes assessment is subroqated
AQPC. $Q13:2 Rev . . Pdnted: 03112/2009.
Recent entries made inthecourt fll1ng offices may notbe Immediately reflected onthese docket sheets. Neitherthe courts of the Unified JUdicial
System of ll.1e Commonwealth of Pennsylvania northeAdministrative Office of Pennsylvania Courts assume anyHabl1lty forinaccurate or delayed
data, errors or omissions en these reports. Docket Sheetinformation should notbe used inplace of a criminal history background checkwhich can
Dilly beprovided bythePennsylvania SlatePolice, Moreover an employer whodoes not comply with theprovisions of theCriminal History Record
Information Actmay be SUbject tocivil liability as set forth lrl18 Pa.C.S. Sectlon 9183.

in the case 01Commonwealth v, Cheryl Ann CamlOn
4. Docket

E, Kathleen M. Kloos, Clerk of Common Pleas Court,


Criminal, in and for said county and stale, do hereby certify that
the foregoing is a full, true and correct copy of the following: '
1. Complaint
,2. D.A. Information and Signed Plea'
3. Se"tence
COMMONWEALTH OF PENNYLVANllA
COUNTY OF MtIRCEIR
, ,
so full and entire as the same remains of record before the said Court at No, 697 CTiminal ZOD3.
In Testimony Whereof, J have hereunto set my hand and affixed the seal of said Court this
12th day or. March, 2009 " UJ. LA lI
u
.m2Th.LJ!}----<Ii '
Pleas ----

X, Thomas R. Dobson, a Judge of the Thirty-fifth JudJicilill District, composed of the County of
Mercer, do hereby certify that Kathleen M. Kloos by whom the annexed record.certificate and attestation was
made and given and who, in her own proper handwriting, thereunto subscribed her name and affixed the seal of
.the said Court of Cemmon Pleas of said County, was at the time of so doing and now is Clerk of COmIDOJ11l
Pleas COURIrt in and for said County of Mercer, in the Commonwealth of Pennsylvania, duly commissioned and
qualified, to 'all of whose acts as such full faith and credit are and ought to be given as well in courts of
judicature as elsewhere, and that the said record, certificate and attestation are in due form of law, and made by
the 'proper officer,
I
i
t
!

COMMONWEALTH OF I'ENNSYLVANEA
COUNTY OF MERCER SS
E, Kathleen M. Kloos, <Clerk of Common Pleas Court, in and for said County, do certify
that the Honorable Thomas R. Dobson, by whom the foregoing attestation was made and who has hereunto
subscribed his name, was at the time of making thereof and still is a Judge of tile Court of Common Pleas,
Criminal, in and for said County duly commissioned and qualified, to all of whose acts as such full faith and
credit are and ought to be given as well in courts ofjudicature as elsewhere,
In Testimony Whereof, I have hereunto set m hand and affixed the seal of Clerk ,,1 Courts this
12thday of March, 1009
,
.,
.. _. ----
------ . ----
,.,.,.
-
, .. _."
,-_ .. , .-, ._.,--' -_.-
, c;,OMMONWEALTHOFPENNS:
--
I>,NIA
, POliCE
COUNTYOF:Mercer CIFmtlilijNAl. COMPl.AijlNll
Magislerlal Olslrlcl Number:
35-2-02'
.
Oislric.\ JuSlicaName: Hon.
COMIliIONWlEAl1rH Of PIEIi'lNSVlIIAl\lijP\
Henry J. Russo
vs,
Address, DEFENDANT,
111SMercer Avenue
r
NAMEand ADDRESS
I
Hermitage, PA 16148
(724)346-3591
Cheryl A Cannon

"ow'
, Docket No.:
CIR-147-03
302 Budd SL
Sharon, Pa, 16146
Date Filed:
4/1/03
L
I ---"--"- 1M
OTN:
II 772847-5
j t
- ",).c, M' aFtt,' j
,.;. Of .. .
Defendanl':; RacefElhnlcHy Deferw.1arnSex DefendanTs'O.C.B. Social Securily Number Defendant'sSID(SIlitP."ltllmfilJ..'4aWr'l Numbel
"
o VVhlle 1m Slack 18I Female
/lIddd:lL.
o Asl;m a NativeAmerican o Male
2/1/61
CJ Unk/iown'
Dlllfand.anl's A.KA (13lso Mown asl
"
Oarendalll'sVehiele Information Defendant's Dlwer's license Number
Number I
Stale
I
ReglslratlQn (MMIYY) asre
I
ENF-5893 Pa 01/03
compll:llnUlncldentNumber UveScafl Tracking umber CompleinYlnc!denl Number if olher Part!cipanls UCRlNIBRS Code
03-02291
DistrictAttorney's Office 0 Approved 0 Disapproved because:
(Thedlstrlct,atlprney may require thatthecomplaint, arrestwarrant affidavit. or both.beapproved bytheattorney for 1MCommonwealth prior 10 ii1l1ig, 507,)
(Name'of AUorney(OrComrnol'lwaallhPlealla Print or Type) {Signatureof Allotney for CommollWGallhl {Dalal
I, Ofc. David,Moyer 138
(Nl.lIlteof Affiant-Plesse Print or Typa, (Offit::efBartgNumberll.D.}
of Southwest Mercer Co, Regional PA0430'100 03-02291 ) ,
Qdenllfy Oepsl1lTllanl or Represented and PolitIcal Subdivision) (PoHee Agency or ORl Number) (Origln:ltlngAgency Case Number (OCA
-do herebystate: (check appropriate box),
1. IZI I accuse the abovenameddefendantwho livesat the address set forthabove
o I accusethe defendant whosenameis unknownto me but who is described as
/
0
1accuse the defendant whosenameand popular designation or nickname is unknown to me and whom I
Farrell, Pa,
in Mercar County on or about 04-01-03 appx. 0142 hrs.
Participants were: (if therewere participants, placetheir names here, repeating the name of the above defendant)
Cheryl A Cannon
AOPC<112A (4101)
.. ,_. ----,-,--:... - --"-
.\
Defendan!'s Name:Cheryl A. Cannon
d.
Docket Number:
CR-147-03
IP'OUCIE
COMlP-'lAH\!lT
2. The acts committedby the accusedwere: .'
(Setforth a. summary ofthe fadssufficient toadvise thedefendant ofthe nature oflheOffense clierged. Acitation tothestatute allegedly violated, without more,
isnotsufficient. Ina summary case, you must citethespecific sectlcn andsubsec!19tl9f Ptordaence oUegedly .vlolated.)
Title35 '780-113(8)(16) Possession of a controlled substance. (1 count)--The above named defendant did
have in her possessiona controlled substance, being suspected crack cocaine, not being licensedor
registered to do so under this act.
.On Tuesday, 01 April 2003at appx. 0142 hrs. the abovenamed defendant, Cheryl Cannon, was a front
seat passanger in a vehicle which was stoppedfor a traffic Violation, being expired registration. Upon a
check of Cannon.it was found therewas an activewarrant for her filed out of D.J. Russo's office for unpaid
finas totaling $657.50. The warrant was verifiedto be activethrough theS.W. Regional Police Dept at which
time Cannonwas advisedof the warrant and advisedshe was under arrest Cannon was then requested to
exit the vehicleand place her hands on the trunk of the car: As Cannonwas walking to the rear of the car it
was noticed she had her right hand closedto a fist, and asCannon ptaced her hands on thE! trunk of the car,
Officers observed a substanceof suspected crack cocainein her right hand. Officers then grabbed Cannon's
hand, handcuffedher and securedthesuspected crack cocaine. The suspected crack cocaine was later field
tested by CpL Jon C. Rocod at 0200 hrs, 'With positiveresults.
(coun!s)
lemHlls)
3. I aSK that a warrant 6f arrest or a summons be issuedand that the defendant be required to answer thecharges I
have made. (In order for ",warr",,,t arrest 10Issue, the attached affidavit of probable cause mus! be
completed a!ld sworn to Mfore tli" i\'lsl8ilI1!11 lIIlDthorilly.) .
4. I verify that the facts set forth in this complaint are true and correct to the best of my or lnforrnation and
belief. This verification is made subject to the penalties of Sectton 4904 of the Crimes Code (18 PA.C.S.4904)
relating to unsworn falsificationto authorlties. .
If!.! I , . DR
(Date) .: (Sign2f Affian!}
AND NOW, on this date, 4/1 ,2003 I certify that the c0mplalflt has beenproperly completed and verified. An
affidavit of probable causemust be completed Inorder for a
35-2-02
(MagistenaIOlstrn::l)
TLV
IN THE COURT OF COMM:ON lP'LEAS
OF MERCERCOUNTY, PENNSYLVANIA
The District Attorney of Mercer County, Pennsylvania, by this information presents that
on (or about) AjpJrill, i@03, at [ible 1000Block o ; ~ Fruit Avenue, illil the City o ~ Farrell,' Mercer
County, Pennsylvania, the defendant did commit the following violationts) oftbe Controlled
Substance, Drug, Device and Cosmetic Act (the; Act):
( X) 35 Plil. C.s.A. 780-n3 (a) (Hi) Possession of III Controlled! Substance
Defendant knowingly or intentionally possessed a controlled or counterfeit ,
substance, to wit: CJrlIl<ck Cocame II Schedule ID!, Drug, the said defendant not
being registered under this act or of that class of persons whose profession,
business, employment, occupation or duties are permitted aod allowed to have in
their possession and under their control such controlledsubstance, and the
substance was not obtained pursuant to a valid prescripti on; .
( ) 35 Pa. CS.A. 780-113 (a) (31) Small Amouiintl>fMl1Jtrijllllllilllll
Defendant possessed less than 30 grams of Marijuana, a Schedule I, Drug, the
defendant not being registered under this act or of that cl ass of persons whose
profession, business, employment or occupation or duties are permitted and
allowed. to have in their possession such controlled substances; . i
L _ ~ _l 35lP'a. C.s.A; rso-rrs (a) (32) Drug P"rallher"aiiil
Defendant used or possessed with intent to use drug paraphernalia fortbe purpose
ofplanting, propagating, cultivating, growing, harvesting, manufacturing,
compounding, converting, producing, processing, preparing, testing analyzing,
packing, repacking, storing, containing, concealing, injecting, ingesting, inhaling
or otherwise introducing into the human body a controlled substance in violation
ofthis act in that defendant did possess _;
All of which is against the Act of Assembly and the peace and dignity of the Commonwealth of
Pennsylvania. . Q. '.
Ce C':J:J,.i\ ) f yw:6' ((liS f )
Di . ict Attorney . '
Attorney for the Commonwealth
3
INTElB COURTOFCOMMON PLEASOF
MERCER COUNTY, PENNSYLVANlA
No. 697Criminal,2003
COMMONWEALTHOF PENNSYLVANlA
VS.
Cheryl Ann Cannon
(defendant)
--_._---_._--
INFORMATION
: Count _1__,: possessionor a Controlled
substance
: Count __, Possession of a Smail
Amount
. Count __z Possession of Drug
Paraphernalia
... ... - ' '.- "':'-" ; -:'
nun IN MERGER COUNTY
,1001 JUL A It} 11
[CATHLEEN t'i. KLOOS
CLEHK AND REGISTER
"'. --- _..._--. __._---_._-
FILED liII MERCER GUUNTY ,,;'--.0
. .;J-:a
'IDOtNQV 10 A II: ii/- .-:"
11. KL ODS
RK ANa REGISTER
'::;.
IN THE .COURT OF COMMON PLEAS OF MERCER COUNTY, PENNSYLVANIA
CRIMINAL
COMMONWEALTH OF PENNSYLVANIA
CHERYL ANN CANNON
vs.
CHARGES:
COUNSEL:
No. 697 Criminal 2003
Possession of a Controlled SUbstance,
35 Pa. C.S.A. '780-113(a)(16)
Dana Flick, Esquire
SlENlENCE
I
i
I
I
AND NOW, this 5th day of November, 2003, IT IS THE
SENTENCE OF THIS COURT on the charge of Possession of
C06aine, an ungraded misdemeanor, that the pay
the costs. THE COURT NOTES for the purpose of the
imposition of Act 198, the additional costs would create an
. undue hardship. The defendant shall undergo imprisonment
in the Mercer County Jail for a period of 20 days. She
shall receive credit for time served in the sum of five (5)
__ '. _, ... _ " O < . ~ ~ _ , __._
days being from September 18, 2003 through September 22,
2003.
8Y THE COURT,
. dl b
Thomas R. Dobson, Judge
J.
i
I
I
.... - .. _..
. __ . , ._. __ .. ._,N,"_." . . , . _., .. _ . _ ..... __N_..... . ' "._" .
C(fUIFU OF COMMON PLEAS Of MERCER COUNTY
DOCKET
Page1 of 7
Judge Assigned: Dobson, Thomas R,
OTN" H7728475
Initial Issuing Authority: Henry J Russo
Arresting Agency: Other
Case I ocai Number Type'(s)
crlmmat IDtt
Legacy Docket Number
D>rcket
CRiM!NlAlIDJOCIKET
Comft Case
Commonwealth of Pennsylvania
v.
Ann.Cannon Cheryl
CASE II\II"ORMA
Date Filed: 05/12/2003 Initiation pate: 05/12/2003
Lower Court Docket"No: CR-000014703
Final ISSUing Authority: HenryJ Russo
Arresting Officer: Affiant
Case Local Number(s)
CR 0000147 03
2003-697
STATUS iNFORMATiON
Case Status: Closed
Status Date
10107/2003
05112/2003
Processing Status
Migrated Final Disposition
Migrated Case
Arrest Date: 04/01/2003
Date Of Birth:
Alias Name
Cannon, Cheryl
participant Tvpe
Defendant
02/0111961
DEFENDANT INlIFOilUI1ATIION
City/State/Zip: Erie, PA 16504
CASE PARTICIPANTS
Name
Cannon, Cheryl Ann
Compiaint Dat!l.;. 04/01/2003
I
, !
AOPC 9082 Rev 0311212009 . Printed: 03/12/2009
Recent entries madein thecourt filing offices may notbeimmediately reflected onthese docketsheets. Neither the courts of the Unified judicial ,
System of the Commonwealth' of Pennsylvania northe Admlnletratlve Office 01 Penneylvanla Courts assume anyliability for inaccurate or delayed
data, errors oromissions onthese reports; Docket Sheet information should notbeused inplaceof a criminal history background check which can
only beprovided bythe Pennsylvania SIE:\te Police. Moreover anemployer whodoes notcomply with the prcvislcns of the Criminal History Record
lntormatlon Act maybesubjecUo cMlllabillty as set forth in18 Pa.C.$. Seetion9183.
-cOlUllRT OIF C MMON PllEAS OIF MlElRClER COUNTY
[]OCKE'1l'
D<ll>;i(a CP43CRl@69720113
CRiMINAL DOCKlET
ComRClIls<!>
Commonwealth of Pennsylvanla
V.
Ann OanncnOheryl
Iii.lA!L
Page2 of 7
Carmon, Cheryl Aim
Bail Action
Set
Bail TYpe
04/0112003 ROR .'
percentage Amount
$0.00
Bail Posting StatUs Posting Dale
Posted 0511212003
M 35 780-113 M! Int Poss Contr Subst By Per Not Reg 1
Orig Seq. l2.mQs: Statute Description Offense OTN
Date
04101/2003 H7728475
Disposition Date Final Disposition
Offense Disposition Section,
Sen!Ence Date Credit For Time Served
IncarcerationlDiversionary Period Start Date
Disposition
Case Event
SequencelDescrip!ion
Sentencing JUdge
SentencelDiversion Program Type
Sentence Cooditions
Linked Offense: Sentence
. Migrated Dlspcsitlon
Migrated Dispositional Event.
1 lint Poss Contr Subst By Per Not Reg
Dobson, Thomas R.
Confinement
Financial Assessments
Link Type
1010712003
Guilty Plea
10/0712003
Max of 20.00 Days
Max of 20.00 Days
Linked Docket Number
Final Disposition
35780-113A16
11/05/2003
1110512003
AQPC 9082 Rev03/1-212009 Printed: 03n2/.2009.
R'ecent entries made inthecourt filing offices maynotb'e immediately reflected onthesedocket Neither thecourts of the Unified JUdicial
System of the Commonwealth of Pennsylvania northeAdminlstralive Office ofPennsylvania Courts assume any liability forinaccurate or delayed
oats, errors oromlsslons onthesereports. Docket Sheet information should not be usedinplace ofa crlmlnelhietory background check which' can
only be provided bythe Pennsylvania StatePolice. Moreover an employer who does not comply wllh-the provisions of theCriminal History Record.
Information Act maybe subject toCivilliablllty as set forth in18Pa.C.S, Section 9183.
COURT OF COMMO!'l!l PlIEA;S OF MIERCIER cousrv
DOC!<E'iI'
INIllmlblew: CIfl>-43CR@@@@$97211}1\'J:l)
CRIMiNAL DOCKIET
Case .
Commonwealth of Pennsylvania
v.
Ann Cannon Cheryl
COMMONWEALTH iNfORMATiOINI
Page 3 of 7
Name: James Peter Epstein, Esq.
District Attorney
Supreme Court No: 021859
Phone Nurnbens):
(724) 6623800 (Phone)
(724) 662-0807 (Fax)
Address:
Mercer County District Attomey's Office
Courthouse Ste 209
Mercer PA 16137
Name: Defender Public
Standby - Court Appointed
Supreme Court No: .
&m. Status: Active
Phone Nurnberts)..
Address:
Representing: Cannon, Cheryl Ann
,
I
1
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I
I
AOPC9082 Rey 03112/2009, Printed: 03112/2009
Recen! entries made in the flling may not be immediately reflected ,on these docket sheets. Nellher the courts of the Un.lfiedjudicial
System of the Commonwealth of Pennsylvania nor the Administrative Office otPennsytvaaia Courts assume any liability for inaccurate or delayed
data, errors or cmtestcns oil these reports. Docket Sheet information should not be used in place of a crimina! history background check w.hich can
only be provided by the Pennsylvania State Police. Moreover an employer who does not comply With the provisions of the Criminal History Record
Information Act may be subject to civil liability as set fonn m18 Pa.C.S. Section 9183.
Sequence Number. CP Filed Date
Commonwealth of Pennsylvania
v.
Ann Cannon Cheryl

Document Date
Page4 of 7
1 04/01/2003 ,
COMPLAINT FILED
COMPLAINT FILED
... .. -,- .. _._. ----" -_..
1 05/12/2003
Original Papers Receivea from Lower Court
, Migrated, Filer
Unknown Filer
' _ .M _..__ __.. _.._" .. __ __ R_. . _"_ ._. _ _.. ,,_. ,_ __.....
1 05/12/2003
TRANSCRIPT TRANSFERRED FROM AOPC SYSTEM
TRANSCRIPT TRANSFERRED FROM AOPC SYSTEM
, Migrated, Fiier
1 07/07/2003
INFORMATION FILED BY DISTRICT ATTORNEY'S
INFORMATIQN FILED BY DISTRICT ATTORNEY'S OFFICE
Migrated, Filer
..__.:. ... ,-_.,;.._-- --- --. ---
2 07/Q712{)03
MOTION FOR PRE-TRIAL DISCOVERY FILED
MOTION FOR PRE-TRIAL DISCOVERY FILED BY DA
Migrated, Filer
1 09/05/2003
BENCH WARRANT DATED
BENCH WARRANT DATED 9/2/03-CALL LIST-DOBSON J-2 COPIES(1CC) TO DA; 1-DEF;1-MCJ
Migrated, Filer
1 09119/2003
RETURN ON WARRANT FILED-DEF LODGED IN .
RETURN ON WARRANT FILED-DEF LODGED IN MCJ BY NAN LUCAS ON 9-18-03- corv DA
Migrated, Flier
____ ... _._:". _.__"0,". ,_. __ _':'_. ., __ __
AOPC 9082 Rev 03f12{2009 . Ptinted: 0311212009.
Recent entries made in the court 111ll1g offices maynot be immediately reflected do these docket sheets. Neither the courts of the Unified Judicial
System of lhe Commonwealth of Pennsylvania nor the Administrative Office of Pennsylvania Courts assume any liability for lneccurate.ce delayed.
data, errors or omissions on these reports, Docket Sheet information should not be used in place ofa criminal history background check Which can
only be provided by the Pennsylvania State Ponce. Moreover ari employer who does not complywith the provisions of the Criminal His10ry Record
. Information Act may be subject to civij liability as set forth In 18 Pa,C.S. Section 9183.
I
I
, ..,... ,. .... _-" -,'." --'", --... _--;-
COURT Of COMMON Of MERCER COUNTY i

[1)0(; lNI!.IImfilJew: iCP-1il3CiFl@@i69'l'.2@1))3
CRiMINAl DOCKET
CO!.llwa Case.
Commonwealth of Pennsylvania
v.
Ann Cannon Cheryl
ENlilRiES
Page 5 of 7
Sequence Number CP Filed Date Document Date
2 0911912003 .
BENCH WARRANT "VACATE'* ORDER DATED
BENCH WARRANT "'VACATE"' ORDER DATED 9118103-BW pREV ENTERED IS VAC ,FURTH ORD'D EFFECT
NOON MON-9122103-BOND SHALL BE SET AT ROR-UNTiL THAT TiME NO BOND SHALL BEIN PLACE-FURTH
.ORD'D DEI'" GIVEN NOTICE SHE SHALL REPTUES-1017l03-CF{rRMS 1 OR 3 OF MC CTY CTHOUSE FOR CALL
LIST-THE TIME TO REP SHALL BE SET AT 8:30 AM-FURTH ORD'D SHOULD CASE NOT BE RESOLVED THAT
DATESHEISNOTIF TRIAL TERM COMMENCES 10114103-THIS ORDER SHALL SERVE AS NOTiCE-FURTH0RD'D
A COPY' OF THIS ORDER SHALL BE PROVIDEDTO MC CT
Migrated, Filer
1 0912512003
APPLICATiON FOR ASSIGNMENT OF LEGAL
APPLICATIONFOR ASSIGNMENT OF Lj:GAL COUNSEL - ORDER DATED 9124103- PD APPT'D
PJ-1 PD
Migrated, Filer
1 1010712003
PLEA ENTERED
PLEA ENTEREDTO POSSESSION OF .23 GRAM CRACK COCAIN
Migrated, Filer
1 1010712003
Migrated Dlsposltlon
Migrated Automatic Registry Entry (Dtsposltion) Text
Migrated, Filer
2 1010712003
Migrated Sentence
Migrated Sentence
Migrated, Filer
1 1111012003
TRANSPORT ORDgR DATED:
TRANSPORT ORDER DATED: 11-9-03 FiLED. SHERIFF SHALL TRANSPORT DFNDT TO GREENE COUNTY
PRiSON FOROVERCROWDING. WHERRY J. COPY DA;p.DAND 2 CC JAIL
Migrated, Filer
AOPQ Rev03112/2009 .. Prlnted: .
Recent entries made inthecourt filing offices maynotbe immediately reflected onthese docket sheets. Neither the courts of the Unified judicial
System of theCommonwealth of Pennsylvania northeAdmloistrative Office of Pennsylvania Courts assume any Iia.bijity inaccurate or delayed
data,errors or omissions onthese reports. Docket Sheet Information should notbe used inplaceofa criminal historybackqround checkwhich.can
only beprovided bythepennsylvania state Pollee. Moreover an employer whO does notcomplyWith the prcvistcna of t.he CriminalHistory Record
. Information Act may be suolect tocivil liability as set forth in18 Pa C.S. Section 9183.
)
-COURT Of COMMON PLEAS Of MERCIER COUNTY
IOOCI{l;;1 1
iQll)cki!lt
DOCKET
COllrt esse
Commonwealth of Pennsylvania
v.
Ann Cannon Cheryl
[ENTRiES
Page 6 of 7 '
Sequence Number CP Filed pate Document Date
1 11/10/2003
SENrENCE:: (DATED: ,
sEi'n:ENCE: (DATED: 11/5/03) PAY COSTS. CRT NOTESTHAT IMPOSITiON OF ACT 198 WOULD CREATE UNDUE
HARDSHIP. IMPRISONMENT MCJ FOR 20 DAYS. RECEIVE 5 DAYS CREDIT BEING 9/18103 THROUGH 9/22/03.
DOBSON) 2 DA;2 PD;1 JAIL H* ACT 198 COSTS REMOVED PER'ABOVE SENT ORDER'*,
, , . Migrated, Filer
1 11/17/2003
ACT 84 PACKET ISSUED
ACT 84 PACKET ISSUED
Migrated, Filer
1 11/17/2003
ABSTRACT(S) ISSUED
ABSTRACT(S) (1) ISSUED
Migrated, Filer
I
I
I
!
I
. !
"._. --- - _.. ---- ---- - _. ,-- _.- _. __..- ---, .__. -_..
2 1,1/17/2003
PA SENT GUIDELINES FILED
PA SENT GUIDELINES FILED
Migrated, Filer
_. ... M" ".__.. _. . _ . __ .__. .__ - --- -_. __ -_.
1 11/21/2003
STATEMENT OF COSTS ISSUED
STATEMENT OF COSTS ISSUED
Migrated, Filer
2 11/21/2003
ACKNOWLEDGMENT OF SUSP/REV/DISQUAL (FORM
ACKNOWLEDGMENT OF SUSP/REV/DISQUAL(FORM DL-16LC) MAILED TO DEFT. W/STATEMENT OF COSTS
Migrated, Filer
3 11/21/2003
FILE TAGGED FOR AOPC 3-SHEET ELECTRONiC
FILE TAGGED FOR AOrC 3-SHEET ELECTRONIC TRANSMiSSION.
Migrated, Filer
,._._. . _.,,_. __ --,- , 'M
- A.OPC$1.08.2 R!=\! 93J1.2{29,Qf3 Prlnted: 03/1212009 "
Recent entriesmadeIn the court ,flUng offtcesmay not be immediatelyreflectedon these sheets, Neither the courts of the Unified Judicial I
Systemof theCommonwealth of Pennsylvanianor the Administrativeoeceof PennsylvaniaCourts assume any liability for inaccurate or delayed
data, errors or omeetcne on these reports, Docket Sheet informationshould not be usedin place of a criminal history background check whlcl1 can I
only be provided bythe PennsylvaniaState Police, Moreoveran employer who does not complywith the prcvlstoas of the Orirninal History Record
InformationAd may be subject to clvilliabilily as set forth in 18Pa,e,s. Section 9183,
I
lDlocitret NIIIII1I1 ber:
CRIMINAL DOCKET
COllin Case
Commonwealth of Pennsylvania
v.
Ann Cannon Cheryl
Page7 of 7
Last Payment Date: Total of Last Payment: $0.00
cannon, Cl1ei'jl! Alln 6l;essment Payments Adjustments Non MonetarY To(al
Defendant payments
Costs/fees
County.Court Costs (Act 204 of 1976) $148.20 $0.00 -$148.20 $0.00 $0.00
State Court Cost (Act 204 of 1976) $9.05 $0.00 -$9.'05 $0.00 $0.00 .
Commonwealth Cost - H.B627 (Act 16;
$7.75 $0.00 47.75 $0.00 $0.00
of 1992)
Domestic Violence Compensation (Ac
$10.00 $0.00 -$10.00 $0.00 $0.00
44 of 1988)
Crime Victims Compensation (Act 96
$35.00 $0.00 -$35.00 $0.00 $0.00
of 1984)
Crimes Commission Cost (Act 96 of
$25.00 $0.00 -$25.00 $0.00 $0.00
1984)
'JCP $9.00 .$0.00 -$9.00 $0.00 $0.00
ATJ $1.00 $0.00 -$1.00 $O.OQ $0.00
Firearm Education and Training Fund
$5.00 $0.00 -$5.00 $0.00 $0.00
(158 of 1994)
Auto Track Fee (Mercer) $3.00 $0.00 -$3.00 $0.00 $0.00
Act 84 (Mercer) $5.00 $0.00 -$5.00 $0.00 $0.00
Automation Fee (Mercer) $5.00 $0.00 -$5.00 $0.00 $0.00
Costs/Fees Totals: $263.00 $0.00 -$263.00 $0.00 $0.00
Grand Totals:
$263.00 $0.00 -$263.00 $0.00 $0.00
., Indicates assessment is subrogated
AQPC9,082 Rev OSn2f2o.os .. ,- .. - . _Printed,: 0311212009
Recent entries made inthecourt flUng offices maynot be Immediately reflected onthese docket sheets, Neither the courts of the Unified Judiciaf
System of theCommonwealth ofPennsylvania nor' theAdministrative Office of Pennsylvania Courts assume any llabillty for Inaccurate or delayed
data. errors Of omissions onthese reports, Docket Sheet infcnnatton s!10uld notbeused inplace of a criminal hlstcry background check \(\lhlen can
only be prcvtded bythe Penneylvanla State, Pollee, Moreover anemployer who' doesnotcomply with theprovisions ofthe Criminal History Record
Information ActmaybeSUbject tocivillia6Hity asset forth in18 Pa,C,S, Section
....." ..._--_..... ---
** ** id<! ***'* '* *'* '* **'* **** **** ** **** **** -><1:** ********* ********* '1< ok*** ** **-**** * *'* *** *** '* *****
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF MERCER SS
X, Kathleen M. Kloos, Clerk of Common Pleas Ccart,
Crimma], in and for saidcountyand state, do hereby certify that
the foregoing is a full, true and correct copy of the following: .
L Complaint and A'ffidav:it of Probable Cause
2. Guilty Plea Colloquy
3. Sentence
4. Docket
.in the case of Commnnwealth v. Ann Cannon
==----
so full and entire as the same remains of record before the said Courtat No. 1034 D.. J. 200"
In Testin;ony Whereof, I have hereunto my hand arid 'affixed the.seal of said Court this
12th day of March. 2009, LI s.. 'rn ,
it:orU/OJ../;U i' I. fSW-4-/
I, Francis J. Forneth, President Judge of the Thirty-fifth Judicial District, composed of the County
of Mercer, do herebycertify that Kathleen ML Kloos by whomthe annexed record, certificate and attestation
was made and givenand.who, in her oWn. properhandwriting, thereunto subscribedher name and affixed the
seal ofthe said Court of Common Pleas of said County, was at the time of S0 doing andnow is Clel1'K of
Common Pleas Court in andfor saidCounty of in the Commonwealth of Pennsylvania, duly
COmmissioned and qualified, to all of whose acts as-such full faith andcredit are and ought to be given as well
in courts of judicature as elsewhere, and that the rej<9id, certi\ficate,andattestation are in due formof law,
andmade by the proper officer.' .: " . ,'\ ( '-..... . .,
,1...,-.._-- .. lP'J
. . I
Francis J. Fornelli '

COMMONWEALTH OF PENNSnVANIA
COUNTYOF MERCER SS
'1; Kathleen M. Kloos, Clerk of Pleas Court, Criminal, h). and for said County, do certify
that the Honorable Francis J, Fornem, by whom the foregoing attestation was made and who has hereunto
subscribed his name, was.at thetime of makingthereof and still is the President Judge of the Court of Common
Pleas, Criminal. in and''for saidCounty dulycommissioned and qualified, to all of whose acts as such full faith
andcredit are and ought to be givenas well in courts ofjudicature as elsewhere. . .
In Testimony Whereof,I have hereunto set mll hand and affixed the'seai of Clerk of C(J>UI'[S this
12th d f March, 2009 pi!
ay 0 , . . . 't4/ s:.> '1m\.,, . /. .
. ,J.,.),-, j d' .' \&<<......
iEXIiIUIIl\U1i Cler.klof Common Pleas COil! ,Oriminai
IE
I
I
I
.._-_.._-------.---_._--------------
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF: Mercer

POUCIE
CRiMiNAL COMPLAINl
COMMONWEAlTH OF iPlENNSybfANi A
\IS.
DIEFENIDAIIlT:
Cheryl Ann Cannon
671 New Castle Ave.
Sharon, Pa. 16146
7243463591
35-2-02
Ronald E. Antos
425 Idaho SL
.Farrell, Pa. )6121
ielephone'
. District Number:
District Judge Name:
Hen,
Aqdrl;!s.:
-
-
Docket No:
CR-305-06
Date Flied: 6/17/06
OTN:
K 431415-5
.
berenoaru's .
Defenc;lant's Defendant's Defendant's Defendant's SID
o Wi
Sex O,O.B, Social Security Number (State Identification Number)
White Black If'

Female
02-01-1961
d 0
0
Asian Hispanic
Male
0
Native American
r:::
Unknown
Defendant's AK.A (alsO known as) Defendant's Vehicle lnformaUoll erendent's Driver's License Number
I
Plale Number. "l$lale Slicker (MMNY) Slale
. ComplalfltllncItietlt Number
Tracking Number
COfl,1plalntllnCiderrt Number If ether Partldpanls
Code
06-6149 18E
[
Office the Attorney for the Commonwealth I:) Approved
0
Disapproved because:
(The attorney for theCommonwealth mayrequlre that thecomplaint, arrest warrant affidavit, 'orboth be approved by the attorney forthe
Oommcnweellb prior tofilling. Pa.RCrim.P,507.) .
I. Marc Anthonv J Adamo
Amuno
of the Southwest Mercer Regional P D,
'
do hereby state: (check appropriate pox)
1

C
o
I accuse the above named defendant who "lives at the address set forth above
I accuse the defendant whose name is unknown to me but who Is described as
I accuse the defendant whose name and popular designation or nickname is unknown to me and whom I have
therefore designated as John Doe
with violating the penal laws of the Commonwealth of Pennsylvania at
1143 Fruit Ave. In the City of Farrell
tPl3<11l.Ptillll::11 Subl'ivislenl
in Mercer County on or about 06-16-06, @1953Hrs.
Participants were: (if there were participants, place their names here, repeating Ihe name of the above defendant)
Cheryl A Cannon
AOPC412 SPA (7/312003)
....__._-
Name:
Docket Number:
Cheryl Ann Cannon
CR-305-06
lPiOlLJCIE
CR!i\fWNAl CiOM\?IlA!i'<!IT
/
' .z'. The acts committed by the accused were: '
CS78 a)(16)The Controlled Substance, Drug, Device and C . Act: Prohibited Acts;
IN THAT, on or a, 'd date, THE DEFENDANT ' ,elng registered under-theControlled Substance, Drug,
'\ Device and Cosmetic Act, no clitioner ered or licensedby the appropriate State Board, did knowingly or
intentionally possess a controlled or stance, which was not obtained directly from, or pursuant to, a
vaiid prescription order or or a practitioner, in vlo a ection 780-t 13(a)(16) of the PA Controlled
Substance, Drug, Devi and Cosmetic Act. Defendant did possess . uspected crack cocaine,
. '
CS7BO-113(a)(32)The Controlled Substance, Drug, Device and Cosmetic Act: Prohibited Acts;
IN THAT, on or about said date, iHE DEFENDANT did use, or possess with Intent to use, drug paraphernalia,
namely, (plastic baggie), for the purpose of planting, propagating, cultivating, growing, harvesting, manufacturing,
compounding, converting, producing, processing, preparing, testing, analyzing,.packing, repacking, storing,
containing, concealing, Injecting, ingesting, inhaling,or otherwise introducing Intothe human body a controlled
substance, that is \0say the DEFENDANT ,did possess the.abovs-descrjbed paraphernalia for the purposes of
(packing, repacking, storing, containing arid concealing crack cocaine), in violation of Section 780-113(a)(32) of the
PA Controlled SUbstance, Drug, Device and Cosmetic Act
all of which were against the peace and dignity of the Commonwealthof Pennsylvania and contrary to the Act of
Assembly, or in violation of
1. 780-113(a)(16) of the Title 35, C.S.D.D,CoA. 1 M
56cllon{swsectlonl
2. 780-113(a)(32) of the Title 35, C.S.D.D,CA' 1 M
(FASlalull'C\
3 . I ask that a warrant of arrest or a summons be issued and that Ihe defendant be required to answer the charges I
have made, (101 order for a warrant of arrest to issue, the attached affidavit of probable cause must be
completed and sworn to the Issuing authorlty.)
4. I verify that the facts set forth in the complaint are true and correct to the best of my knowledqe or Information and
belief, This verification is made subjecl to the penalties of Section 4904 of the Crimes Code (18 Pa.C.S,4904) relating
to.unsworn falsification ' '. ,
/s-'-I
AND NOW, on this date, 'June 17 ,2006 i certIfy thai the corn lalnt has been properly completed
and verified. An affidavit of probable cause must be completed In order for a arra t to,issu/:1-{Qe.
'. 2:
35-2-02 . "V1 ,SEAL
O;stri<;\j
AOPC412SPB (7/312003)
I
Defendant's Name:
Docket Number:
Che I Ann Cannon
CR-305-06
IPOUCIE
CRiMiNAL
COMlPlAUNl
AFFIDAVIT of PROBABLE CAUSE
EROBABlE CAUSE BELIEF is BASED UPON THE FOLLOWiNG FACTS AND CIRCUMSTANCES;
the above date and time I Officer M. Adamo was on patrol in the 100 Block alley between Fruit Ave. and
Iamilton Ave.. I observed the defendant Cheryl A. Cannon exit the back of 1143 Fruit Ave.. Cannon then got on
ier bike and started to ride towards me. as she got. close 1said hello and Cannon stopped to talk to me. As I talked
. 'lith her I observed a plastic baggie sicking out of the end of her left hand. Cannon had a closed fist around the
iaggie. I asked Cannon what was in the baggie and she started to ride off. RIOknowing 1143 Fruit Ave. to be a
lrug house and the plastic baggie in her closed fist along with her suspicious behavior I advised her to hold up.
;annon kept on pedaling away. This time I advised her to stop. Cannonjust pedaled harder. I exited my patrol
/ehicle and started to run-after Cannon. Cannonlookedback and kept pedaling.' I was able to catch up with her at
he intersection of George S1. At this time RIOasked Cannon what was in her hand and she opened her hand up. In
ier hand was a plastic baggie of suspected crack cocaine. At this time I placed Cannon under arrest for possesion of
::::rack Cocaine. CalU10n and her bicycle were transported to the Regional Lockup where she was booked and placed
n a cell with out further incident.
Fhesuspected Crack Cocaine was tested @ 2300 Hrs. and tested positive at 2305 Hrs.
[he Cocaine was then put into the evidence book and secured in locker #16
2006
June .'
.
17th
6/17{06
Swom to me
I, Marc Anthoiw J Adamo, BEING DULY SWORN ACCORDING TO LAW, DEPOSE AND SAY iHAT THE FACTS
$ETfORTH IN THE FOREGOING AFF10IWIT ARE TRUE AND CORRECT TO iHE BEST OF MY KNOWLEDGE,
AND BELlEF.. .
C- ./
JUdge
My commission expires first Monday 9f January. 2012 .. "
SEAL
AOPC-412SPC(713/2003)
j
i
I
I
COMMONWIEAlTHOf .
, I"ENNSVlVANiA

. .
. . ,
bocKet No.:
DateBled: 6$/'17/06.'
E,
YS.
OEFENQANT: . NAME3ndADOReSS
,, ICl'llER'lfL ..ll>D'
',@'l'lI. An
'Il11lUOlilT, Wi!. '16)1.4\'6
L
MOJ Name:. Hen,
llMlJlilTNolli !!l; .!lJin'1(lif!)
Add"". .t25' il:!:lAlllIO llT
p}).
lltOlilTALlll 'll!i 0 Ali<I'll'OS
42:5 IDAlllIO 'Il' ,
F.MUU!I:l1L,l!?A ;i.n2JL
Charnels);
Permissible rang,e of sentenceand/or fines: ...,..._...:.... _'_
!
, ,
e . y ..
acknowledge, that there is a facWal basis for thls plea, .
,understand the nature of tne charges to which lam
I,CBlISlil,YL A
pleadin'ggLiilty"
"I CORTh
. ,
' amaware of the perrnlsslote range otsentences andlor
I,ClllllE:lll.YL ,oil.
lines ottenses with which I amcharoed.
, . , . ' .
, in thi.d cases, please cornplete;:
that I have a right to trial by jury,
I voluntarily, and intelligently make this of GUilTY.
I. PLEAD GUilTY.
(Da.e)
J
, ' ".: v ,v,..;;, v ., V(" .. .. ,.".,-,- -
COUNTY OF; 'Ulll.Cl!I:lI/. ,.. i';, " "
CLEU Oli' C01Dllll.TS
112 ll!l,ll::ltc:ii:lI/." com1f C01Dllll.'l:'lB!OtHt!ll!li '
:l<IElltCElll., PA' lLn:n' ,
.J
(-'
' ,
COMMONWEALTH OF '
PENNSYLVANIA
Docket No.:
Date Flied: ":1$/1'1i fPfJ" .
)li;
V$,.
DEFl::NDAN1: NAME andAPOt;iESS
CDlIl.TL
1/i71J. flm!Ir' WTltoE, An
lllllfUOOIl, ' IFA' :iI/iUI/i
'" .
L
MOJrseme: Hen,
ll!.iOli1llJ:.El E A1l!'E{i)W
AO'''''' 4125 lJ:lJ:lMO $'!r
WUJII.I!I:ir.x., lI',ll.
,T'leph'" ('7,24)' 31Jl1/i-35!li1l.
I
.AfF1AN'!
il103llS;:i.lL.lI.
INCIDENT Np,
(Wame oJ. Defendanl), '

' day 61 __'-- _2_@_1Il_1$,
COMPLAINTNQJCrTA110N NO
of the' rig'ht to certify fhat the plea was made and Inteiligenlly,
'
lt01ll'ALXl lI:'.M'.I1'OO
Auth9rity)
Juns.
( ssujnp.Au
.: '
, .
Within case,'6ertify'1hat this
. .
i above defendan1;s plea of guiily after making inqUiry of ihe defendant.',I'M.,ve advised the defendant: '
intelligently,
residing at __ --,--,_--,_O"- -,-
___'--_--: ...,...__---' plead guiny to:'
, Charoets):
Ill, 315, ''111@-1l31 1l.A1\2UlJiE!lFO\'ilIH)W Dlll.UG
, DOCKET NOS.,OF,OTliER,PARTICIPAN'fS
COUR;- GASES'
" .
A'defendant who enters a plea of'guilty under Pa, 'R. Crim. P, 550 may, ten (10) days alter
sentence, change the plea,10 not gUilty by so notifying the issuing authorny in writing, In such event,
theissutnq authority shall vacate the piea and judgment oj sentence, and .the case Shall proceed in
accordance wilh Pa. R. Cnm. P, 547, as though tMe defendant had been held lor court.
Judgment on aptea 01 gUilty entered under Pa: R. cnm. P. 5;;0 must be certified to the clerk ot .' ".. \
court of the judicial 'district within ten (10) days after acceptance of the guiity plea and Ihe imposition of sentence. .
AOPC<QBA-Ol Jl)l\.TIll; lI?1ll.:i:l!l'l'Elth 6/211/6) I; 9J, 21, 32,J!IIJli:
.: .. ALl'ltI! U][1' --.....----.

C0l'l'" . '. 4Nl
, ,
COUNTY OFMERCER
crrv OFHERMITAGE
CITY OF FARRELL
BOROUGH OFWEST MIDDLESEX
BOROUGH OFWHEATlAND
SHENANGOTOWNSH1P
RONALD E, ANTOS
MAGESTEIUAL DISTRICT JUDGE
Magisterial District 35-2
M02
425 IDAHO STREET
FARRELL, PA 16121
OFFlCE:
TEL(724) 3463591
FAX(724) )464198
COMMONWEALTH OFPENNSYLVANIA
CR-305-06
vs.
OTN: K431415-5
CHERYL ANN CANNON
SENTENCE ORDER
th .
And now this 28 dayof June, 2006, the defendant, Cheryl Ann Cannon, has
pleaded guilty to the charge of Possession of DrugParaphernalia, ungraded
misdemeanor, and is sentencedby this court as follows:
'The-defendant shall pay a fine of$100,00 and court costs of$145.00 payable at a
minimum of $25.00 per month beginning August 15, 2006, The defendant is also
sentenced to one year state-supervisedprobation to be served consecutive'to' any existing
probation, ' .
I

Ronald E. Antos
Magisterial District Judge
I
4
co nr Of. COMMOINI Of M f{CER COIUINITY
[lOCKET
II<!QJJO'II1IIbif: CI"43CR!tl@iI:I11tl412i1li@1$

M3 Disposed oyloweif COQJJift
Commonwealth of Pennsylvania
v,
Cheryl Ann Cannon
CASE iNFORMATiON
Page 1 or 6
Cross Court Docket Nos: CR-0000305-06
Judge Assigned: Fornelll, Francis J,
OTN: K4314155
Initial Issuing Authority: Ronald E Antos
Arresting Agency: SW Mercer Regional Police Dept
Number Type(s)
Date Fil!j!Q: 0711212006 Initiation Date: 06117/2006
Lower Court Docket No:, CR-0000305-06
Final Issuing Authority: Ronald E Antos
Arresting Officer: Adamo, Marc .
Case Local Number(s)
Cas'; Status:' Closed
,Status Date
11117/2008
0711212006
Processing Status
Completed
Awaiting Payment
Arrest Date: 06/16/2006
CALEN[lAR EVENTS
Room Judge Name , Case Calendar Event Schedule Start
Ilme Start Date Time.
Delinquency Hearing 0712512'007 1:30 pm Assembiy Room Ruth Ann Bice
Schedule
Status
Cancelled
Date Of Birth'
Alias Name
Cannon, Cheryl
Participant Type
Defendant
02/01/1961
DEfIEN[lANT iNfORMATiON,
CitylStatelZip: Erie, PA 16504
CASIE PARTICIPANTS
Jiiilll!l
Cannon, Cheryl Ann
AOPC 9082 Rev 03/12{2009 . Piil1ted: .
Recent entries madeinthe court flling offices maynotbe immediately reflected onthese docket sheets. Neither thecourts of the Unified Judicial
System of theCommonwealth of Pennsylvania northe Administratlve Office of Pennsylvania Courts assume any liabl11ty for inaccurate or delayed
data,errors or omissions on these reports. Docket Sheetinformation should notbeused in-place of a criminal history background.check. Which can
only be provided by the Pennsytvanle SlatePolice. lVloreover anemployer who.doesnot comply with theprovisions oftheCriminal History Record'
Inrormaticn Actmaybe subject tocivilliabillty as set forth In'18 Pa.C:S. Section 9183.
-".. __
COURT Of COMMON PLEAS OF MERCER COIlJINITY
DOCKET
[(i)ck<!lt il!lImfi:l<er: CP-43CR@@@101141:!t@@!6
bOCKET
M3 [lusj)oseliJ Ill/lower COl>lrt
Commonwealth of Pennsylvania
v.
Cheryl Ann Cannon
BAil iNfORMATiON
Page2 of 6
Carmon, Chegyi AnI!
Bail Action Date Ball Tvpe Parcentage Amount
Bail Posting Status Posting Date
Set 06117/2006 Unsecured $5,000.00
Offense
Date
06116/2006 K4314155
Statute Description
35 780-113 A1. Int Poss Contr Subst By Per Not Reg
Posted 0611712006
I
,
2 2 M 35 780-113 UselPoss Of Drug Paraph 06/16/2006 K431A155
Disposition Date Final Disposition
Offense Disposition @gtion
Sentence Date Credit For Time Served
Incarceration/Diversionary Period Start Date
Disposition
. Case Event
Sequence/Description
Sentenciog judge
Sentence/piversion Program Type
Sentence Conditions.
Linked Offense =Sentence
Lower Court Proceeding (gsU)eric)
Lower Court Disposition
1 / int Pass Contr SubstBy Per Not Reg
Antos, Ronald E
2/ use/Poss of Drug Paraph
Antos,' Ronald E .
Link Tvpe
06128/2006
Withdrewn
07/12/2006
GUilty Plea (Lower Court)
07/12/2006
Linked Docket Number
Not Final
35780-113A16
35780-113A32
AOPC 9082 . Rev03/12/.2009 , . . . . . .. . . . .Printed: Q3I12120D.9.
Recent entries madeinthecourt filing offices maynotbe immediately reflected onthese docket sheets, Neitherthe courts of the Unified Judicial'
, System oftheCommonwealth of Pennsylvania nor theAdministrative Office of Pennsylvania courts assume any llablfity forInaccurate or delayed.
data, errors or omissions onthese reports, Docket Sheetinformalion should not be usedinplaceof a criminal history backgroul"Iq check whichcan
only be provided bythePennsytvenia State Pollee. Moreover an employer whodoesnotcomply with theprovisions of theCriminal History Record
. Information Act maybe subject to clvilliablllty as set forthin 18 Pa.C,S. Section
COURT Of COMMON PI.IEAS Of MIERCIER COUNTY
DOCKET
Docket h\>!umflller: CP43-CIR-I()l@01Jil54-2001!t
CRiMiNAl. DOCKIET
Commonwealth 01 Pennsylvania
'v.
Cheryl Ann Cannon
COMMONWEAI..TH !/IlI"ORMA ATiORiliEY
Name: James Peter Epstein, Esq.
District Attorney
Supreme Court No: 02185Q
Phone Number(sl:
(724) 662-3800 (Phone)
(724) 662-0807 (Fax)
Address:
Mercer County District Attorney's Office
Courthouse ste 209
MercerPA 16137
Page3 016
AQPC 9082 03112120",00 Prlnted: 03112/.2009
Recententriesmadeln the court fUing offices may not be immediatelyreflectedon thesedocket sheets. Neither the courts of the Unified Judicial
Systemof the ccrrmcoweana of Pennsylvania nor the AdministrativeOtflce of Pennsylvania Courts assume any liability for inaccurate or delayed
data, errorsor omissions on these reports. Docket aheetlnrormeucn should not be usedin placeof a crh:ninal history background check Which can
onlybe provided bythe PennsyfvanieSlate Police. Moreover an employerwho does not ccmply'whh the provisions of the Criminal History Record
tntormatlon Act may be SUbject 10 CIVl! liabilily as set fortJ1lh 18 P3,C.S, Section
' ... ,.. -.......;... '.
COURT IF COMMONlPlEAS Of MERCER COUNTY

lDoi(et Number:
ClRiMiNAllDOCKET
M3 lOisllC!set! by Lower COllrt
Sequence Number CP Filed Date
Commonwealth of Pennsylvania
v.
Cheryl Ann Cannon
Ei\iTlRiIES
Document Date
Page 4 01 6
1 06/1712006
Bail Set - Cannon, Cheryl Ann'
Antos, Ronald E
1 06/Z81Z006 061Z7/2006 .
Appointment of Public Defender
ORDER DATED 6-27-06 FILED-PO APPT'D-FORNELLI PJ-COPY PD VIA BOX (KPILM)
Fornelll, Francis J.
... ..._. ,-_ _ _.- -._.. -"-' _ "-'-' . - - .,.., ., .
2 061Z81Z006 061Z8/Z006
Order of
DEF SHALL PAY FINE OF $100 AND CRT COSTS OF $'145WITH PAYMENT OF $Z5 PER
MONTH BEG 8-15-06-DEF IS ALSO SENTENCED TO ONE YR STATESUPERVISED
PROBATION TO BE SERVED CONSECUTIVE TO ANY EXISTiNG PROBATION-OJ ANTOS
Antos, Ronald E
1 07l1ZIZ006
M3 Disposed by Lower Court Fiied
Court of Common Pleas - Mercer
County
1 081Z51Z006
STATEMENT OF COSTS ISSUED TO DEF
Kloos, Kathleen M.
1 08130lZ006
Payment Plan Introduction Letter
Court of Common Pleas - Mercer
County
1 1211512006
Delinquency Notice Filed - 91 Deys Overdue
Court of Common Pleas - Mercer
County
1 . 0311ZIZ007
Delinquency Notice Filed 117 Days Overdue
Court of Common Pleas - Mercer
County
AOPC9082 , Ra'll Q3!12f2Q09 ' . Printed: 03(12(2009-
Recententries made inthecourt filing offices maynotbe immediately reflected on thesedocketsheets. Neither the courts of theUnified Judicial
System of the Commonwealth of Pennsylvania northeAdministrative Officeof pennsylvania Courts assumeany; liability forinaccurate ordelayed
data, errors or cmleslons onthesereports, Docket Sheet information should not be used lnplaceof a cfimlnal historybacRground checkWhich can '
only be provided bythe Pennsylvania State Police. Moreoveran employer whodoes comply with theprovisions of the Criminal History Record
Information Act maybe subject 10ci'Villiability as setforth in18 Pa.C.S. Section 9183.
I
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COURT OiFCOMMOINI Of MERCER COUINITY

@$li.<$:2@@6
CRiMilNlAIL DOCKET
M3 1)!IlP0!l<!!(iJ b>1f low@r Court
Sequence Number CP Filed Date
Commonwealth of Pennsylvania
v.
Cheryl Ann Cannon

Document Date
Page5of6
1 06/18/2007
Order: Prehrg non-cornp sched for 7/25/07 at 1:30 PM
1 Copy DA; 1-Def; t-cost Coil
. ...- ---"- --- .""....." .._.- -- -. --- ._- -- - - ---.
1 06/19/2007
Delinquency Notice Filed - 216 Days Overdue
-ForneUi, Francis J.
Court of Common Pleas - Mercer
County
9082 Rev Printed: 03112/2009
Recent'entriesmade in the court filingoffices ma.Y not be immediately reflected. 011 these docket"sheets..'-Neltl1er the courts' of the Unifl'ed Judfcial .
Systemof the Commonwealth of Pennsylvania nor the"Administratlve Office of Pennsylvania Courtsassume any liability for inaccurateor delayed
data, errors or omissions on these reports. Docket Sheet information should not be used in place of a criminal history beckqrcund check which can
only be provided by the Pennsylvania Slate Pollee. Moreover an employer who oces.not comply with the provisions of the Criminal History Record
. Information Act may-be subiect to civil liability as Slj!ltortnm 18 Pa.C.S. Section 9183.
COUJRT Of COMMON IfillEASOf MERCIERCOUJINITY
oocxer
CI"43-CIRIJl1JJ108421S
CRiMiNAL DOCKET
M3 [j)jsposeli by lower COQ.!ft
Commonw.ealth of Pennsylvania
Page6 of6
v.
Cheryl Ann Cannon
CASEFi!>lANC!AiI.. iNfOlRlI\IiAnON
l':ast Payment Date: 07/25/2007 Total of Last Payment: -$170.00
cennon, Cheryl Arm Assessment Payments Adjustments Non Monetary Total
Defendant Payments
Cosls/Fees
JCP $8.00 -$8.00 $0.00 $0.00 $0.00
ATJ $2.00 -$2.00 $0.00 '$0.00 $0.00
StateCourt Cost (Act 204 of 1976) $9.70 -$9.70 $0.00 $0.00 $0.00
County Court Costs (Act 204 of 1976) $27.00 -$27.00 $0.00 $0.00 $0.00
Commonwealth Cost - HB627 (Act 16',
$8:30 -$8.30 $0.00 $0.00 $0.00
of 1992)
. Crime Victims Compensation (Act 96
$35.00 -$35.00 $0.00 $0.00 $0.00
of 1984)
Victim Witness Services (Act 111 of
$25.00 -$25.00 $0.00 $0.00 $0.00
I
1998)
I
Domestic Violence Compensation (Ac
$10.00 -$10.00 $0.00 $0.00 $0.00
44 of 1988)
,
. I
Firearm Education and Training Fund
$5.00 -$5.00 $0.00 $0.00 $0.00
I
(158 of 1994) I
Act 84 (Mercer) $5.00 -$5.00 $0.00 $0.00 $0.00
I
Automation Fee (Mercer) $5.00 -$5.00 $0.00 $0.00 $0.00
Postage (Mercer) $5.00 -$5.00 $0.00 $0.00 $0.00
Costs/Fees Totals: $145.00 -$145.00 $0.00 $0.00 $0.00
Fin"s
Crimes Code, etc. $100.00 -$100.00 $0.00 $0.00 $0.00
Fines Totals:
. $100.00 -$100.00 $0.00 $0.00 $0.00
Grand Totals:
$245.00 . -$245.00
$0.00 $0.00. $0.00
... Indicates assessment is subrogated
Aore 9082 Rev 03f12fZOOS Prinled: 03112/2009
.. . . . " .
Recent entries madeinthecourt filing offices may not beimmediately reflected on these docket sheets, Neitherthecourts of the Unified aueroer
System oftheCommonwealth of Pennsylvania northeAdministrative Office of Pennsylvania Courts assume any liabmty forinaccurate or delayed
data. errors or omissions ontnese reports. Docket Sheet inf<?"rmatlon should notbeused in place' of a criminal historY background checxwblch can
only beprovided bythe Pennsylvania StatePolice. Moreover an employer wno does notcomply with the provisions ofthe Criminal History Record
Information Act may besubject tocivilliabilily set forth in18 Pa.C S. Section 9183
.'
COpy
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF STATE
BEFORE THE STATE BOAJID OF NURSING
Commonwealth of Pennsylvania,
Bureau of Professional and
Occupational Affairs
vs.
Docket No. cdl3-5i-l I)
File No, 09-51-10707
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CONSENT AGREEMENT AND ORDER
Cheryl Ann Cannon, RN,
Respondent
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The, Commonwealth and Respondent stipulate as follows in settlement ,of the.aboiVe;
captioned
I. This matter is before the State Board ofNursing ("Board") pursuant to the Professional
Nursing Law (Act), Act of May 22,1951, P.L. 317, as amended, 63 P.S. 211-225,5.
2. At all relevant and material times, Cheryl Ann Cannon, RN ("Respondent") held a
license to practice professional nursing in the Commonwealth of Pennsylvania, License No.
RN289734L.
3. The Respondent admits that-the following facts are true: ,
a. Respondent's last address on file Withthe Board is 1130 StambaughAve, .
Sharon, Pa, 16146.
b. On November 12, 2009, the Commonwealth filed a Petition for
Automatic Suspension, atDocket No. 205i -51-09/FileNo. 09-51-01835 alleging that
on or about August 22, 2000, Respondent pled/was found. guilty/pled nolo
contendere, etc., In the Court of Common pieas ofMercer County at Docket No. 327
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CERTIFIED !'ROM'i1-\E. RECORD ",\ I '1 .
A.D.

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Criminal 2000, to possessionof drugparaphernalia, a misdemeanor, in violation of
35Pa. C.SA 780-1l3(a)(32) oftheAct of April 14, 1972(p.L. 233,No. 64) known
as The Controlled Substance, Drug, Device and CosmeticAct, (DrugAct), 35 P.S.
780-101, et seq.; also, on or about April 9. 2001, Respondent ,pled/was found
guilty/pled nolocontendere, etc., intheCourtof CommonPleasof MercerCountyat
Docket No. 1365 Criminal 2000, to possession of drug paraphernalia, . a
, misdemeanor, in violationof35 Pa. C.S.A. 7S0-113(a)(32)' of the Act of April 14,
1972 (P.L. 233, No. 64) known as The Controlled Substance, Drug, Device and
Cosmetic Act, (DrugAct), 35 P.S. 780-101, et seq.; also, on or about March 17,
2003, Respondent pled guilty, in the Court of 'Common Pleas of Mercer County,
Pennsylvaniaat docketnumber 780Crlmina12002, to criminal conspiracyto posses
a controlled substance inviolation of ISPa. C.s.A.'903(a)(l) and/or (2) andSection
13(a)(16), 35P.S. 780:113(a)(16), of the Act of April 14, 19?2(p.L. 233, No. 64)
known asTheControlled Substance, Drug,DeviceandCosmetic Act (DrugAct),35
P:S. 780-101, et seq.; also,onor aboutOctober7,2003, Respondent pled guilty, in
(
the Court of Common Pleasof Mercer County, Pennsylvania at docketnumber 697
Criminal 2003; to possession of a controlled' substance in violation of Section
13(a)(16), 35 P.S. 7S0-1l3(a)(16), of the Act ofApril 14, 1972(P.L. 233, No. 64)
known asTheControlled Substance, Drug,DeviceandCosmetic Act (DrugAct),35
,P.S. 7S0-l 01, et seq., and also,onor aboutJune2S'h, 2006,Respondent pledguilty,
in Magisterial District 35-2-02 in Mercer County, Pennsylvania, at docket number ,
, to possessionof drugparaphernalia, a misdemeanor, in violation of 35
Pa, C.S.A. 7S0-113(a)(32) of the Act of April 14, 1972(P.L.233, No. 64) known
C:umonG9SllHB3SCA&O121{i1}9mjb a.c 03J804.
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as The Controlled Substance, Drug, Device and Cosmetic Act, (Drug Act), 35 P.S:
7S0-101, et seq..
c. The Petition also alleged that, on or about March I, 2001, Respondent
was sentenced at docket number'Sz? Criminal 2000 forthe aforementioned charge of
. possession of drug paraphernalia, to pay the costs, to undergo imprisonment in the
Mercer County jail for a period ofnot less than twenty (20) clays nor more than one
(1) year, to be subject to random drug testing at a minimum of twice per month and .
to successfully complete White Deer Run's short term residential program; also, on -
or about May 2
nd
, -2001, at Docket No. 1365 Criminal 2000, Respondent was
sentenced on the charge of possession of drug paraphernalia to pay the costs and
undergo imprisonment inthe Mercer County Jail for a period of not less than sixty
(60) days nor more than one (1) year and shall be randomly drug tested at a-minimum
of twice a month; also on or about May 2, 2003, at docket 780 Criminal 2002,-
Respondent was sentenced on the charge of criminal conspiracy to posses a
controlled substance to pay the costs and undergo imprisonment in the -Mercer
CountyJail for a period of not less than five (5) days nor more than one (1) year and
was referred to the Mercer County Day Reporting Treatment Programfor the purpose
of drugtreatment and drug testing; also, on or about November 5, 2003, in the above-
referenced criminal proceedings, at docket 697 Criminal 2003,Respondent was
sentenced on the charge of criminal conspiracy to posses a controlled substance to
paythe costs andundergo imprisonment in the Mercer County Jail for a period ofnot
less than twenty (20) days; also on or about June 28
th
, 2006, at docket CR-305-06
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CotM01l09S10183SCA&O121669mjb 3.lt031804
was sentenced on the charge of possession of drug paraphernalia to pay a fine of
$100.00 andcourt costsof $145.00 and.to one (1) yearstatesupervised probation.
d. OnNovember 20, 2009,the Boardissueda Second Amended Notice and
. Order of Automatic Suspension suspending Respondent's license and providing
Respondent withanopportunityto file anAnswer to thePetitiouwithintwentydays.
e. On or about December 9, 2009; Respondent filed a response to the
Commonwealth's PetitionforAutomatic Suspension, seeking astayoftheAutomatic
.Suspension, andrequesting a hearing.
f. Respondent admits that she was addicted to cocaine for approximately
eight (8)yearsandshelast usedjust short of twoandone half (2Y:z) yearsago.
g. Respondent completed the in-patient chemical dependency program at
WhiteDeer Run in 2007. A true and correct copy of Respondent's Certificate of
Completion is attached as Exhibit A.
h. Respondent entered the halfwayhouseat CoveForgeRenewal Center at
the endof August 2007andremained until January 2008. At i u ~ and correctcopyof
Respondent's Certificate fromCoverForge Renewal Center isattached asExhibit B.
i. Respondent, after her release from CoveForge, has followed up with
Behavioral HealthSystem of SharonRegional Hospital.
j. Respondent has successfully completed all probation givenbythe Court
withregard to the abovelistedcriminal matters.
.k. Respondent's criminal convictions underthe DrugActwerebasedupon
. Respondent addictionto cocaine.
4
Cannon09S1 0163SCA&.OlZI6l)9mjl> 3,0 031804
1. 'Respondentand the Commonwealth herebyrequest that the Board allow
Respondentto enter into the Disciplinary MonitoringUnitfor a period ofno less than
five (5) years.
4. Based upon the factual allegations in paragraph 3 above, the Board is authorized to
suspend, revoke or otherwise restrict Respondent's license under: .
a. Section 23(c) of the Drug Act, 35 P.S. 780-123(c) in that Respondent
pled/was found guilty/pled nolo contendere, etc., of misdemeanors under The
Controlled Substance, Drug, Device and Cosmetic Act(Dmg Act), 35 P.S. 780-101.
b. Section 14(a)(2) of the Act, 63 P.S. 224(a)(2) in that Respondent Is
unable to practice professional nursing with reasonable skill and safety to patients by
reason of physiological or psychological dependenceuponalcohol, hallucinogenic or
narcotic drugs or other drugs which tend to impair judgment or coordination.
5. The parties consent to the issuance ofthe following Order in settlement of this matter:
.a. The Board is authorized to, suspend' or revoke, or otherwise restrict
Respondent's license, or impose a civil penaltyunder:
(1) Section 23(c) of the Drug' Act, 35 P.S. 780-123(c) in that
Respondent pled/was found guilty/pled nolo contendere, etc., of
misdemeanors under The Controlled Substance, Drug, Device and Cosmetic
Act (DmgAct),35 P.S. 780-101.
(2) Section 14(a)(2) of the Act, 63P.S. 224(a)(2)in that Respondent
is unable to practice professional nursing with reasonable skill and safety to
patients by reason of physiological' or psychological dependence upon
5
CanMnllS'S IIlIS3SCA&0121G09mjb 3.0 03HiM
alcohol.hallucinogenic or narcotic drugsor other drugswhichtend to' impair
judgmentor coordination., and
b. Respondent withdrawsher request for a hearingat Docket No. 2051-51-
09, FileNumber09-51-01835 asksthat afinal orderofsuspensionbe issuedeffective
November 12,2009, and .
c. Oncethe Board approves this Agreement, this Orderwill supercede the
final order at DocketNo. 2051-51-09iFile Number.09-51-01835.
d. Respondent's license,No. RN289734L, is indefinitely SUSPENDEDfor
no less thanfive(5) years, such suspension to be immediately STAYED in favor of
no less than five (5) years ofPROBATloN, said probation to be subject to the
following termsand conditions:
.GEWRAL
(1) Respondentshall fullyandcompletelycomply andcooperatewith
the Bureau of Professional and Occupational Affairs, Professional Health
Monitoring Program(''PHMP''), Disciplinary Monitoring Unit ("DMU") and
its agents and employees in their monitoring of Respondent'simpairment
under this Consent Agreement and Order ("Agreement").
(2) Respondentshall abideby andobeyall lawsofthe United States,
the Conunonwealth of Pennsylvania and its political subdivisions and all
rules andregulations arid laws pertainingto the practiceof the profession in
. this Conunonwealth or any other staie or jurisdiction in which Respondent
holds a licenseto practicethe profession, Summarytraffic violations shall
6
ClInl1lJn<l9S101S35CA&.OI216.Q9mjb 3.0031804 .
not constitute a violation of this Agreement. However, violations of any
criminal probation and/or parole are a violation of this Agreement.
(3) Respondent shall atall times cooperate with the PHMP and its
agents and employees in the monitoring, supervision and investigation of
Respondent's compliance with the terms and conditions of this Agreement.
Respondent shall cooperate with any requests for written reports, records or
verifications of actions that may be required by the PH1v,!P; the requested
shall be obtained and.submitted at Respondent's expense.
(4) Respondent's failure to fully cooperate with the PHMP shall be
deemed a violation ofthis Agreement.
(5) Upon request ofthe PHMP case manager, Respondent shall enroll
in a peer assistance program, When available, including, but not limited to,
Physician's Health Program (PHP), SecundumArtem Reaching Pharmacists
with Help (SARFH), and Pennsylvania Nurse Peer Assistance Program
(PNAP), and shall fully and completely comply with all of the terms and
conditions of Respondent's agreement with the peer assistance program.
Respondent's failure to fully and completely comply with Respondent's
agreement with the peer assistance program shall constitutea Violationofthis
Agreement.
(6) Respondent shall not falsify, misrepresent or make material
omission of any information submitted pursuant to this Agreement.
(7) Respondent may not be absent from the Commonwealth of
Pennsylvania for any period exceeding twenty (20) days unless Respondent
7
9hljb3.0031&04
seeks and receives prior writtenpermission fromthe PHMP subject to any
additionalterms and conditions required by the PHMP.
(8) Respondentshallnotifythe PHMPin writingwithinfive (5) days
ofthe filingof anycriminal chargesagainstRespondent;the final disposition
of anycriminalchargesagainstRespondent; theinitiation of anylegal action
pertainingtoRespondent'sprivilegesto practicethe profession;the initiation
of charges,action, restriction or limitationrelatedto Respondent's privileges
to practicethe professionbya professionallicensingauthorityof anystate or
jurisdiction or the Drug Enforcement Agency of the United States
Department of Justice; or anyinvestigation, action, restriction or limitation
relatedtoRespondent'sprivileges topracticetheprofessionat anyhealthcare
facility.
(9) Respondent shall notifythe PHMPby telephonewithin48 hours
and in writing within five (5) days of any change of Respondent's home
address, phone number, employment status, employer and/or change in
practice at a health carefacility. Fallure to timely advise the PHMP under
this subsectiondue to thePHMPoffice beingclosedis not anexcuse for not
leavinga voice mail message with this information.
(10) In the event Respondent relocates to another jurisdiction,
within five days (5) daysof relocatingRespondent shall either enroll in the'
other jurisdiction's impaired professional program and have the reports
requiredunder tills Agreement sent to the PHMP, or ifthe otherjurisdiction
does not have an impairedprofessionalprogram, Respondentshall notifythe
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. licensing board of the other jurisdiction that Respondent is impaired and
enrolledin this Program. In the event Respondentfails to do so,in addition
to being in violation of this Agreement, the periods of suspension and
probation shall be tolled.
(11) Respondent shall cease or limit her practiceifthe PHMP case
manager directs that Respondent do so.
EVALUATION -TREATMENT
(12) If an assessmentltreatmentevaluation has not been done by a
provider approved byPHMPwithinthirty (30) dayspriortothe effectivedate
.ofthis Agreement, or withinthirty (30) dayssubsequent to the effective date
of this Agreement, Respondent shall have forwarded to the PHMP-DMU,
P.O. Box 10569,Harrisburg, PA 17105-0569, (717) 783-4857or (800) 554-
3428, a written evaluation by a provider approved by PHMP assessing
Respondent's fitness to actively practice the profession, If the provider
determines that Respondent is not fit to practice, Respondent shall
immediatelycease practicingthe professionand not practiceuntil a provider
approvedby PHIY.lP andthe PHMP case manager determinethat Respondent
is fit to resume practice with reasonable skill and safety to patients.
, '<'.
(13) Respondent shall provide the provider approved by PHMP
with a copyof any prior evaluationsand counselingrecordsanda copy ofthis
Agreement.
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(14) Respondent shall.authorize, in writing, the PHMP to have a
. .
copy of the provider approved by PHMP's written' evaluationreports.
9
(15) If a provider approved by PHM:P recommends that
Respondent obtain treatment, Respondent must fully comply with those
recommendations as part of these probationary requirements .
. (16) Respondent shall arrange and ensure that written treatment
reports from all providers approved by PHMP are submitted to the PHM:P
upon request or at least every ninety (90) days after the effective date of this
Agreement. The reports shall contain at least the following information:
(i) Verification that the provider has received a
copy ofthis Agreement and understands the conditions of this
probation;
(H) A treatment plan, if developed;
(Hi) Progress reports, including information
regarding compliance with the treatment plan;
(iv) Physical evaluations, if applicable;
(v) The results of any testingincluding anytesting
for therapeutic levels ofprescribedmedicationswhen deemed
appropriate by the provider;
(vi) Modifications in treatment plan, ifapplicable;
(vii) .Administrationor prescription of any drugs to
Respondent; and
(viii) Discharge summary and continuing care plan
at discharge.
10
Canmin09mnS1SCA&{)\21609mjb 3.,0 031804
(ix) Any change inthe provider's assessment ofthe
Licensee's fitness to actively practice the profession.
(17) Respondent shall identify a primary care physician who shall
send written notification to the Respondent's PHMP case manager certifying
Respondent's health status as requested.
SUPPORT GROUP AT'I'ENDANCE'
(18) Respondent shallattend and activelyparticipate in any support
group programs recommendedby the provider or the PBMP case manager at
the frequency recommended by the provider, but no less than twice a week.
(19). Respondent shall provide writtenverification of all support
group attendance to the PBMP on at least a monthly basis or as otherwise
directed by the PHMP.
ABSTENTION,
(20) Respondent shall ,completely abstain from the use of
controlled substances, caution legend (prescription) drugs, mood altering
drugs or drugs ofabuse including alcohol in any form, including alcohol in-
food, or beverages, medications, chemical solutions, cleaning solutions,
gasoline, hand'sanitizers, or other skin'pniparatious, except under the
following conditions:
(i) Respondent is a bona fide patient ofa licensed
health care practitioner who', is aware of Respondent's
impairment and participation in the PHMP;
11
121G09rnjb 3.0031804
(ii) Such medications are lawfully prescribed by
Respondent's treating practitlonerand approved bythe PHlVlP
case manager; and
(iii) Upon receiving the medication, Respondent
must provide to the PHMP: the name of the medication: the
name o'f the practitioner prescribing the drug, the illness' or
medical condition diagnosed; the.type, strength, amount and
dosage ofthe medication; and,a signed statement consenting
, to the release of medical information from the prescribing
practitioner to the PHMP or its designated representative for
the purpose of verification within,48 hours by telephone
andwithin5 days inwriting.
(iv) Upon refilling a medication, Respondent
must provide to the PJ1MP: the name' of the medication: the
name of the practitioner prescribing the drug, the illness or
medical condition diagnosed; the type, strength, amount and
dosage of the medication; and a signed statement consenting
to the release of medical information from the prescribing
practitioner to the PHlVlP or its designated representative for
the purpose of verification within 48 hours by telephone
andwithin5 days.in writing:.
MONITOREDPRACTICE
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C n n n t m 0 9 ~ 101S35CA&OI :nOOr;mjb ac 031804
, (21) "Practice" includes employment in any position requiring a
current license to practice as a registered nurse or attendance at any
educational program/course that includes a clinical practice component with
patients and/or requires a current license to practice as a registered or
practical nurse.
(22) Respondent shall not practice unless a treatment provider
approved by PHJ.v.[P recommends that practice in writing andthe PFlMP case
manager gives written permission to practice.
(23) When permitted to return to practice, Respondent shall not do.
any of the following unless Respondent first obtains written approval from
the PHJ.v.[P case manager:
(a) Practice in any capacity that involves the
administration of controlledsubstances;
(a) Function as a supervisor;
(b) Practice in a private practice setting or without
direct supervision;
(c) Work in an emergency room, operating room,
. intensive care unit, cardiac catheterization laboratory, or
coronary care unit; or
(e) Practice as an agency riurse.
(24) . Respondent may not work in any practice setting, including
attendance at anyeducational program/course that includesa clinical practice
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component with patients and/or requires a current license to practice as a
registered or practical nurse, without direct supervision.
(25) Direct supervision is the physical presence of the supervisor
onthe premises so that the supervisor is immediately availableto the licensee
being supervised when needed.
(26). If Respondent is practicing or attending any educational
program/course that includes a clinical practice component with patients
and/orrequires a current license to practice as a registered nurse, Respondent
shall give any employer, supervisor, preceptor, or instructor (hereinafter
referredto collectively as "supervisor") a copy'ofthis Agreementwithin five
(5) days ofthe effective date of this Agreement.
(27) Respondent shall give a copy of this Agreement to any
prospective employer and supervisor when applying for employment in the
practice, of the profession and to any prospective school/program when
applyingfor any educational program/course that includes a clinical practice
component with patients andlor requires a current license to practice as a
registered or practical nurse,
(28) Respondent shall provide the 'PHMP by telephone within 48
hours, and in writing within five (5) days of the effective date of this
Agreement or obtaining employment, notification of the following:
(a) Name(s) andaddress(es) of supervisorfs) who will
be responsible for evaluating Respondent's practice if
required by PHMP;
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(a) The name(s) and addressees) of the placets) at
,
which Respondent will practice the profession and a
description ofRespondent's duties andresponsibilitiesat such
. places of practice; and
(b) Any restrictions on Respondent's Practice.
(29) Respondent shall ensurethat Respondent's supervisor submits
to the PHMP the following information in writing:
(i) Verification,at the time Respondent 0 blains or
changes a supervisor, that the employer and supervisor have
.received a copy of this Agreement and understand the
conditions of this probation;
(ii) An evaluation of Respondent's work,
performance on a 90-dayor more frequent basis as requested'
by the P;HMP; and '
(iii) Immediate notification of any suspected
,violation of this probation byRespondent,
DRUG TESTIN'G
(30) shall submit to random unannounced and '
observed drug and alcohol tests, inclusiveof bodilyfluid, breath analysis,hair
analysis Or another procedure as may be directed by the PHMP for the
detection of substances prohibited under this Agreement as directed by the
PHMP. A positive, adulterated or substituted' result on a drug test shall
constitute an irrefutable violation of this Agreement Respondent has
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CfIIlnml09S IOl SaSCA&OI'W509m,ib M 031804
complied with the provisions of this Agreement pertaining to the use of
drugs. Failuretoprovidea specimen or a specimenof sufficientquantityfor
testingwhenrequestedwill be considered a violationof this Agreement.
(31) Respondent shall avoid all foods that contain poppy seeds.
.Ingestionof poppy seeds will not be accepted as a valid explanation for a
positive screen.
(32) Respondent shall avoid all substances 'containing alcohol
including alcohol in food or beverages, medications, chemical solutions,
cleaning solutions; gasoline, hand sanitizers, or other skin preparations.
Incidental use of alcohol will not be acceptedas a valid explanation for a
positivedrugtest unlessRespondenthas c,omplied withtheprovisions of'this
Agreement pertaining to the uSe of drugs as set forth in the Abstention
Section above.
REPORTINGIRELEASES
(33) Respondent, Respondent's treatment providers, superVisor(s),
employers or oilierpersons requiredto submitreportsunder this Agreement
. .
shallcausesuchreports,data or oilier informationtobe:filed withthe PHlVlP,
. unless otherwise directed; at:
PHMP-DMU
Box 10569
Harrisburg, PA 17105-0569
(34) . Respondent consents to the release by the PHMP of any
informationor data produced as a result of this probation, including written
provider evaluations, to anytreatment provider, supervisor, Commonwealth's
16
ClIllJ1onOIJSHH33SCA&O121609mJ'b 3.0031Sritt
attorney, hearing examiner or Board members in the administration and
enforcement of this Agreement.
(35) Respondent shall sign any required waivers or release forms
.requested by the PHMP for any and all records, including medical or other
. . .
health-related and psychological records, pertaining to treatment and
monitoring rendered to Respondent during this probation and any
corresponding criminal probation, as well as any employment, personnel,
peer review or review records pertaining to Respondent's practice of the
profession during this probation, to be released to the PHMP, the
Commonwealth's attorney, hearing examiner or Board members in the
administration and enforcement of this Agreement.
. COSTS
(36) .Respondent shall be responsible for all costs incurred in
complying with the terms of this Agreement, including but not limited to
psychiatric or psychotherapy treatments, and reproduction of treatment or
other records. Respondent shall pay the costs for any drug testing and any
subsequent reanalysis -of specimens required by PHMP. Failure of
Respondent to pay any of these costs in a timely manner shall constitute a.
violation ofthis Agreement.
BUREAU/PHMR EVALUATIONS
(37) Upon request of the PBMP, the Respondent shall submit to
. mental or physical evaluations, examinations or interviews by a treatment
provider approved by the PHMP or the PHMP. Respondent's failure to
17
ClInnenOl)Sl 01S35CA&O121609m,Jb 3,0Q31S04
submit to such an examination, evaluation or interview shall constitute a
violation of this Agreement.
VIOLATION OFTIDSAGREEMENT
(38) Notification of a violation of the terms or conditions of
probation contained in this Agreement shall result in the IMMEDIATE
VACATING of the stay order, the IMMEDIATE TERMINATION of the
period ofprobation, and ACTIVATION of the SUSPENSION in paragraph
5(b) above of Respondent's license to practice the profession in the
Commonwealth of Pennsylvania as follows:
(i) The prosecuting attorney for the
Commonwealth shall present to the Board's Probable Cause
Screening Committee (Committee) a Petition that indicates
that Respondent has violated anyterms or conditions of this
Agreement.
(ii) ,Upon a probable causedetermination by the
Committee that Respondent has violated any,of the terms or
conditions of this Agreement; the Committee shall, without
holding a formal hearing, issue a preliminary order vacating
the stay of the within suspension, terminating this probation
and activating the suspension of Respondent's license.
(iii) Respondent. shall be notified of the
Committee's preliminary order within three (3) business days
of its issuance by certified mall and first class mall, postage
18
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prepaid, sent to the Respondent's last registered address on
file with the Board, or by personal service if necessary.
(iv) Within twenty (0) days of mailing of the
preliminary order, Respondent may submit a written answer
to the Commonwealth's Petition and request that a fo:rroal
hearing be held concerning Respondent's violation of
. probation, in which Respondent may seek relief from the
preliminaryorder activating the suspension.Respondent shall
mail the original answer and request for hearing. to tile
Department of State, BureauofProfessionaland Occupational
Affairs, Office of Prothonotary,2601 NorthThird Street, P.O.
Box 2649, Harrisburg, PA 17105-2649, and a copy to the
prosecuting attorney for the Commonwealth, as well as all
subsequent filings in the matter.
(v) If Respondent submits a timely answer and
request for a formal hearing, the Board or a designated
hearing examiner shall convene a formal hearingwithin forty-
five (45) days from the date of the Prothonotary's 'receipt of
Respondent's request for a formal hearing'.
(vi) Respondent's submission of a timely answer
and request for a hearing shan not stay tile suspension of
Respondent's license under the preliminary' order. The
suspension shall remain in effect unless tile Board or the
.19
Canllof\09S IOIa3SCA&OlZIG,G9mjl13.0 0,31804
hearing examiner issues an order after the formal hearing
stayingthe suspension again and reactivatingthe probation.
(vii) The facts and averments in this Agreement
shall be deemed admitted and uncontested at this hearing..
(viii) If the Board or hearing examiner after the
formal hearing makes a determination against Respondent, a
final order will be issued sustaining the suspension of
Respondent's license and imposing any additional
disciplinarymeasures deemed appropriate.
(ix) If Respondent fails totimelyfileananswer and
request for a hearing, the Board shall issue a final order
:1
affirming the suspension ofRespondent's license.
(x) IfRespondent does not make a timely answer
I
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and request for a formal hearing and' a final order affirming
the suspension is issued, or the Board or the hearingexaminer
makes a determination against Respondent sustaining the
suspension of Respondent's license, after at least three (3)
years of active suspension. and any additional imposed
discipline, Respondent may petition the Board for
reinstatement based upon .an affirmative showing that
Respondent has at least thirty-six (36) months of sustained
documented recovery, Respondent has undergone : an
evaluationby it treatment provider approvedbyPHMP and is
20
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fit to safely practice the profession, and Respondent has
abided by and obeyed all laws of the United States, the
Commonwealth of Pennsylvania and its political
subdivisions, and all rules and regulations pertaining to the
practice of the profession in this Commonwealth.
(39) Ifthe Board issues a Preliminary Order terminating the stay of
the suspension and actively suspending Respondent's license to practice the
profession in accordance with the procedure set forth above, Respondent
shall immediately cease the practice of the profession. Respondent shall
,continue to comply with all of the terms and conditions ofprobation in this
Consent Agreement and Order during the active suspension until the Board
issues a Final Order. Continued failure by Respondent to .comply with the
unaffected terms and conditionsofprobation while awaitingthe issuance ofa
Final Order by the Board may result in further disciplinary action against
Respondent.
(40). Respondent's failure to fully comply with any terms of this
Agreement may also' constitute grounds 'for additional disciplinary action.
(41) Nothing in this Agreement shall preclude the' prosecuting
attorney for the Commonwealth from filing charges or the Board from
imposing disciplinary action or corrective measures for violations or facts not
contained in this Agreement.
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COMPLETION OF PROBATION
(42) After successful completion of ' the minimum period of
probation; Respondent may petition the Board, 'upon a form provided by ,
PHMP, to dismiss this matter and to reinstate Respondent 's license to
unrestricted, non-probationary status' upon an affirmative showing that
Respondent has complied with all terms and conditions of this Agreement
and that Respondent 'sresumption ofunsupervisedpractice does not present a
threat to the public health and safety. Respondent shali be required to
'remain in compliance with all terms and conditions Ofthis Agreement
until the BoardISSUes the order terminating Respondent's probationary
status.
6. Respondent knowingly and voluntarily waives the right to an administrative hearing
in this matter, and to the following rights related tothat hearing: ' to be represented by counsel itt
the hearing; to present witnesses and testimony in defense or in mitigation of any sanction that
may be imposed for a violation; to cross-examine witnesses and to challenge evidence presented
, ,
by the Commonwealth; to present legal arguments by means ofa briefiand to take an appeal
from any final adverse decision.
7. This Agreement shall take effect immediately upon its approval and' adoption by the
Board.
8. Respondent agrees, as a condition of entering into this Agreement, not t-o seek
, ,
modification ofit at a later date without first obtaining the express written concurrence of the
i . .
Prosecution Division of the Department of State.
22
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CONGRATULATIONS To
CHERYL C..
Yod,had your beginning stage of a new life of recovery at
Cove forge Renewal Center at Johnstown.
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" God, grant roe the serenity to accept the things I cannot change, 'the courage to .changethe things I can, and
the wisdom to know the difference."
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9. This Agreement is betweentheprosecuting attorney and Respondent only. Exceptas
otherwise noted, this Agreement isto have nolegal effect unless and until the Office ofGeneral
Counsel approves the contents astoform and legality and theBoard approves and adopts the
Agreement.
10. Should the Boardnot approve this Agreement, presentationto and consideration of it
bytheBoard shaJl not prejudice theBoard orany of its members from further participation in the
adjUdicatIon oftbismatter. Thisparagraph is binding ontheparticipants even if theBoard does
notapprove thisAgreement,
11. This Agreement contains thewhole agreement betweentheparticipants.' There areno
other tenus, obligations. covenants, representations, statements 0; condltions, orotherwise, of
anykind whatsoever concerning thisAgreement.
12. Respondent verifies thatthefacts andstatementa set forth inthis Agreement aretrue
and correcttothe best of Respondent's knowledge, information andbelief Respondent
understands thatstatements inthisAgreement are madesubject to thecrlminai penalties of 18
Pa.C.S. 4904 relatlngto unswornfalsification toauthorities.
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Prosecuting Attorney
Department ofState .
DATED:
MJB/n1b
13
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ORDER
. AND NOW, this . 1&\/ '. .,2010,theState
cfNursing approves andadopts the' foregoing Consent Agreement andincorporatesfhetenris
.of paragraph 5;which shall constitute the Board's Order and is now issued in resolution of this
matter.
. This'Order shalltake effectimmediately.
BUREAU OF PROFESSIONAL AND
.OCCUPATIONAL AFFAIRS'
Basil1. Merenda .
Commissioner
BY ORDER:
THE STATE BOARD OF NURSING
'" .
FileNo.
Date of Mailing:
...
Forthe Commonwealth:
For Respondent:
095110707
" ....
MontyJ. Batson, Esquire
Prosecuting Attorney .
P.O.Box2649, .
Harrisburg, PA 17105-2649
. Ronald D. Amrhein, Jr., Esquire
Attorney for Respondent
109S.01l,tl'\ WaterA
Sharon, Pa. 16146
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COMMONWEALTH 011' PENNSYLVANlA
DEPARTMENTOF STATE.
BEFORETHESTATEBOARD OF NURSING
DocketNo.: ') 14<-51-11
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11-51-09954 FileNo.:
NOTICE
vs.
Cheryl Ann Cannon, R.N.,
Respondent.
Commonwealthof pennsylvania,
Bureauof Professional and
Occupational Affairs,
i
Formal disciplinary action has been filedagainst youfor violating thetermsof probation imposed onyou
by a priororderofthe board. Theattached Preliminary Order hasactivated the stayed suspension ofynur
license under theterms ofthepriororder and youmayalso besubject to civilpenalties of upto
$10,000.00 for eachviolation oftheProfessional Nursiug Law, Actof May22, 19S1, P.L. 317, as
amended, (Act), 63 P.S. 211226, andtheimposition of costs of investigation.
Ifyouwishto defend against thecharges inthe attached petition for appropriate reliefOr to present
evidence to mitigate anypenalty thatmaybe imposed, theprocedures for doing soareexplained iu the
Preliminary Orderattached to thepetition for appropriate relief.
Youhavetherighttoretaiu anattorney. Although youmayrepresent yourselfwithout an.attcmey, you
areadvised to seekthe help of anattorney. Youalsohavethe right to haveaninterpreter provided should
yourequest one.
All proceedings areconductedundertheAdministrative AgencyLawandtheGeneral Rules of
Administrative Practice andProcedures.
Ifyoudesireahearing, youare directed tofileawritten answer tothepetition for appropriate reliefanda
written requestfor ahearing withiutwenty (20)days ofthe mailing dateof thePreliminary Order, IF
YOUDONOTFILE AWRlTTENANSWERAND REQUEST FORAHEARJNG, ANOEDER
. MA.K:rnGTHEPRELlMlNARY OEDERFJNALMAY BEENTEREDAGAINST YOUWITHOUT A.
HEARlNG. To file yourwrittenanswer andrequest for a hearing, youmustbringor sendan original and
three copies of your written answer andrequestfor a hearing andanypleadings or otherdocuments
related to thismatter to thefollowing address:
Prothonotary
Bureau of Professional andOccupational Affairs
2601 North ThirdStreet
P.O. Box2649
Harrisburg, PA17105
You mustalsosenda separate copy of yourwritten answer andrequest for ahearing andani other
pleadings or documents related tothiscase 10theprosecuting attorney named in. the petitioll. for .
appropriate relief . . !RUE AND
. CERTIfIED ffl AD
. . .. ,1B\$1!ltl:. . . .
.. . S
ROi'HCNOT"'l'IV
COMMONWEALTHOF PENNSYLVANIA
DEPARTMENTOF STATE
BEFORE THE STATE BOARDOF NURSING
Commonwealth of Pennsylvania,
Bureau of Professional and
Occupational Affairs,
vs.
Cheryl Ann Cannon, R.N.,
Respondent.
Docket No.r
File No.:
_--:-51-11
11-51-09954
. f\ 1PRELIMINARY ORDER .
. CJ J b. 11.:.rv/l)2>!V' tRr'\
AND NOW, thiV dayof , J::::V\ I, ~ O l l , lhe StateBoardof NursingProbable
Cause Screening Committee, makes a probable cause determination that Cheryl Ann Cannon
("Respondent"), license No. RN289734L, violated the terms and conditions of the Voluntary
Recovery Program Consent Agreement and Order ("DMU Agreement") as alleged in the
attached Commonwealth's Petition for Appropriate Relief.
Accordingly, the stay of the suspension of Respondent's license Is now VACATED, the
period of probation is nowTERM:INATED, and Respondent's licenseto practice as a registered
nurseis nowactively Indefinitely SUSPENDED for no lessthanthree (3) years.
Respondent shall immediately cease practicing the profession. Within ten (10) days,
Respondent shall surrender the wall certificate, registration certificate, wallet card and other
licensure documents by forwarding themto:
MontyJ. Batson, Esquire
Commonwealth ofPennsylvania
Bureauof Professional andOccupational Affairs
P.O. Box2M9
Harrisburg,PA 17105-2649
Respondent shall be notified of this Preliminary Order within three (3) days of its
issuance by certified mail andfirst class mall postage prepaid, sent to the last registered address
onfile withthe Board;
,
Within twenty (20) days of mailing of tillsPreliminary Order, Respondent mayanswer
the Commonwealth's Petition and request that a formal hearing be convened concerning'
Respondent's violation of probation, in whichRespondent may seekrelief fromthis Preliminary
Order activating the suspension. The answer shall be set forth in numbered paragraphs .
corresponmng to the numbered paragraphs of the Petition for Appropriate Relief.
Respondent shall admit or deny each of the allegations'set forth in the paragraphs in the
Petition for Appropriate Relief. Respondent's answer shall be in writing,and so drawnas to
fully and completely advise the parties and the agency as to the nature of the defense.
Respondent shall serve the prosecuting attorney for the .Commonwealth with a copy of the
answer andall subsequent filings in thismatter;
If ananswer anda request for a formal hearing is received fromRespondent, the Boardor
its dulyauthorized hearing examiner shall convene a formal hearing withinforty-five (45) days
fromthe date of theBoard's receipt ofRespondent's request for a formal hearing;
If Respondent files ananswer andrequestfor a hearing withinthetwenty (20)dayperiod,
thisPreliminary Order activating the suspension shall remain in effect unless anduntilthe Board
issuesa determination favorable to Respondent after holding the formal hearing;
The facts and averments in the Agreement shall be deemed admitted and uncontested at
this hearing;
If the Board after suchhearing makes a determination adverse to Respondent, the Board
will issue a Final Order activating the suspension of Respondent's license and imposing any
additional disciplinary measures it deemsappropriate;
If an answer and a request for a formal hearing is not received fromRespondent within
the prescribed twenty (20) dayperiod,the Board's Preliminary Ordershall automatically become
theFinal Orderinthis mattertwenty (20)days after thedate of its mailing;
.. .
If the stay is terminated, Respondent shall still comply with all terms and conditions of
probation in the Agreement during the active suspension, other than those terms and conditions
pertaining to practicing the profession. Continued failure by Respondent to comply with the
unaffected terms and conditions. of probation shall result in further disciplinary action against
Respondent;
This Order shall take effect immediately upon mailing,
BYORDER:
BEFORE THE STATE BOARD OF NURSING
PROBABLE CAUSE SCREENING
COMMITTEE
AnnM, Coughlin, RN, MSN
Committee Member
:!CD
SUZaJIll M. Hendricks, BSBH, LPN
Committee Member
RobertE. Ames
Committee Member
For the Commonwealth:
FortheRespondent:
Monty J. Batson, Esquire
Commonwealth of Pennsylvania
Bureau of Professional andOccupational Affairs
P,O.Box 2649
Harrisburg, PA 17105-2649
Cheryl AnnCannon
1130 Stambaugh Avenue
Sharon, PA16146
Dateof Mailing:
COMMONWEALTHOFPENNSYLVANIA
DEPARTMENTOF STATE
BEFORE THE STATEBOARDOF NURSING
Commonwealth of Pennsylvania,
Bureau of Professional and
OccupationalAffail's,
vs.
DocketNo.: ?tl.f{ -51-11
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Cheryl Ann Cannon, R.N.,
Respondent.
FileNo.: 51-09954
PETITION FOR APPROPRIATE RELIEF
NOW COMES the Commonwealth of Pennsylvania, by and through its Prosecuting
Attorney, Monty J. Batson, and files the within Petition for Appropriate Relief and in support,
avers as foilows:
1. At all relevant andmaterial times; Cheryl AnnCannon (Respondent) heldthe
following license to practice as a registered nurse hi the Commonwealth of Pennsylvania, license
no: &'1289734L, whichwasoriginally issued on September 4, 1987.
,
2. Respondent's license is current through Apri130, 2012, andmaybe continually
renewed, reactivated or reinstated uponthefiling ofthe appropriate documentation and payment
of the necessary fees.
3., Respondent's last known address onfilewiththeBoard is: 1130 Stambaugh Avenue,
Sharon, PA16146.
4. OnJanuary 7,2010, theBoardissued anOrderadopting a Disciplinary Monitoring
Unit Consent Agreement, (n DMU Agreement") entered intobetween Respondent andthe
"
Commonwealth, FileNo. 09-51-10707, and, among otherthings, found Respondent to have
violated the Actat Section 14(a)(2) of theAct, 63P.8. 224(a)(2), in thatRespondent wasunable
to practicetheprofession withreasonable skillandsafety topatients by coPY ,
, D, ",111
, . " A.D.
,
OTHONOTARY
addiction todrugsor alcohol, or mental incompetence. Atrueandcorrect copyof the
Agreement is incorporated asExhibit A.
5. TheDMUAgreement, at paragraph 5, further provides that Respondent's license shall
be suspended underthe terms of theAgreement, but the enforcement of that suspension shall be
stayed for the lengthof timeRespondent remains Inan approved treatment andmonitoring
program andmakessatisfactory progress, complies withthe othertermsof the DMUAgreement
andadheres to all conditions as set forthin theagreement.
6. Respondent violated thetermsof theDMUAgreement as follows:
a. Respondent hasfailed to 'fully andcompletely comply andcooperate
withtheProfessional HealthMonitoring Program (pHMP) andthe DMUprogram
in theirmonitoring of Respondent's impairment under theDMUAgreement in
that Respondent failed to complete andreturnthe Personal DataSheet(PDS) to
her case manager when requested. (DMU Agreement 15d(3)),
b. Respondent's aforementioned failure to cooperate withthePHMPand
DMU Is a violation of the Respondent's DMU Agreement. (DMU Agreement
1Sd(4)).
c. Respondent failed to arrange for her evaluationresultsto be submitted
to thePHMP. (DMU Agreement 1Sd(16)).
d.. Respondent has failed to fully andcompletely comply andcooperate
withtheProfessional HealthMonitoring Program (pHMP) andthe DMUprogram
in theirmonitoring ofRespondent's impairment undertheDMUAgreement in
thatRespondent falled to complete andreturn the twosets. of releases that were
provided to Respondent. (DMU Agreement 1[5d(3)).
e. Respondent's aforementioned failure tocooperate withthePHMP and
DMUis a violation ofthe Respondent's DMUAgreement. (DMU Agreement
,-rSd(4.
f. Respondent hasfailed tofullyandcompletely comply andcooperate
withthe Professional Health Monitoring Program(pEMP) andtheDMU program
in theirmonitoring of Respondent's impairment under the DMU Agreement in
that Respondent failed to enroll inFirstl.ab. (DMU Agreement ,-rSd(3.
g. Respondent hasfailed tosubmitto drug testing as required bythe
DMUAgreement. (DMU Agreement ,-rSd(30.
h. Respondent's aforementioned failure to cooperate withthePHMP and
DMUis a violation of theRespondent's DMUAgreement. (DMU Agreement
,-rSd(4.
7. Paragraph 7d(38) of the DMUAgreement states that notification of a violation of the
teJ:111s or conditions of the Agreement shallresult in the IMMEDIATEVACATING of the stay
order, TERMINATION of theperiodof probation, andACTlVATION ofthe entire period of
suspension of Respondent's license to practice as a registered nursein the Commonwealth of
Pennsylvania, subject to theprocedure set forthin that sub-paragraph.
WHEREFORE, pursuant to theprocedure set forthin pARAGRAPH 7d(38) of the DMu
Agreement, the Commonwealth respectfully requests that the Board (1) make a probable cause
determination that Respondent violated the terms and conditions of the Agreement; (2) issue a
Preliminary Order V A C A T ~ G its previous Order staying the suspension in this matter,
TE:RMINATINGthe period of probation andACTIVELY SUSPENDING Respondent's license
to practice as a registered nurse,' license no. RN289734L; (3) notify Respondent of the
j
Preliminary Order and suspension, and; "(4) take such other action as the Board deems
appropriate.
Respectfully submitted,
Monty J. Ba n
Prosecutin ttorney
Commonwealth of Pennsylvania
Departmentof State
Case #2012-002818
Ohio Board of Nnrsing www.nursing.ohio.gov
17South High Street, Suite400 Columbus, Ohio 43215-7410 (614) 466-3947
November 16,2012
NOTICE OF OPPORTUNITY FOR HEARING
Kelley Anne Carpenter, R.N., L.P.N.
3920 Ireland Road
Coolville, Ohio 45723
Dear Ms. Carpenter:
In accordance with Chapter 119. of the Ohio Revised Code (ORC), you are hereby notified that
the Ohio Board of Nursing (Board) proposes under the authority of Section 4723.28, ORC, to
deny, permanently revoke, revoke, suspend or place restrictions on your licenses to practice
nursing as a registered nurse and as a licensed practical nurse; reprimand or otherwise discipline
you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the
following reasons:
1. On or about May 2, 2012, State of West Virginia Board of Examiners for
Registered Professional Nurses (West Virginia Board) issued an Order of
Summary Suspension (West Virginia 2012 Order) in which your license to
practice as a registered professional nurse in West Virginia was summarily
suspended. A certified copy of the West Virginia 2012 Order is attached
hereto and incorporated herein.
Section 4723.28(B)(l), ORC, authorizes the Board to deny a license or otherwise discipline a
licensee for denial, revocation, suspension, or restriction of authority to practice a health care
occupation, including nursing, for any reason other than a failure to renew, in Ohio or another
state or jurisdiction.
Accordingly, the Board is authorized to impose one or more of the sanctions as cited in Section
4723.280RC.
You are hereby further informed that, if you timely request a hearing, you are entitled to appear
at such hearing in person, by your attorney, or by such other representative as is permitted to
practice before the Board, or you may present your position, arguments, or contentions in
writing. At the hearing you may also present evidence and examine witnesses appearing for and
against you.
Should you choose to request a hearing, please mail or deliver the request, in addition to any
other correspondence regarding this matter, to: Lisa Ferguson-Ramos, Compliance Unit
Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, OH 43215-
7410, or to the email address, hearing@nursing.ohio.gov.
Kelley Anne Carpenter, R.N. , L.P.N.
Page 2
If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing
of this notice, the Board may, in your absence and upon consideration of the factual and legal
allegations set forth in this Notice of Opportunity for Hearing, deny, permanently revoke,
revoke, suspend or place restrictions on your licenses to practice nursing as a registered nurse
and as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not
more than five hundred dollars ($500.00) per violation.
Sincerely,
Judith A. Church, R.N., C.N.P.
Supervising Board Member
Certified Mail Receipt No. 70121010 0002 4157 4152
cc: Henry G. Appel, Assistant Attorney General
Laura S. Rhodes, M.S.N., R.N.
ExecutiveDirector
email:rnboard@wv.gov
web address: www.wvrnboard.com
TELEPHONE:
(304)5583596
FAX (304) 5583666
STATE OFWESTVIRGINIA
BOARD OF EXAMINERS FOR REGISTERED PROFESSIONAL NURSES
101 Dee Drive, Suite 102
Charleston, WV 253111620
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Gl
I, LAURA SKIDMORE RHODES, MSN, RN, EXECUTIVE DIRECTOR
of the West Virginia Board of Examiners for Registered Professional Nurses do hereby
certify that the attached documents, all in the matter of Kelley Carpenter, registered
professional nurse, license number 64170, are true and correct copies of said
documents as they appear among the files and records of this office.
Witness my hand and seal of the Board of Nursing this 23rd day of JUly, 2012.
BOARD OF NURSING
Lura Skidmore Rhodes, MSN, RN
Executive Director
BEFORE THE WEST VIRGINIA BOARD
OF EXAMINERS FOR REGISTERED PROFESSIONAL NURSES
KEllEY CARPENTER
v.
WEST VIRGINIA BOARD OF EXAMINERS
FOR REGISTERED PROFESSIONAL NURSES
License No. 64170
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GO)
C';l!
ORDER OF SUMMARY SUSPENSION
Pursuant to West Virginia Code 30-1-4 and 30-7-4, and West Virginia
Legislative Rules 19-3-14.4:
If the board finds that public health, safety and welfare requires
emergency action and incorporates a finding to that effect into its order,
the board shall order summary suspension of a license pending proceedings
for revocation of the license or other action. The board shall promptly institute
and determine further disciplinary action.
Information supporting this order is as follows:
On January 30,2010 the Board received a Complaint Form from Charleston
Area Medical Center (CAMC), Charleston, West Virginia. The Complaint Form
states, Carpenter waited until the end of the work shlft to perform narcotic
wastes, after being instructed not to do so. There were delays between the time
narcotics were removed from the Accudose until administered to patients, sometimes
up to one hour. There was a patient documented as receiving scheduled and PRN (as
needed) pain medication at the same time, the patient stated they had not asked for
1
any extra medication. Carpenter gave P.O. (by mouth) PRNand IV PRN pain
medications at the same time. Carpenter did not follow the Doctor's order that IV is
","
only for breakthrough pain. It was documented that a patient received P.O., PRN and
IV PRN pain medication at the same time; the patient was found with P.O. dose at
bedside by the charge nurse and the patient was asleep. The patient stated she had
not asked for any pain medication. Other nurses caring for the same patients did not
give IV PRN medication, only P. O. Carpenter removed medications from the
Accudose before patients asked. Carpenter revised MAK administration times (ex:
scanned pain medication in at 2140, but revised the time to state it was given at 1705).
Carpenter removed Dilaudid from Accudose for a patient at 1703, no documentation
that patient received this dose; patient signed discharge papers at 1600, was
discharged out of system at 1649. Dilaudid was removed from Accudose at 1604 and
1637. The dose removed at 1604 was administered per MAK at 1608. There is no
documentation in
the MAK that patient received dose removed at1637.
On July 18, 2011 the Board received a complaint letter from Ohio Valley Medical
Center (OVMC) stating Carpenter was placed on administrative leave of absence
pending an investigation of her practices while handling narcotics. A review of OVMC's
pyxis controlled medications charges/credits for the period of June 8, 2011 through July
7, 2011 and a Pyxis medstation report for July 6, 2011 revealed the following:
1 instance of removing Dilaudid 2 mg at a period of two hours after the medication was
discontinued, 1 instance of Dilaudid 4mg being removed prior to a written order, 3
instances of Dilaudid 4 mg being removed with no order, 1 instance of Dilaudid 2mg
2
removed with no order, 2 instances of failure to scan medication during the
administration process and 3 instances of removing larger doses than profiled with no
wasting process documented.
During the Board's investigation, Carpenter's employment records from St.
Joseph's Hospital (SJH), Buckhannon, West Virginia were reviewed. SJH's records
reflect Carpenter did not write telephone orders to hold total parental nutrition for a
patient, Carpenter did not give the right Insulin, and forged another nurse's initials as a
second check for Insulin. Carpenter stopped an IV on the resident without the
physician's order. Carpenter failed to give medication to 25 out of 34 residents,
resulting in a negative outcome for one resident due to no finger stick or insulin being
given as ordered.
Therefore, based on the foregoing, the Board finds that public health, safety and
welfare are threatened and emergency action is necessary. The Board ORDERS that
license number is 64170 issued to Carpenter is herein SUMMARILY SUSPENDED.
The Board ORDERS Carpenter to respond to the above allegations and have an
evaluation performed by a Certified Addictions Counselor who has received a copy of
Carpenter's Board file. The Board further ORDERS Carpenter to cause a copy of all
documents resulting from her evaluation by the Certified Addictions Counselor be sent
directly to the Board office by the Certified Addictions Counselor. A determination of
further disciplinary action will be made once the Board receives and reviews all required
information.
Such suspension shall become effective immediately upon Carpenter receiving
notice of the suspension or two days after being mailed from the Board office,
3
whichever occurs first and shall remain in effect until such time as a hearing is held
before the West Virginia Board of Examiners for Registered Professional Nurses and a
final order entered or until such time that other disciplinary action is taken by the Board,
whichever is first.
Entered this 2
nd
day of May 2012.
At the Direction of the West Virginia
Board of Examiners for Registered
Professional Nurses
(Board Seal)
L ra S. Rhodes, RN, MSN
Executive Director
4
Case #12-001139
Ohio Board of Nursing www.nursing.ohio.gov
17 South High Street. Suite 400 Columbus, Ohio 43215-7410 (614) 466-3947
November 16,2012
NOTICE OF OPPORTUNITY FOR HEARING
Shannon Marie Cloyd, L.P.N., R.N.
3701 Cordell
Kettering, Ohio 45439
Dear Ms. Cloyd:
In accordance with Chapter 119 Ohio Revised Code (ORC), you are hereby notified that the
Ohio Board of Nursing (Board) proposes under authority of Section 4723.28, ORC, to deny,
revoke, permanently revoke, suspend or place restrictions on your licenses to practice nursing as
a licensed practical nurse and as a registered nurse; reprimand or otherwise discipline you; or
impose a fine of not more than five hundred dollars ($500.00) per violation for the following
reasons:
1. On or about May 9,2012, in Montgomery County Court of Common Pleas Case
No. 2012 CR 00888, you pled guilty to and were subsequently found guilty of six
(6) counts of Trespass in a Habitation (Person Present or Likely), all fourth-
degree felonies, in violation of Section 2911.12(B), ORC. The acts underlying
your convictions noted above occurred from on or about January 14,2012 to on
or about March 7, 2012, in Montgomery County, Ohio, and consist of you
unlawfully entering the residences of elderly victims.
Section 4723.28(B)(4), ORC, authorizes the Board to discipline a licensee for conviction of, a
plea of guilty to, a judicial finding ofguilt of, a judicial finding of guilt resulting from a plea of
no contest to, or a judicial finding of eligibility for intervention in lieu of conviction for, any
felony or of any crime involving gross immorality or moral turpitude.
2. On or about April 11,2012, you provided a written statement indicating that you
were prescribed Vicodin and, after a while, you began using more than you
should have. You further reported that you "never had a way to get more" and
that you began entering residences at (assisted living) facilities in an attempt to
get more Vicodin. You reported that you "got Vicodin at Lincoln Park and then
kept going to other assisted livings trying to get more."
Section 4723.28(B)(8), ORC, authorizes the Board to discipline a licensee for self-administering
or otherwise taking into the body any dangerous drug, as defined in Section 4729.01, ORC, in
any way not in accordance with a legal, valid prescription issued for that individual.
Shannon Marie Cloyd, L.P.N., R.N.
Page 2
Accordingly, the Board is authorized to impose one or more of the sanctions as cited in Section
4723.280RC.
In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing
on this matter. If you wish to request such hearing, the request must be made in writing and
must be received in the Board office within thirty (30) days of the time of mailing this notice.
You are hereby further informed that if you timely request a hearing, you are entitled to appear at
such hearing in person, by your attorney, or by such other representative as is permitted to
practice before the Board, or you may present you position, argument, or contentions in writing.
At the hearing you may also present evidence and examine witnesses appearing for and against
you.
Should you choose to request a hearing, please mail or deliver the request, in addition to any
other correspondence regarding this matter to: Lisa Ferguson-Ramos, Compliance Unit
Manager, 17 South High Street, Suite 400, Columbus, OH 43215-7410, or to the email
address,
If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing
of this notice, the Board may, in your absence and upon consideration of the factual and legal
allegations set forth in the Notice of Opportunity for Hearing, deny, revoke, permanently revoke,
suspend or place restrictions on your licenses to practice nursing as a licensed practical nurse and
a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five
hundred dollars ($500.00) per violation.
Sincerely,
Judith Church, R.N., C.N.P.
Supervising Board Member
Certified Mail Receipt No. 7012 1010 000242574190
cc: Henry G. Appel, Assistant Attorney General
Case 12-002970
Ohio Board of Nursin.g www.nursing.ohio.gov
17 South High Street, Suite 400 Columbus, Ohio 43215-7410 (614) 466-3947
November 16,2012
NOTICE OF OPPORTUNITY FOR HEARING
Jeremy D. Coleman, L.P.N.
17748 Rock Creek Road, Lot 46
Thompson, Ohio 44086
Dear Mr. Coleman:
In accordance with Chapter 119, Ohio Revised Code (ORC), you are hereby notified that the
Ohio Board of Nursing (Board) proposes under authority of Section 4723.28 ORC, to deny,
revoke, permanently revoke, suspend or place restrictions on your license to practice nursing as a
licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more
than five hundred dollars ($500.00) per violation for the following reasons:
1. On or about June 20, 2012, while working as a nurse at Embassy Madison
HealthCare, in Madison, Ohio, (Madison Health Care) you failed to comply
with a request by your employer to submit a urine specimen for laboratory
analysis. In an interview with a Board Compliance Agent on or about July 17,
2012, you admitted that had you provided the urine specimen, it would have
tested positive for THC (marijuana). In a written statement to the Board,
dated July 25,2012, you indicate: "On the day in question at Madison Health
Care when I was drug tested I could have given a specimen but purposely did
not. I had smoked a small amount of marijuana 2-3 weeks prior. ... I had
smoked it 1-3x/year previously...."
Section 4723 .28(B)(8), ORC, authorizes the Board to discipline a licensee for self-administering
or otherwise taking into the body any dangerous drug, as defined in Section 4729.01, ORC, in
any way not in accordance with a legal, valid prescription issued for that individual.
2. While working as a nurse at Madison Health Care, the following occurred:
(a) On or about June 20, 2012, you documented a 4:00 p.m. blood sugar
reading of "148" on the MAR for Patient #1 despite the fact that you were off
the clock and no longer working as of 12:15 p.m. that day [See Attached
Patient Key - to Remain Confidential and Not Subject to Public Disclosure].
In an interview with a Board Compliance Agent on or about July 25, 20i2,
you admitted that you "pre-charted" Patient #l's blood sugar reading on the
patient's MAR, documenting an event that had not occurred;
Jeremy D. Coleman, L.P.N.
Page 2
(b) In a written statement to the Board, dated July 25,2012, you indicate that:
"During my time at Madison Health Care I often pre[-]signed my MAR early
in the shift and did not sign off my MAR PRNs/Narcotics until the end. I
know this was wrong and dangerous and have no excuses for my actions."
Section 4723.28(B)(l9), aRC, authorizes the Board to discipline a licensee for failure to practice
in accordance with acceptable and prevailing standards of safe nursing care. Section
4723.28(B)(16), aRC, authorizes the Board to discipline a licensee for violation of Chapter
4723, ORC, or any rules adopted under it. Specifically, Rule 4723-4-06(E), Ohio Administrative
Code (OAC), states that a licensed nurse shall, in a complete, accurate, and timely manner, report
and document nursing assessments or observations, the care provided by the nurse for the client,
and the client's response to that care. Rule 4723-4-06(0), OAC, states that a licensed nurse shall
not falsify any client record or any other document prepared or utilized in the course of, or in
conjunction with, nursing practice. This includes, but is not limited to, case management
documents or reports or time records, reports, and other documents related to billing for nursing
services. Rule 4723-4-06(H), OAC, states that a licensed nurse shall implement measures to
promote a safe environment for each client.
Accordingly, the Board is authorized to impose one or more of the sanctions cited in Section
4723.28,ORC.
In accordance with Chapter 119, aRC, you are hereby informed that you are entitled to a hearing
in this matter. If you wish to request such hearing, the request must be made in writing and must
be received in the Board office within thirty (30) days of the time of mailing of this notice.
You are hereby further informed that, if you timely request a hearing, you are entitled to appear
at such hearing in person, by your attorney, or by such other representative as is permitted to
practice before the Board, or you may present your position, arguments, or contentions in
writing. At the hearing, you may also present evidence and examine witnesses appearing for and
against you.
Should you choose to request a hearing, please mail or deliver the request, in addition to any
other correspondence regarding this matter, to Lisa Ferguson-Ramos, Compliance Unit
Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, Ohio 43215-
7410 or to the email address, hearing@nursing,ohio.gov.
If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing
of this notice, the Board may, in your absence and upon consideration of the factual and legal
allegations set forth in this Notice of Opportunity for Hearing, deny, revoke, permanently
revoke, suspend, or place restrictions on your license to practice nursing as a licensed practical
nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred
dollars ($500.00) per violation.
Sincerely,
Jeremy D. Coleman, L.P.N.
Page 3
Judith A. Church, R.N., C.N.P.
Supervising Board Member
Certified Mail Receipt No. 7012 1010 0002 42574084
cc: Henry G. Appel, Assistant Attorney General
Case# 12-004723
Ohio Boa't'd of Nursing www.nursing.ohio.gov
17South High Street, Suite 400 COlumbus, Ohio 43215-7410 (614) 466-3947
November 16,2012
NOTICE OF AUTOMATIC SUSPENSION AND
OPPORTUNITY FOR HEARING
Karen Denise Combs, L.P.N.
3701 Richard Drive
Hamilton, Ohio 45015
Dear Ms. Combs:
You are hereby notified that, on or about September 25, 2009, you entered into a Consent
Agreement (September 2009 Consent Agreement) with the Ohio Board of Nursing (Board), a
copy of which is attached hereto and incorporated herein, in which you agreed with the Board
that your license to practice nursing as a licensed practical nurse in the State of Ohio would be
reinstated and suspended indefinitely and that such suspension would be stayed subject to
probationary terms, conditions, and limitations until at least September 2012. Attached to and
incorporated within the September 2009 Consent Agreement is a July 18, 2008 Consent
Agreement (July 2008 Consent Agreement).
A. Item 5. of the September 2009 Consent Agreement states, "MS. COMBS
shall continue submitting, at her expense and on the day selected, blood or
urine specimens for drug and/or alcohol analysis at a collection site specified
by the Board at such times as the Board may request. Refusal to submit such
specimen, or failure to submit such specimen on the day she is selected, or in
such a manner as the Board may request, shall constitute a violation of a
restriction placed on a license for purposes of Section 4723.28(B), ORC. This
screening shall require a daily call-in process. The specimens submitted by
MS. COMBS shall be negative, except for substances prescribed,
administered, or dispensed to her by another so authorized by law who has full
knowledge of MS. COMBS' history of chemical dependency and recovery
status."
Despite this provision, on or about the dates set forth in Attachment A, attached
hereto and incorporated herein, you failed to call Firstlab, the Board's random
drug/alcohol screen program administrator, to determine if you had been selected
to provide a specimen for analysis. -
Furthermore, on the following dates, you were selected to provide a specimen for
analysis and failed to do so: March 18,2009; November 18,2011; January 18,
2012; May 14,2012; June 25,2012; August 5, 2012; September 4, 2012; and
September 11,2012.
Karen Denise Combs, L.P.N.
Page 2
Section 4723.28(B)(17), Ohio Revised Code, ORC, authorizes the Board to discipline a licensee
for violation of any restrictions placed on a nursing license by the Board.
In accordance witb the paragraph under "FAILURE TO COMPLY" of the September 2009
Consent Agreement, you are hereby notified that it appears to the Board that you have violated
Item 5. of the September 2009 Consent Agreement.
YOU ARE FURTHER NOTIFIED THAT YOUR LICENSE TO PRACTICE NURSING
AS A LICENSED PRACTICAL NURSE, PN-096935, IS HEREBY AUTOMATICALLY
SUSPENDED. Continued practice after receipt of this notice of suspension shall be considered
engaging in the practice of nursing as a licensed practical nurse without a current, valid license,
which is a violation of Section 4723.03(B), ORC.
You are further notified that in accordance with Chapter 119, ORC, the Board proposes under
authority of Section 4723.28, ORC, to deny, permanently revoke, revoke, suspend or place
restrictions on your license to practice nursing as a licensed practical nurse; reprimand or
otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per
violation for the following reasons:
1. On or about September 25, 2009, you entered into a Consent Agreement
(September 2009 Consent Agreement) with the Ohio Board of Nursing
(Board), a copy of which is attached hereto and incorporated herein, in which
you agreed with the Board that your license to practice nursing as a licensed
practical nurse in the State of Ohio would be reinstated and suspended
indefinitely and that such suspension would be stayed subject to probationary
terms, conditions, and limitations until at least September 2012. Attached to
and incorporated within the September 2009 Consent Agreement is a July 18,
2008 Consent Agreement (July 2008 Consent Agreement).
2. Item 5. of tbe September 2009 Consent Agreement states, "MS. COMBS
shall continue submitting, at her expense and on the day selected, blood or
urine specimens for drug and/or alcohol analysis at a collection site specified
by the Board at such times as the Board may request. Refusal to submit such
specimen, or failure to submit such specimen on the day she is selected, or in
such a manner as the Board may request, shall constitute a violation of a
restriction placed on a license for purposes of Section 4723.28(B), ORC. This
screening shall require a daily call-in process. The specimens submitted by
MS. COMBS shall be negative, except for substances prescribed,
administered, or dispensed to her by another so autborized by law who has full
knowledge of MS. COMBS' history of chemical dependency and recovery
status."
Despite this provision, on or about the dates set forth in Attachment A, attached
hereto and incorporated herein, you failed to call Firstlab, the Board's random
drug/alcohol screen program administrator, to determine if you had been selected
to provide a specimen for analysis.
Karen Denise Combs, L.P.N.
Page 3
Furthermore, on the following dates, you were selected to provide a specimen for
analysis and failed to do so: March 18,2009; November 18,2011; January 18,
2012; May 14, 2012; June. 25, 2012; August 5, 2012; September 4, 2012; and
September 11,2012. .
Section 4723.28(B)(17), Ohio Revised Code, ORC, authorizes the Board to discipline a licensee
for violation of any restrictions placed on a nursing license by the Board.
Accordingly, the Board is authorized to impose one or more of the sanctions as cited in Section
4723.28,ORC.
In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing
in this matter. If you wish to request such hearing, the request must be made in writing and must
be received in the Board office within thirty (30) days of the time of mailing of this notice.
You are hereby further informed that, if you timely request a hearing, you are entitled to appear
at such hearing in person, by your attorney, or by such other representative as is permitted to
practice before the Board, or you may present your position, arguments, or contentions in
writing. At the hearing you may also present evidence and examine witnesses appearing for and
against you.
Should you choose to request a hearing, please mail or deliver the request, in addition to any
other correspondence regarding this matter, to: Lisa Ferguson-Ramos, Compliance Unit
Manager, Ohio Board of Nnrsing, 17 South High Street, Suite 400, Columbus, Ohio 43215-
7410, or to the e-mail address, hear!!!g@nursiJJg.ohio.gQY.
If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing
of this notice, the Board may, in your absence and upon consideration of the factual and legal
allegations set forth in this Notice of Automatic Suspension and Opportunity for Hearing, deny,
permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a
licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more
than five hundred dollars ($500.00) per violation.
Sincerely,
Judith A. Church, R.N., eN.p.
Supervising Board Member
Certified Mail Receipt No. 70121010 0002 4257 4541
cc: Henry G. Appel, Assistant Attorney General
Case #Oslr1773 & #094542
..
17 SoufliHigh Street,S"ifi 400 Columbus, Ohio 43215"7410 (614) 466-3947
CONSENT AGREEMENT
BETWEEN
KAREN DENISE COMBS, L.P.N.
AND
OHIOBOARD OF NURSING
This Consent Agreement is entered into by and between KAREN DENISE COMBS,
LoP.N. (MS. COMBS) and the Ohio Board of Nursing (Board), the state agency charged
with enforcing Chapter 4723. of the Ohio Revised Code (ORC), and all administrative
rules promulgated thereunder.
MS. COMBS voluntarily enters into this Consent Agreement being fully informed of her
rlghtSurideiCh:ipter 119. ORC, including the right to representationby legal counsel and
the right to a formal adjudicative hearing on the issues considered herein.
This Consent Agreement contains the entire agreement between the parties, there being
no other agreement of any kind, verbal or otherwise, which varies the terms of this
Consent Agreement.
BASIS FOR ACTION
This Consent Agreement is entered into on the basis of the following stipulations,
admissions and understandings:
A. The Board is empowered by Section 4723.28, ORC, to deny,
permanently revoke, revoke, suspend, or place restrictions on any
license issued by the Board; reprimand or otherwise discipline a
licensee; or impose a fine of five hundred dollars ($500.00) or less
per violation. MS. COMBS admits to violating Section 4723.28,
ORC, as set forth in the attached Consent Agreement.
B. MS, COMBS was initially issued a license to practice nursing in
Ohio as a licensed practical nurse, PN-096935 on September 5,
1995, and she placed her license on inactive statos in August 2001.
Further, on or about July 18, 2008, MS. COMBS and the Board
entered into a Consent Agreement (July 2008 COnsentAgreement)
in which her license was indefinitely suspended, a copy of which is
attached and incorporated herein.
C. Under the terms of the July 2008 Consent Agreement, MS.
COMBS is now eligible to request reinstatement of her license and
KarenDenise Combs, L.P.N.
Page 2
has provided the Board with evidence of a chemical dependency
evaluation performed by Patty Sons, CDCA, at Butler County
TASC, on or about April 21, 2009, in which MS. COMBS was
diagnosed with Opioid Dependence Full Sustained Remission.
Further, MS. COMBS reportedthat she has been sober for over 31
months and that she regularly attends three to four 12 step
meetingsper week.
D. MS. COMBS understands that any violations of this Consent
Agreement and/or any further violations of the laws and rules
governing the practice of nursing may result in further disciplinary
action, up to and includingpermanent revocation of her license.
AGREED CONDITIONS
Wherefore, in consideration of the foregoing and mutual promises hereinafter setforth,
and in lieu of any formal proceedings at this time, MS. COMBS knowingly and
voluntarily agrees with the Board to the following terms, conditions, and Iimitations:
Upon meeting the requirements for renewal, MS. COMBS's license to practice nursing
as a licensed practical nurse shall be reinstated and suspended indefinitely. Such
suspensionshall be stayed, subject to the followingPROBATIONARY terms, conditions,
and limitationsuntil at least September 2012:
1. MS. COMBS shall obey all federal, state, and local laws, and all laws
and rules governingthe practiceof nursing in Ohio.
2. MS. COMBS shall appear in person for interviews before the full
Board or its designated representative as requested by the Board or its
designee.
Monitoring of Rehabilitation and Treatment
3. MS. COMBS shall abstain completely from the personal use or
possession of drugs, except those prescribed, administered, or
dispensed to her by another so authorized by law who has full
knowledge of MS. COMBS's history of chemical dependency and
recovery status. MS. COMBS shall self-administer prescribed drugs
only in the manner prescribed.
4. MS. COMBS shall abstain completelyfromthe use of alcohol.
5. MS. COMBS shall continue submitting, at her expense and on the day
selected, blood or urine specimensfor drug and/or alcohol analysis at a'
collection site specified by the Board'at such times as the Board may
request. Refusal to submit such specimen, or failure to submit such
Karen Denise Combs, L.P.N.
Page 3
specimen on the day she is selected, or in such a manner as the Board
may request, shall constitute a violation of a restriction placed on a
license for purposes of Section4723.28(B), ORC. This screening shall
require a daily call-in process. The specimens submitted by MS.
COMBS shall be negative, except for substances prescribed,
administered, or dispensed to her by another so authorized by law who
has full knowledge of MS. COMBS's history of chemical dependency
and recovery status,
6. MS. COMBS shall continue attending a minimum of one (1) meeting
per week of a support or peer group meeting approved in advance by
the Board, or a Twelve Step program, and MS. COMBS shall provide
satisfactory documentation of such attendance to the Board every six
(6) months beginning March 1, 2010.
7. Upon request by the Board or its designee, MS. COMBS shall, at
her own expense, and within sixty (60) days of such request(s),. obtain
a chemical dependency evaluation and/or a psychiatric evaluation and
shall provide the Board with complete documentation of the
evaluation(s) from professional(s) approved in advance by the Board.
Prior to the evaluationfs), MS. COMBS shall provide the
professional(s) with a copy of this Consent Agreement and the attached
July 2008 Consent Agreement. If the Board or its designee requestsa
chemical dependency evaluation, MS. COMBS shall provide the
chemical dependency professional with summaries from Butler County
TASC. Further, if the Board or its designee requests a psychiatric
evaluation, MS. COMBS shall also provide the physician witli
summaries from her treating physicians for the past five years,
including the types and frequency of psychiatric medications she has
beenprescribed in that period. MS. COMBS shall execute releases to
permit the professional(s) to obtain any information deemed
appropriate and necessary for the evaluatioms), The evaluating
professional(s) shall submit a written opinion to the Board that includes
diagnoses, recommendations for treatment and monitoring, any
additional restrictions that should be placed on MS. COMBS's license
to practice, and statement(s) as to whether MS. COMBS is capable of
practicing nursing according to acceptable and prevailing standards of
safe nursing care.
8. If the Board or its designee requests evaluations, MS. COMBS shall
provide the Board with satisfactory documentation of compliance with
all aspects of the treatment plan(s) developed by the professionai(s)
described above until released. Further, MS. COMBS agrees that the
Board may utilize the professional's recommendations and conclusions
from the evaluatloms) as a basis for additional terms, conditions, and
Karen Denise Combs, L.P.N.
Page 4
limitations on MS. COMBS's license and that the terms, conditions,
and limitations shall be incorporated in an addendum to this Consent
Agreement.
Treating Practitioners and Reporting
9. Within sixty (60) days of the effective date of this Consent
Agreement, MS. COMBS shall provide a copy of this Consent
Agreement and the attached July 2008 Consent Agreement to all
treatingpractitioners and shall provide to the Board a list of all treating
practitioners, including addresses and telephone numbers. Farther,
MS. COMBS shall be under a continuing duty to provide a copy of this
Consent Agreement and the attachment, prior to initiating treatment, to
additional treating practitioners, and to update the list of treating
practitioners with the Board within forty-eight (48) hours of being
treated by another practitioner.
10. MS. COMBS shall cause all treating practitioners to complete a
medication prescription report that is to be mailed by the practitioner
directly to the Board. The medicationreport is to be completedfor any
and all substances prescribed, administered, or dispensed to MS.
COMBS throughout the durationof this Consent Agreement.
11. Within twenty-four (24) hours of release from hospitalization or
medical treatment, MS. COMBS shall notify the Board of any aud ali
medication(s)or prescription(s)received.
Employment Conditions
12. Prior to accepting employment as a nurse, each time with every
employer, MS. COMBS shall notify the Board in writing.
13. Prior to acceptingnursingemployment, MS. COMBS shall provide her
employer(s) with a copy of this Consent Agreement and the attached
Jnly 2008 Consent Agreement. Further, MS. COMBS is under a
continuing duty to provide a copy of this Consent Agreement and the
attachment to any new employer prior to accepting employment to
work as a nurse. MS. COMBS shall have her employer(s) submit
written reports regarding job performance on a quarterly basis
commencing thirty (30) days after beginning nursing employment.
MS. COMBS shall have her employer(s) send documentation to the
Board. along with the first employer report, of receipt of a copy of this
Consent Agreement and the attachment, including the date the Consent
Agreementand the attachmentwere received.
Karen Denise Combs, L.P.N.
PageS
Reporting Requirements of Licensee
14. MS. COMBS shall report to the Board, in writing, any violationof this
Consent Agreement within thirty (30) days of the occurrence of the
violation.
15. MS. COMBS shall sign release of information forms allowing health
professionals and other organizations to submit the requested
documentationdirectly to the Board.
16. MS. COMBS shall submit any and all informationthat the Board may
reqnestregarding her ability to practice according to acceptable and
prevailingstandards of safe nursingpractice.
17. MS. COMBS shall not submit or cause to be submitted any false,
misleading, or deceptive statements, information, or documentation to
the Board or to employers or potential employers.
18. MS. COMBS shall submit the reports and documentation required by
this Consent Agreement on forms specifiedby the Board. All reporting
and communicationsrequired by this Consent Agreement shall be made
to the Compliance Unit of the Board.
19. MS. COMBS shall submit the reports and documentation required by
this Consent Agreement or any other documents required by the Board
to the attention of the Compliance Unit, Ohio Board of Nursing, 17
SouthHigh Street, Suite 400, Columbus, OH43215-7410.
20. MS. COMBS shall verify that the reports and documentation required
by this Consent Agreement are receivedin the Board office.
21. MS. COMBS shall informthe Board within five (5) business days, in
writing, of any change in employment status or of any change in
residential or home address or telephonenumber.
Nursirig lWfresher Course or Orientation
MS. COMBS shall, prior to working in a position where a nursing license is
required, complete and submit satisfactory documentation of completion of a nursing
refresher course or an extensiveorientation to be approved in advance by the Board or its
designee.
Karen Denise Combs, L.P.N.
Page6
Permanent Narcotic Restriction
MS. COMBS further knowingly and voluntarily agrees with the Board to the following
PERMANENT LICENSURE RESTRICTIONS:
Unless otherwise approved in advance by the Board or its designee, MS. COMBS
shall not administer, have access to, or possess (except as prescribed for MS. COMBS's
use by another so authorized by law who has full knowledge of MS. COMBS's history
of chemical dependency and recovery status) any narcotics; other controlled substances,
or mood altering drugs. In addition, MS. COMBS shall not count narcotics or possess or
carry any work keys for locked medication carts, cabinets, drawers, or containers. MS.
COMBS shall not call in or order prescriptions or prescription refills for narcotics, other
controlled substances, or mood altering drugs.
Permanent Practice Restrictions
MS. COMBS further knowingly and voluntarily agrees with the Board to the following
". PERMANENT LICENSURE RESTRICTIONS:
Unless otherwise approved in advance by the Board or its designee, MS. COMBS
shall not practice nursing as a licensed practical nurse (1) for agencies providing home
care in the patient's residence; (2) for hospice care programs providing hospice care in
the patient's residence; (3) for staffing agencies or pools; (4) as an independent provider
where the nurse provides nursing care and is reimbursed for services by the State of Ohio
through State agencies or agents of the State; or (5) for an individual or group of
individuals who directly engage MS. COMBS to provide nnrsing services for fees,
compensation, or other consideration or as a volunteer.
Unless otherwise approved in advance by the Board or its designee, MS. COMBS
shall not function in a position or employment where the job duties or requirements.
involve management of nursing and nursing responsibilities, or supervising and
evaluating nursing practice. Such positions include, but are not limited to, the following:
Director of Nursing, Assistant Director of Nursing, Nurse Manager, Vice-President of
Nursing.
FAILURE TO COMPLY
MS. COMBS agrees that her license to practice nursing as a licensed practical nurse will
be automatically suspended if it appears to the Board that MS. COMBS has violated or
breached any terms or conditions of the Consent Agreement. Following the automatic
suspension. the Board shall notify MS. COMBS via certified mall of the specific nature
of the charges and automatic suspension of her license. Upon receipt of this notice, MS.
COMBS may request a hearing regarding the charges.
The above described terms and conditions shall constitute' "restrictions placed on a
license" for purposes of Section 4723.28(B), ORC. If, in the discretion of the Board.
MS. COMBS appears to have violated or breached any terms or conditions of this
Karen Denise Combs, L.P.N.
Page 7
Consent Agreement, the Board reserves the right to institute formal disciplinary
proceedings for any and all possible violations or breaches, including, but not limited to,
alleged violations of the laws of Ohio occurring before the effective date of this Consent
Agreement.
DURATIONI MODIFICATION OFTERMS
The terms, limitations, and conditions, of this Consent Agreement, other than the
permanent practice restrictions, may be modified or terminated. in writing. at any time
upon the agreement of both MS. COMBS and the Board.
The Board may only alter the probationary period imposed by this Consent Agreement if:
(1) the Board determines that MS. COMBS has complied with all aspects of this Consent
Agreement', and (2) the Board determines that MS. COMBS is able to practice according
to acceptable and prevailing standards of safe nursing care without Board monitoring,
based upon an interview with MS. COMBS and review ofthe reports as required herein.
Any period during which MS. COMBS does not work in a position for which a nursing
license is required shall not count toward fulfllling the probationary period imposed by
this Consent Agreement.
ACKNQWLEDGMENTSILIABILITY RELEASE
MS. COMBS acknowledges that she has had an opportunity to ask questions concerning
the terms of this Consent Agreement and that all questions asked have been answered in a
satisfactory manner.
MS. COMBS waives all of her rights under Chapter 119, ORC, as they relate to matters
that are the subject of this Consent Agreement.
MS. COMBS waives any and all claims or causes of action she may have against the
Board, and its members, officers, employees and/or agents arising out of matters, which
are the SUbject of this Consent Agreement.
This Consent Agreement shall be considered a public record as that term is used in
Section 149.43, ORC. The information contained herein may be reported to appropriate
organizations, data banks and governmental bodies.
This Consent Agreement is not an adjudication order as discussed in Chapter 119, ORC.
Any action initiated by the Board based on alleged violations of this Consent Agreement
shall comply with the Administrative Procedures Act, Chapter 119. ORC.
.', i':";
" .,
Il:aren Combs, 'L.P.N.
PegeS '
EF!1EC'l.'lVEDATE
MS. COMll$ understands that this Consent Agreement is s\\bJect to ratification by lhe
Boatd ;priQr t signature by the Board President ani:l shall upOn th lam:
daleof si&!lSture below, >
'.
,', ,'" ' ,1
> ,.
,,", .
LISA N,lQ;: esident
". ". , " .. ""... ,_,...1, .. " __ ...
Ohio Boardot NursiDg>
, :.
Case# 04-2916
Ohio Board of Nursing www.l1ursing.ohio.gov
i7 South High Street, Suite 400 Columbus, Ohio 432157410 (614) %63947
CONSENT AGREEMENT
BETWEEN
KAREN DENISE COMBS, L.P.N.
AND
OHIO BOARD OFNURSING
This Consent Agreement is entered into by and between KARENDENISE COMBS. L.l'.N.
(MS. COMBS) and theOhioBoard ofNurslng (Board). the stateagency charged with enforcing
Chapter 4723. of the Ohio Revised Code (ORC), and all administrative rules promulgated
thereunder.
MS. COMBS voluntarily enters into this Consent Agreement being fully informed of her rights
under. Chapter119. ORC, ineludlng theright to representation by legal counsel andthe rightto a
formal adjudicative hearing on theissues considered herein.
This ConsentAgreement contains theentireagreement between the parties, there beingno other
agreement of anykind,verbal or otherwise, which varies thetermsof this Consent Agreement.
MSlS FOR ACTION
This Consent Agreement is entered into on the basis of the following stipulations, admissions
andunderstandings:
A. The Board is empowered by Section 4723.28, ORC, to deny, permanently revoke,
revoke, suspend, or placerestrictions on any license issued by tile Board; reprimand or
otherwise discipline a licensee; or impose a fine of five hundred dollars($500.00) or less
per Violation. Section 4723.28(B)(4), ORC, the Boardto discipline a licensee
for conviction of, a plea of guilty to, a judicial finding of guilt of, a judicial finding of
guilt resulting from a plea of no contest to, or a judicial finding of eligibility for
intervention in lieu of conviction for, any felony or cf any crime involving gross
immorality or moral turpitude. Section 4723.28(B)(5), ORC, authorizes the Board to
discipline a licensee for conviction of, a plea of guiltyto, a judicial finding of guilt of, a
judicial finding of guilt resulting from a plea of no contest to, or. a judicial finding of
eligibility forintervention in lieuof conviction for, violating anymunicipal, state, county,
or federal drug law. Section 4723.28(B)(8), ORC, authorizes the Board to discipline a
licenseefur self-administering or otherwise takinginto the body any dangerous drug, as
defined in Section 4729.01, ORC, in any way not in accordance witil a legal, valid
prescription issued for that individual. Section 4723.28(B)(9), ORC, authorizes the Board
to discipline a licensee for habitual indulgence in theuse of controlled substances, other
habit-forming drugs, or alcohol or other ebemical substances to an extent that impairs
ability to practice Section 4723.28(B)(13), ORC, authorizes the Board to discipline a
licenseefor obtaining or attempting to obtain money or anything of value by intentional
KarenDenise Combs, L.P,N.
Page2
misrepresentation or material deception in thecourseof practice. Section 4723.28(B)(25),
. ORC, authorizes the Boardto discipline a licensee for failure to comply with the terms
and conditions of participation in the chemical dependency monitoring program
established under Section4723.35, ORC. Section 4723.28(B)(16), ORC, authorizes the
Boardto discipline a licensee for violation of Chapter 4723, ORC, or anyrules adopted
under it. Specifically, Rule 4723603(A), Ohio Administrative Code, requires a
participant in the Alternative Program for Chemical Dependency to comply with all of
the terms andconditions of the participant's agreement withtheAlternative Program for
Chemical Dependency for the timeperiodspecified in theagreement.
B. MS. COMBS's license to practice nursing as a licensed practical nurse in the Stale of
Ohio, PN096935, has been inactive since August 2001. MS. COMBS's Ohio nursing
license wasinitially issued in 1995.
C. MS. COMBSknowingly andvoluntarily admits tothe following:
1. In July 1999, while employed as a Charge Nurse at Clovernook Health
Care Pavilion in Cincinnati, Ohio, MS. COMBS Was confronted
regarding her possession of ten Ultram tablets. MS, COMBS admitted
that she had diverted the Ultram from the facility for her personal Use.
MS. COMBS wasterminated from her employment at Clovernook Health
Care Pavilion.
2. MS. COMBS further admitted to the Board a long history of chemical
abuse and dependence including use of marijuana, alcohol. Xanax, Soma,
and narcotics including Vicodln, MSContin and OxyContin, MS.
COMBS received 90 days inpatient chemical dependency treatment at
APAPT for Women beginning in August 1999. MS. COMBS
subsequently participated in Continuing Care treatment at First Step
Home, Inc, fromNovember 1999 through 2001.
3. On March 30, 2000, effective through April 1, 2003, MS. COMBS
entered into an Alternative Program Participant Agreement (Agreement)
with the Board's Alternative Program for Chemical Dependency
(Alternative Program).
While in the Alternative Program, MS. COMBS had negative drug
screens from August 2000 through May 2001. On June 8, 2001, MS.
COMBS failed to undergo a drug test when selected to do so and in
violation of her Agreement.
In August 2001, MS. COMBS made her nursing license inactive rather
than continue with her Agreement. MS. COMBS indicated that she was
going inactive because she did not want to rerumto nursing at that time
andbecause of thefinancial burden of paying for drugscreens.
Karen Denise Combs, L.P.N.
PageJ
4. MS. COMBSindicated that shortly after leaving the Alternative Program,
she relapsed andbegan usingpainmedications.
5. In 2005, MS. COMBS was convicted of Disorderly Conduct, a fourth
degree misdemeanor, in Hamilton Municipal Court Case Number
05CRBQ7267.
6. On June I, 2006.MS. COMBS was stopped byHamilton City Policefor
stopping traffic. An unlabelled prescription bottle containing Morphine
and Ativan was found in MS. COMBS' possession. MS. COMBS also
lied to police about having a valid driver's license and provided police
with a false social security number, Based on the acts set forth above, on
October 5, 2006, in Butler County Court of Common Pleas Drug Court
Case Number CR2006-06-1023, MS. COMBS, havingentered a guilty
plea, was found guilty of one (1) count of Aggravated Possession of
Drugs, a fifthdegreefelony in violation of Section 2925.11, aRC; one (1)
count of Possessing Dangerous Drugs, a first degree misdemeanor in
violationof Section 4729.51(C)(3); aRC; andone(1) count Possession of
Drugs, a third degree mJsdemeanor in violation of Section 2925.11, aRC.
In October 2007, MS. COMBS was successfully discharged from the
Butler County TASCProgram and Horizon DrugCourtTreatment On or
about February 4, 2008, the Court determined that MS, COMBS had
successfully completed the Butler County Court Directed Treatment
Program in CaseNumberCR2006-06-1023.
7. MS. COMBS contacted the Board in March 2008 and indlcated her
Willingness to cooperate withthe Boardinorderto ensure her returnto the
safe practice of nursing, MS. COMBS indicated that she has been sober
for over 18 months, remains active in Narcotics Anonymous and
submitted a letterof support fromher sponsor.
AGREEDCONDlTlONS.
Wherefore, in consideration of the foregoiug and mutual promises hereinafter set forth, and iu
lieuof anyformal proceedings at this time, MS. COMBS knowingly andvoluntatily agrees with
the Boardtothefollowing terms, conditions, andlimitations:
SUSPENSION OFLICENSE
I. MS. COMBS's license to practice nursing as a licensed practical nurse is hereby
suspended for an indefinite period of time. MS. COMBS may submit a written
request far reinstatement anytime after the conditions for reinstatement have
been met.
Karen Denise Combs, L.P.N.
Page 4
CONDITIONS FORREINSTATEMENT
2. MS. COMBS shall obey all federal, state, and local' laws, and all laws and rules
governing the practice of nursing InOhio.
3. MS. COMBS sball appear in person for interviews before the full Board or its
designated representative as requested bytheBoard or itsdesignee.
4. Within six (6) monthsprior to requestingreinstatement, MS. COMBSagrees that
she will submit a request to the Bureau of Criminal Identification and Investigation
(BCII) to conduct a criminal records check of MS. COMBS, including a check of
Federal Bureau of Investigation records, and shall cause BeH to submit MS.
COMBS's completed criminal records check reports totheBoard.
5. Prior to reinstatement, MS. COMBSshall enter Into a Consent Agreement with the
Boardfor probationary terms, conditions, andlimitations determined by the Board for
a minimum period of three (3) yearsfollowing reinstatement.
Monitoringof Rebabilltationand Treatment
6. MS. COMBSshall abstain completely fromtbe personal useor possession of drugs,
exceptthose prescribed, administered, or dispensed to herbyanother so authorized by
lawwhohas full knowledge of MS. COMBS's history of chemical dependency and
recovery status, MS. COMBS shall self-administer the prescribed drugs only in the
manner prescribed.
7. MS. COMBSshall abstain completely from theuseof alcohol.
8. Withln six (6) monthsprior to seekingreinstatementby the Board, MS. COMBS
shall, at her own expense, seek a chemical dependency evaluatlon by a Board
approved chemical dependency professlonal and shall provide the Board with
complete documentation ofthisevaluation. Priortothe evaluation, MS. COMBSshslJ
provide thechemical dependency professional with a copy of thisConsent Agreement.
Further, MS. COMBS shall execute releases to permit the chemical dependency
, professional to obtain any information deemed appropriate and necessary for the
evaluation. The chemical dependency professional shall submit a written opinion to
the Board that includes diagnoses, recommendations for treatment and monitoring,
any additional restrictions to be placed on MS. COMBS's license to practice, and
stating whether MS. COMBS is capable of practicing nursing according to acceptable
andprevailing standards of safe nursing care.
9. MS. COMBS shall provide the Board with satisfactory documentation of compliance
with all aspects of the treatment plan developed by the chemical dependency
professional described above until released. Further. MS. COMBS agrees that the
Board may utilize the professional's recommendations and conclusions from the
Karen Denise Combs, L.P.N.
PageS
evaluation as a basis for, additional terms, conditions, and limitations on MS.
COMBS's license and that the terms, conditions, and limitations shall be incorporated
in an addendumto this Consent Agreement.
10. For a minimnm, continuous period of six (6) months immediateiy prior to
requesting reinstatement, MS. COMBS shall submit, at bel' expense and on the day
selected, blood 01' urine specimens for drug and/or alcohol analysis at a collectlon site
specified by the Board at such times as the Board may request. Upon and after MS.
COMBS's initiation of drug screening, refusal to submit such specimen, or failure to
submit such specimen on the day she is selected, or in such a manner as the Board
may request, shall constitute a violation of a restriction placed on a license for
purposes of Section 4723.28(B), ORC. This screening shall require a daily call-in
process, The specimens submitted by MS. COMBS shall be negative, except for
substances prescribed, administered, 01' dispensed to her by another so authorized by
law who has full knowledge of MS. COMBS's history of chemical dependency and
recovery status.
a, Within thirty (30) days prior to MS. COMBS initiating drug screening, MS.
COMBS shall provide a copy of this Consent Agreement to all treating
practitioners and shall provide to the Board a list of all treating practitioners,
including addresses and telephone numbers and cause all treating practitioners
to complete a medication prescripnon report that is to be mailed by the
practitioner directly to the Board. The medication report is to be completed for
any and all substances prescribed, administered. or dispensed to MS.
COMBS.
b. After initiating drng screening, MS. COMBS shall be under a continuing duty
to provide a copy of this Consent Agreement, prior to initiating treatment, to
additlonel treating practitioners. ~ n d to update the list of treating practitioners
with tile Board within forty-eight (48) hours of being treated by another
pracritioner; Further, MS. COMBS 'hall notify tile Board of any and all
medicatlonts) or prescrlptionrs) received within twenty-four (24) hours of
releasefrom hospitalization or medical treatment.
11. For a minimum, continuous period of six (6) months Immediately prior to
requesting reinstatement, MS. COMBS shall attend a minimum of one (l) meeting
per week of a support or peer group meetingapproved in advance by the Board, or a
Twelve Step program, and licensee shall provide satisfactory documentation of such
attendance to the Board prior to reinstatement.
Psychiatric Evaluation and Treatment
12. Upon request by the Board or its designee and prior to reinstatement, MS.
COMBS shall, at her own expense, seek a psychiatric evaluation from a Board
approved psychiatrist and shall provide the Board with complete documentation of
such evaluation. Prior to the evaluation, MS. COMBS shall provide the psychiatrist
KarenDenise Combs, L,P.N.
Page6
with a copy of this Consent Agreement and shall execute releases to permit the
psychiatrist to obtain any information deemed appropriate and necessary for the
evaluation. The psychiatrist shall submit a written opinion to theBoard that includes
diagnoses, recommendations for treatment andmonitoring, any additional restrlctions
that should be placed on MS. COMBS's license, and a statement as to whether MS.
COMBS is capable of practicing nursing according to acceptable and prevailing
standards of safenursing care.
13. If a psychiatric evaluationis requested, MS. COMBSshall provide the Board with
satisfactory documentation of compliance with all aspects of the treatment plan
developed by the professional until released. Further, MS. COMBS agrees that the
Board mayusetheprofessional recommendations andconclusions fromtheevaluation
as a basis for additional terms, conditions, and limitations on MS. CoMBS's license
andthat theterms, conditions, and limitations shall beincorporated in an addendum to
this Consent Agreement.
Reporting Requirements of Licensee
14. MS, COMBS shall report to the Board, in writing, any violation of this Consent
Agreement within thirty(30) daysof theoccurrence of theviolation.
15. MS. COMBS shall sign release of information forms allowing health protesalonals
and otherorganizations to submit requested documentation or information directly to
theBoard.
16. MS, COMBS shall submit any and all information that the Board may request
regarding her ability to practice according to acceptable and prevailing standards of
safenursing practice.
17. MS. COMBS shall not submit or cause to be submitted any false, misleading, or
deceptive statements, information, or documentation to the Board or to employers or
potentia! employers.
18. MS. COMBS shall submit the reports anddocumentation required by this Consent
Agreement on forms specified by the Board. All reporting and communications
required by this Consent Agreement shall be made to the Compliance Unit of the
Board.
19, MS. COMBS shan submit the reports and documentation required by this Consent
Agreement to theattention of the Compliance Unit, OhioBoardof Nursing, 17 S0'1th
High Street, Suite400, Columbus, OH43215-7410.
20. MS. COMBS shall verify thatthe reports anddocumentation required by this Consent
Agreement arereceived in theBoardoffice.
Karen DeniseCombs, L.P.N.
Page?
21. MS. COMBS shall informthe Board within three (3) business days, in writing, of any
change in address andlorteiephoue number. .
Nursing Refresher Course or Orientation
MS. COMBS shall, prior to working in a position where a nursing license is
required, complete and submit satisfactory documentation of completion of a
nursing refresher course or an extensive orientation approved in advance by the
Boardor its designee.
Permanent Narcotic Restrictions
MS. COMBS further knowingly and voluntarily agrees with the Board to the following
pERMANENT LICENSURERESTRICTIONS:
Unless otherwise approved in advance by the Board or its designee, MS.
COMBS shall not administer, have access to, or possess (except as prescribed for
MS, COMBS's use by another so authorizedby law who has full knowledge of MS.
COMBS's history of chemical dependency) any narcotics, other controlled
substances, or mood altering drugs. in addition, MS. COMBS shall not count
narcotics or possess or carry any work keys for locked medication carts, cabinets,
drawers, or containers. MS. COMBS shall not call in or order prescriptions or
prescription refillsfor narcotics, other controlledsubstances, or moodaltering drugs.
Permanent Practice Restrictions
MS. COMBS further knowingly and voluntarily agrees with the Board to the following
PERMANENT LICENSURE RESTRICTIONS:
Unless otherwise approved In advance l:Iy the Board or its designee, MS.
COMBS shall not practice nursing as a licensed practical nurse (1) for agencies
providing home care in the patient's residence; (2) for hospice Care programs
providing hospice care in the patient's residence; (3) for staffingagencies or pools;
(4) as an Independent provider where the nurse provides nursing care and is
reimbursed for services by the State of Ohio through State agencies or agents of the
State; or (5) for an individual or gronp of individuals who directly engage MS.
COMBS to provide nursingservices for fees, compensation, or other consideration
or as a volunteer.
Unless otherwise approved in advance l:Iy the Board or its designee, MS.
COMBS shall not function In a posltlon or employment where the job duties or
requirements involve. management of nursing and nursing responsibilities, or
snpervislng and evaluating nursing practice. Such positions include but are not
limited to the following: Director of Nursing, Assistant Director of Nursing, Nurse
Manager, Vice Presidentof Nursing.
Karen Denise Combs, LP.N.
Page B
FAILURE TO COMPLY
The abovedescribed terms and conditions shall constitute "restrictions placedona license"for
purposes of Section 4723.28(13), ORC. If, in the discretion of the Board,MS. COMBS appears
to have violated or breached any terms or conditions of this Consent Agreement, the Board
reserves the right to institute formal disciplinary proceedings for any and all possible violations
or breaches, including, but not limited to, alleged violations of thelawsof Ohio occurring before
theeffective dateof thisConsent Agreement.
DPRATION/MQDIFICATION OF TERMS
The terms, limitations, and condltions of this Consent Agreement, other than the permanent
licensure restrictions, maybe modified or terminated in writing at anytime npon tileagreement
of both MS. COMBSandthe Board..
The Board may only alter tile indefinite suspension imposed if: (1) MS. COMBS submits a
written requestfor reinstatement; (2) the Boarddetermines that MS. COMBS bas complied with
all conditions of reinstatement; (.0) the Boarddetermines that MS. COMBS is able to practice
according to acceptable and prevailing standards of safe nursing care based upon an interview
withMS. COMBSand review of the documentation specified in this Consent Agreement; and
(4) MS. COMBShas entered into a Consent Agreement withthe Boardfor probationary terms,
conditions, and llmitations determined by the Board for a minimum period of three (3) years
foliowing reinstatement.
ACKNOWLEDGMENTSIUABILITY RELEASE
MS. COMBS acknowledges that she has had an opportunity to ask questions concerning the
terms of this Consent Agreement and that all questions asked have been answered in a
satisfactory manner.
MS: COMBSwaives all of her rights under Chapter 119, ORC,as theyrelateto matters that are
thesubject of this Consent Agreement,
MS. COMBSwaives anyand all claims or causes of action shemuy have against the Board, and
its members, officers, employees and/or agents arising out of matters that are the subjectof this
Consent Agreement.
This Consent Agreement is not an adjudication order as discussed in Chapter 119, ORC. Any
actioninitiated bytheBoardbased on alleged violations of thisConsent Agreement shall comply
withthe Administrative Procedures Act, Chapter119,ORe.
This Consent Agreement shall be considered a public record as that term is used in Section
149,43, ORC The information contained herein may be reported to appropriate organizations,
databanks and governmental bodies.
Karen Denise Combs, L.P.N.
Page 9
EFFECTIVE DATE
MS. COMBS understands that this Consent Agreement is subject to ratification by the Soard
prior to signature by the Board President and shall become effective upon the last date of
signature below.
c'mk-r
KA NDENISECOMBS,L.l'.N. DATE
USAIU.ENIm, l:'resJ,dent
Ohio BoardofNuising
1-\tD-(f>
DATE
ATTACHMENT A
Period From: Tuesday, 11/04/2008 To: Wednesday, 09/19/2012
Name: Karen Combs Case 10: 616 Status: Active
Missed call History
Date
Missed
call?
12/10/08 Missed CaB
12/11/08 Missed CaB
1/25/09 Missed CaB
2/3/09 Missed CaB
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2/21/09 Missed CaB
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3/6/09 Missed CaB
3/12/09 Missed CaB
Missed CaB
Scheduled
3/18/09 for Testing
5/21/09 Missed CaB
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5/28/09 Missed CaB
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7/12/09 Missed CaB
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8/9/09 Missed Call
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8/21/09 Missed CaB
8/29/09 Missed Call
8/31/09 Missed CaiJ
9/2/09 Missed CaB
9/3/09 Missed Call
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10/24/09 Missed Call
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3/18/10 Missed Cali
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4/2/10 Missed Call
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4/17/10 Missed Call
4/18/10 Missed Call
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6/5/10 Missed Call
6/19/10 Missed Call
7/4/10 Missed Call
7/18/10
.
Missed Call
7/25/10 Missed Call
8/8/10 Missed Call
9/2/10 Missed Call
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10/10/10 Missed Call
10/21/10 Missed Call
10/30/10 Missed Call
11/3/10 Missed Call
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12/25/10 Missed Call
1/2/11 Missed Call
1/14/11 Missed Call .
1/29/11 Missed Call
2/20/11 Missed Call
2/23/11 Missed Cali
2/26/11 Missed Call
3/6/11 Missed Call
4/1/11 Missed Call
4/6/11 Missed Call
6/5/11 Missed Call
6/24/11 Missed Call
7/3/11 Missed Call
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7/23/11 Missed Call
7/28/11 Missed Call
8/6/11 Missed Call
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8/20/11 Missed Call
8/27/11 Missed Call
8/30/11 Missed Call
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9/2/11 Missed Call
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10/6/11 Missed Call
10/10/11 Missed Call
10/16/11 Missed Call
11/4/11 Missed Call
11/12/11 Missed Call
11/16/11 Missed Call
12/12/11 Missed Call
12/30/11 Missed Call
1/7/12 Missed Call
1/9/12 Missed Call
1/17/12 Missed Call
1/31/12 Missed Call
3/3/12 Missed Call
3/6/12 Missed Call
3/11/12 Missed Call
4/1/12 Missed Call
4/9/12 Missed Call
4/13/12 Missed Call
4/22/12 Missed Call
4/23/12 M'issed Call
5/3/12 Missed Call
5/10/12 Missed, CaII
5/11/12 Missed Call
5/12/12 Missed Call
5/13/12 Missed Call
5/28/12 Missed Call
6/24/12 Missed Call
6/29/12 Missed Call
7/15/12 Missed Call
7/22/12 Missed Call
7/27/12 Missed Call
7/28/12 . Missed Call
7/29/12 Missed Call
8/4/12 Missed Call
Missed Call
Scheduled
8/5/12 for Testing
8/18/12 Missed Call
8/19/12 Missed Call
9/2/12 Missed Call
9/6/12 Missed Call
9/12/12 Missed Call
9/13/12 Missed Call
9/14/12 Missed Call
9/15/12 Missed Call
9/16/12 Missed Call
9/17/12 Missed Call
9/18/12 Missed Call
9/19/12 Missed Call
RowCount: 146
Cases #11-003490; 12-006499
Ohio Boa.rd of Nursing www.nursing.ohio.gov
17 South High Street. Suite 400 . ~ Columbus. Ohio 43215-7410 (614) 466-3947
November 16,2012
NOTICE OF OPPORTUNITY OF HEARING
Crystal Lee Cooper, L.P.N.
2908 Amoy Ganges Rd
Mansfield, Ohio 44903
Dear Ms. Cooper:
In accordance with Chapter 119, Ohio Revised Code (ORC), you are hereby notified that the
Ohio Board of Nursing (Board) proposes under authority of Section 4723.28, ORC, to deny,
permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a
licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more
than five hundred dollars ($500.00) per violation for the following reasons:
1. On or about April 27, 2011, while working as a nurse at Crystal Care Center of
Mansfield (Crystal Care), you contacted facility personnel, and indicated that
Patient #1 wanted to be discharged from Crystal Care [see attached Patient Key -
to Remain Confidential and Not Subject to Public Disclosure]. You further
indicated that you loved Patient #1, that you wanted to help Patient #1, and that
you were willing to continue to provide nursing care to Patient #1 at her home. On
or about July 21,2011, Patient #1 was discharged out of Crystal Care, after which
time, you began providing nursing care to the Patient #1 as a private duty nurse.
According to an Ontario, Ohio Police Division Narrative Report (Report), on or
about August 12, 2011, you and/or your husband attempted to cash a check
written to "cash" on Patient #l's account in the amount of $3,800.00. The check
was not honored at one bank, but was then cashed for $38.00 at another bank. The
Report indicates you stated that you engaged in the check-related activity because
Patient #1 told you to do this.
Section 4723.28(B)(31), ORC, authorizes the Board to discipline a licensee for failure to
establish and maintain professional boundaries with a patient, as specified in rules adopted under
section 4723.07, ORC. Section 4723.28(B)(16), ORC, authorizes the Board to discipline a
licensee who has violated Chapter 4723 or any of the rules adopted under it. Specifically, Rille
4723-4-06(L), OAC, states, in pertinent part, that a licensed nurse shall not misappropriate a
client's property or: (3) Engage in behavior that constitutes inappropriate involvement in the
client's personal relationships or financial matters; or (4) Engage in behavior that may
reasonably be interpreted as inappropriate involvement in the client's personal relationships or
Crystal Lee Cooper, L.P.N.
Page 2
financial matters. For the purpose of this paragraph, the client is always presumed incapable of
giving free, full, or informed consent to the behaviors by the nurse set forth in this paragraph.
2. On or about October 30, 2012, in the Common Pleas Court of Richland County
Case No. 2012 CR 0103 H, you pled guilty to Theft, a fifth-degree felony in
violation of Section 2913.02(A)(1), ORC; Forgery, a fifth-degree felony in
violation of Section 2913.31(A)(3), ORC; and Receiving Stolen Property, a fifth-
degree felony in violation of Section 2913.51(A), ORC. The acts underlying these
crimes occurred on or about August 12, 2011 in Richland County.
Section 4723.28(B)(4), ORC, authorizes the Board to discipline a licensee for conviction of, a
plea of guilty to, a judicial finding of guilt of, a judicial finding of guilt resulting from a plea of
no contest to, or a judicial finding of eligibility for intervention in lieu of conviction for, any
felony or of any crime involving gross immorality or moral turpitude.
Accordingly, the Board is authorized to impose one OJ more of the sanctions as cited in Section
4723.28,ORC.
In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing
on this matter. If you wish to request such hearing, the request must be made in writing and
must be received in the Board office within thirty (30) days of the time of mailing this notice.
You are hereby further informed that if you timely request a hearing, you are entitled to appear at
such hearing in person, by your attorney, or by such other representative as is permitted to
practice before the Board, or you may present you position, argument, or contentions in writing.
At the hearing you may also present evidence and examine witnesses appearing for and against
you.
Should you choose to request a hearing, please mail or deliver the request, in addition to any
other correspondence regarding this matter to: Lisa Ferguson-Ramos, Compliauce Unit
Manager, 17 South High Street, Suite 400, Columbus, OR 43215-7410, or to the email
address,
If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing
of this notice, the Board may, in your absence and upon consideration of the factual and legal
allegations set forth in the Notice Opportunity for Hearing, deny, permanently revoke, revoke,
suspend or place restrictions on your license to practice nursing as a licensed practical nurse;
reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars
($500.00) per violation.
Sincerely,
Crystal Lee Cooper, L.P.N.
Page 3
Judith Church, R.N., C.N.P.
Supervising Board Member
Certified Mail Receipt No. 7012 1010 0002 42573759
cc: Henry G. Appel, Assistant Attorney General
Cases #12-000265 & 12-002465
Ohio Board of Nursing www.nursing.ohio.gov
17 South HighStreet, Suite400 Columbus. Ohio 43215-7410 (614) 466-3947
November 16,2012
NOTICE OF OPPORTUNITY FOR HEARING
Vickie Lynn Davis, L.P.N.
60 S. Brownell Street
Chillicothe, Ohio 45601
and
2817 Quentin Place
Madison, IN 47250
Dear Ms. Davis:
In accordance with Chapter 119, of the Ohio Revised Code (ORC), yon are hereby notified that
the Ohio Boardof Nursing (Board) proposes under the authority of Section 4723.28, ORC, to
deny, permanently revoke, revoke, suspend or place restrictions on your license to practice
nursing as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of
not more than five hundred dollars ($500.00) per violation for the following reasons:
1. On or about December 27, 2011, while working as a nurse at Traditions of
Chillicothe in Chillicothe, Ohio, you were asked to submit a specimen for a
reasonable suspicion drng screen. The results of your drug screen were
positive for Opiates, and you did not have a legal, valid prescription for
Opiates.
Section 4723.28(B)(8), ORC, authorizes the Board to discipline a licensee for self-administering
or otherwise taking into the body any dangerous drug, as defined in Section 4729.01, ORC, in
any way not in accordance with a legal, valid prescription issued for that individual.
2. On or about February 7,2012, the Indiana State Board of Nursing issued a
Findings of Fact, Conclusions of Law and Order (2012 Indiana Order), in
which your license to practice nursing in the State of Indiana was indefinitely
suspended for a period of not less than six months. A copy of the 2012
Indiana Order is attached hereto and incorporated herein.
Section 4723.28(B)(I), ORC, authorizes the Board to discipline a licensee for denial, revocation,
suspension, or restriction of authority to practice a health care occupation, including nursing, for
any reason other than a failure to renew, in Ohio or another state or jurisdiction.
Accordingly, the Board is authorized to impose one or more of the sanctions as cited in Section
4723.28,ORC.
Vickie Lynn Davis, L.P.N.
Page 2
In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing
in this matter. If you wish to request such hearing, the request must be made in writing and must
be received in the Board office within thirty (30) days of the time of mailing of this notice.
You are hereby further informed that, if you timely request a hearing, you are entitled to appear
at such hearing in person, by your attorney, or by such other representative as is permitted to
practice before the Board, or you may present your position, arguments, or contentions in
writing. At the hearing, you may also present evidence and examine witnesses appearing for and
against you.
Should you choose to request a hearing, please mail or deliver the request, in addition to any
other correspondence regarding this matter, to: Lisa Ferguson-Ramos, Compliance Manager,
Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, Ohio 43215-7410, or to
the e-mail address, hearing@nursing.Qpio.gov.
If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing,
of this notice, the Board may, in yonr absence and upon consideration of the factual and legal
allegations set forth in this Notice of Opportunity for Hearing, deny, revoke, permanently
revoke, suspend or place restrictions on your license to practice nursing as a licensed practical
nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred
dollars ($500.00) per violation.
Sincerely,
Judith A. Church, R.N., C.N.P.
Supervising Board Member
Certified Mail Receipt No. 70121010 0002 4257 3560
Second Address Certified Mail Receipt No. 7012 1010 0002 4257 3667
cc: Henry G. Appel, Assistant Attorney General
BEFORE THE INDIANASTATE
BOARDOF NURSING
CAUSENUMBER: 2011 NB 347
IN THE !I1ATIER OF THE LICENSE OF:
VICIaE LYNNDAVIS, L.P.N.
LICENSE NO: 27034510A
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fiLED
FEB 07 2012
indiao2 Professional
licensingAgency
FINDINGS OF FACT, CONCLUSIONS OF LAWANDORDER
The IndianaState Board of Nursing ("Board") held an administrative hearingon January
19,2012 at the L.A. Pittenger StudentCenter, Cardinal HaJJ, Second Floor, Ban State University,
2000 West University Avenue, Muncie, Indiana concerning the disciplinary complaint filed
against tbe lndiaua nursing licenseof Vickie LYlUl Davis, L.P.N. ("Respondent") on October 18,
2011.
The State of Indiana ("Petitioner") was represented by DeputyAttorney General Patricia
Gibson. The Respondent failed toappeal' ill personor by counsel.
The Board, after considering the evidencepresented and takingofficial notice of its file in
this matter, by a vote of 5-0-0, found Respondent to be in default. The Board then held further
proceedings in Respondent's absence, and, by a vote of 5-0-0, issues the following Findings of
Fact and Order:
FINDINGS OF FACT
1. Respondent is a Licensed Practical Nurse ("LPN") in the State of Indiana having
been issuedlicense number 27034510A on February 5,1992. Respondent's address on filewith
the IndianaProfessional Licensing Agencyis 2817Quentin Place, Madison, Indiana 47250. CD
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2. On or about December 7, 2007, Respondent began employment as a LPN at The
Waters of Clifty Falls ("The Waters") located in Madison, Indiana.
3. On or about January 24, 2008, Respondent received an oral warning for failure to
change a resident's dressing.
4. On or about March 21,2008, Respondent received an oral warning for failing to
have a resident's labs drawn.
5. On or about March 21, 2008, Respondent received a written warning for only
giving one (1) tablet to a resident when the order was written for two (2) tablets, incorrectly
counting on a narcotic sheet, and not signing off narcotics 0', the medication administration
record three (3) times.
6. all. or about April 14,2008, Respondent received a written warning for failing to
complete skin assessment on two (2) residents.
7. On or about April 22, 2008, Respondent received a written warning for failing to
remove two (2) lidoderm patches.
8. On or about May 15, 2009, Respondent received a written warning for failing 10
notify the physician when a feeding tube was lett disconnected for multiple hours. There was no
documentation to justify the feeding tube being off and no orders to change the feeding to
boluses. Respondent also failed to give a resident her morning medication, pre-pulled
medications and. did not remain ill the room while a resident took her medication.
9. 011 or about August 18,2009, Respondent received a written warning for failing
to administer two doses of a resident's medication for two days. Respondent failed to document
a new order for pain medication, a follow-up for a resident's fall, and IV sitelUlerapy/MCR.
Respondent also failed to complete a pain assessment.
2
On or about September 27, 2009, Respondent failed 10 sign out narcotics when
On or about September 26, 2009, Respondent failed to sign out narcotics when
10.
given.
11.
given.
12.
On or about September 30, 2009, Respondent's employment with The Waters
was terminated due to poor work performance.
13. On or about October 22, 2009, Respondent submitted an application to Maxim
Healthcare Services ("M,rxim"), located in Jeffersonville, Indiana. Respondent stated on the
Maxim application that the reason for leaving The Waters was "employment needs changed,
needed more flexibility."
14. On or about November 4, 2009, Respondent was employed as a LPN by Maxim.
15. On or about December 24, 2009, a patient's mother called Maxim to report
Respondent fell asleep on her shift, was frequently late, and the patient's clothes and bed were
saturated from water that was to go in the patient's gastronomy tube.
16. On 0" about January 7, 2010, Respondent's employment with Maxim was
terminated fOT inappropriate conduct.
17. On OT about July 8, 20I 0, Respondent began intake with the Indiana State Nurses
Assitance Program ("1SNAP") at the request of Petitioner. Respondent was diagnosed with an
adjustment disorder, rule out anxiolytic abuse. Respondent successfully completed her Recovery
Monitoring Agreement and was closed out oflSNAP in July 2011.
i 8. On or about October 5, 2010, Respondent renewed her nursing license and
answered "No" to question five (5) which asks, "Since you last renewed, have you ever been
3
terminated, reprimanded, disciplined, or demoted in the scopeof your practiceas a Nurseor as
another health care professional?"
19. On October 18, 2011, an Administrative Complaint was filed in this mailer
against Respondent's Indiana nursinglicense.
20. On November 17, 2011, IPLAsent notice toRespondent, by certifiedand regular
mail to her address on file with IPLA of the date and time of the Settlement/Pre-hearing
Conference scheduled for December I, 2011.
21. Pursuant to Ind. Code 4-21.5-3-20, Respondent was provided adequate notice
of the Settlement/Pre-hearing Conference and failed to appear for the scheduledconference on
December 1,2011.
22. On December I, 2011, Lynda Narwold, R.N., designated by the Board pursuant
to Ind. Code 4-21.5-3-9 to act as Administrative Law Judge issued a Notice of Proposed
Default Order. The Noticeof Proposed Default Order was mailedby certified and regular mail
to Respondent at her addresson file withIPLA.
23. Respondent failed to respond to the Notice of Proposed Default Order within
seven (7) daysas required by Ind. Code 4-2J.5-3-24.
24. OnJanuary 19, 2012, the Board votedto holdRespondent in default.
CONCLUSIONSOF LAW
1. Respondent's conduct as described above constitutes a violation of Ind. Code
25-1-9-4(a)(4)(A) in that Respondent has become unfit to practice due to professional
incompetence as evidenced byher numerous medication errors and subsequent terminations from
The Waters and Maxim.
4
2. Respondent's conduct as described above constitutes a violation of Ind. Code
25-1-9-4(a)(l)(B) in that Respondent engaged in fraud or material deception in the course of
professional services or activities as evidenced by stating on her Maxim application that she left
The Waters due to changing employment needs, rather than being terminated.
3. Respondent's conduct as described above constitutes a violation of Ind. Code
25-1C9-4(a)(l)(A) in that Respondeut engaged in material deception in order to obtain a license
to practice as evidenced by Respondent's failure to disclose her termination from111e Waters in
2009, and termination from Maxim in January, 2010, on her Indiana nursing licensure renewal
in October, 20IO.
ULTIMATE FINDINGS OF FACT
Respondent's failure to comply with the above referenced standards is cause for
disciplinary sanctions which could include censure, a Jetter of reprimand, a fine up 10the amount
of $1,000.00, probation, suspension, 01' a revocation of license as detailed at Ind. Code 25- j -9-
9.
ORDER
Based upon the above Findings of Fact, the Board issues the following Order:
1. -Re$pondent's Indiana nursing license is hereby placed' on INDEFINITE
SUSPENSION for a period of not less than six (6) months.
2. Prior to petitioning for reinstatement, Respondent shall pay to the Professional
Licensing Agency a FINE in the amount of FIVE HUNDRED DOLLARS ($500.00). Said
fine shall be paid by check or money order payable to the Indiana Professional Licensing Agency, .
and submitted to the following address:
5
Professional Licensing Agency
Attn: Indiana State Board of Nursing
402 W. Washington Street, Roomwon
Indianapolis, Indiana46204
3. Prior to petitioning for reinstatement, Respondent shall submit to tile Boardproof
of completion of forty-eight (48) contact hoursof continuing education in the followingareas:
A. Twelve(12) hours in the area of medication administration;
B. Twelve(J 2) hours in tilearea of professionalism! ethics in nursing;
C. Twelve(12) hours in the area of documentation! charting; and
D. Twelve(12) hours in the area of assessment.
4. Prior to petitioningfor reinstatement, Respondent shall pursuant to Ind. Code 4-
6-14-10 (b), pay a fee of Five Dollars ($5.00) to be deposited into the Health Records and
Personal Identifying Information Protection Trust Fund This fee shall be paid by check or money
order payableto the State of Indiana, and submitted to tilefollowing address:
Indiana Office of theAttorney General
Attn: Katie Thorpe
302West Washington Street, 51" Floor
Indianapolis, IN 46204
S. Prior to petitioning for reinstatement, Respondent shall pay to the Indiana
Professional Licensing Agency COSTS in the amount of Ninety Two Dollars and Eighteen
Cents ($92.18). Costs shan be paid by checkor moneyorder payableto the IndianaProfessional
Licensing Agency, and submittedto the following address:
Professional Licensing Agency
Attn: IndianaStateBoardof Nursing
402 W. Washington Street, Room won
Indianapolis, Indiana 46204
6
6. Prior to petitioning for reinstatement, Respondent shall pay to the Indiana Office
of the Attorney General COSTS in the amount of Ten Dollars and No Cents ($10.00). Costs
shall be paid by check or money order payable to the Indiana Office of the Attorney General, and
submitted to the following address:
Indiana Office of the Attorney General
Attn: Katie Thorpe
302 West Washington Street, 5
th
Floor
Indianapolis, IN46204
7. A violation of the Final Order or any non-compliance with the statutes Or
regulations regarding the practice of nursing may result in the State requesting an emergency
suspension of Respondent's license, an Order to Show Cause as may be issued by the Board, or a
new cause of action pursuant to Ind. Code 25-1-9-4, anyor all of which could lead to additional
sanctions, up to and including a revocation of Respondent's license.
SO ORDERED, this __----10"':....,1 day of February, 2012.
INDIANA STATE BOARD OFNURSING
By:
7
Copies to:
VickieLynnDavis, L.P.N.
2817 QuentinPlace
Madison, IN47250
CERTIFIED MAlL NO: 91 7190 0005 2720 0016 0154
RETURN RECEIPT REQUESTED
Patricia Gibson, Deputy Attorney General
IndianaGovernment CenterSouth
302West Washington Street, FifthFloor
Indianapolis, IN 46204-2770
8
Case# 12-001791
Ohio Board of Nursing www.nursing.ohio.gbV
17 SouthHighStreet, Suite400 Columbus, Ohio 43215-7410 (614) 466-3947
November 16,2012
NOTICE OF AUTOMATIC SUSPENSION AND
OPPORTUNITY FOR HEARING
Latrina Marie Dotson, L.P.N.
23921 Banbury Circle #8
Warrensville Heights, Ohio 44128
Dear Ms. Dotson:
You are hereby notified that, on or about May 21,2010, you entered into a Consent Agreement
(May 2010 Consent Agreement) with the Ohio Board of Nursing (Board), a copy of which is
attached hereto and incorporated herein, in which you agreed with the Board that your license to
practice nursing as a licensed practical nurse in the State of Ohio would be suspended
indefinitely and that such suspension would be stayed subject to probationary terms, conditions,
and limitations for a minimum period of two (2) years. Attached to an incorporated within the
May 2010 Consent Agreement is a September 25, 2009 Notice of Opportunity for Hearing
(September 2009 Notice).
A. Item l.of the May 2010 Consent Agreement states, "MS, DOTSON shall
obey all federal, state, and local laws, and all laws and rules governing the
practice of nursing in Ohio." Section 4723.28(B)(l6), ORC, authorizes the
Board to discipline a licensee for violation of Chapter 4723, ORC, or any
rules adopted under it. Specifically, Rule 4723-4-06(J), Ohio Administrative
Code (OAC), states, in pertinent part, that at all times when a licensed nurse is
providing direct nursing care to a client the licensed nurse shall: (2) Treat each
client with courtesy, respect, and with full recognition of dignity and
individuality. Section 4723.28(B)(21), ORC, authorizes the Board to
discipline a licensee for, in the case of a licensed practical nurse, engaging in
activities that exceed the practice of nursing as a licensed practical nurse.
Despite this provision, on or about March 26,2012, while working as a nurse at
Beachwood Pointe Care Center, in Beachwood, Ohio, you restrained a patient
without physician orders authorizing you to do so. Specifically, without
physician orders, you used a garbage bag to restrain the right arm of Patient #1
[see attached Patient Key - to Remain Confidential and Not Subject to Public
Disclosure], who you reported was attempting to pull out his inner cannula and
ventilation tube.
On or about June 26, 2012, you submitted a written statement to the Board
admitting that you "applied soft restraint to the rt. wrist area to prevent resident
from pulling out inner cannula."
Latrina Marie Dotson, L.P.N.
Page 2
Section 4723.28(B)(16), ORC, authorizes the Board to discipline a licensee for violation of
Chapter 4723, ORC, or any rules adopted under it. Specifically, Rule 4723-4-06(J), OAC, states,
in pertinent part, that at all times when a licensed nurse is providing direct nursing care to a
client the licensed nurse shall: (2) Treat each client with courtesy, respect, and with full
recognition of dignity and individuality. Section 4723.28(B)(21), ORC, authorizes the Board to
discipline a licensee for, in the case of a licensed practical nurse, engaging in activities that
exceed the practice of nursing as a licensed practical nurse. Section 4723.28(B)(l7), ORC,
authorizes the Board to discipline a licensee for violation of any restrictions placed on a nursing
license by the Board.
In accordance with the paragraph under "FAILURE TO COMPLY" of the May 2010 Consent
Agreement, you are hereby notified that it appears to the Board that you have violated Item I. of
the May 2010 Consent Agreement.
YOU ARE FURTHER NOTIFIED THAT YOUR LICENSE TO PRACTICE NURSING
AS A LICENSED PRACTICAL NURSE, PN-123838, IS HEREBY AUTOMATICALLY
SUSPENDED. Continued practice after receipt of this notice of suspension shall be considered
engaging in the practice of nursing as a licensed practical nurse, without a current, valid license,
which is a violation of Section 4723.03(B), ORC.
You are further notified that in accordance with Chapter 119, ORC, the Board proposes under
authority of Section 4723.28, ORC, to deny, permanently revoke, revoke, suspend or place
restrictions on your license to practice nursing as a licensed practical nurse; reprimand or
otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per
violation for the following reasons:
1. On or about May 21,2010, you entered into a Consent Agreement (May 2010
Consent Agreement) with the Ohio Board of Nursing (Board), a copy of which
is attached hereto and incorporated herein, in which you agreed with the
Board that your license to practice nursing as a licensed practical nurse in the
State of Ohio would be suspended indefinitely and that such suspension would
be stayed subject to probationary terms, conditions, and limitations for a
minimum period of two (2) years. Attached to an incorporated within the
May 2010 Consent Agreement is a September 25, 2009 Notice of Opportunity
for Hearing (September 2009 Notice).
2. Item 1. of the May 2010 Consent Agreement states, "MS. DOTSON shall
obey all federal, state, and local laws, and all laws and rules governing the
practice of nursing in Ohio." Section 4723.28(B)(16), ORC, authorizes the
Board to discipline a licensee for violation of Chapter 4723, ORC, or any
rules adopted under it. Specifically, Rule 4723-4-06(J), OAC, states, in
pertinent part, that at all times when a licensed nurse is providing direct
nursing care to a client the licensed nurse shall: (2) Treat each client with
courtesy, respect, and with full recognition of dignity and individuality.
Section 4723.28(B)(21), ORC, authorizes the Board to discipline a licensee
Latrina Marie Dotson, L.P.N.
Page 3
for, in the case of a licensed practical nurse, engaging in activities that exceed
the practice of nursing as a licensed practical nurse.
Despite this provision, on or about March 26,2012, while working as a nurse at
Beachwood Point Care Center, in Beachwood, Ohio, you restrained a patient
without physician orders authorizing you to do so. Specifically, without
physician orders, you used a garbage bag to restrain the right arm of Patient #1,
who you reported was attempting to pull out his inner cannula and ventilation
tube.
On or about June 26, 2012, you submitted a written statement to the Board
admitting that you "applied soft restraint to the rt. wrist area to prevent resident
from pulling out inner cannula."
Section 4723.28(B)(16), ORC, authorizes the Board to discipline a licensee for violation of
Chapter 4723, ORC, or any rules adopted under it. Specifically, Rule 4723-4-06(1), OAC, states,
in pertinent part, that at all times when a licensed nurse is providing direct nursing care to a
client the licensed nurse shall: (2) Treat each client with courtesy, respect, and with full
recognition of dignity and individuality. Section 4723.28(B)(21), ORC, authorizes the Board to
discipline a licensee for, in the case of a licensed practical nurse, engaging in activities that
exceed the practice of nursing as a licensed practical nurse. Section 4723.28(B)(17), ORC,
authorizes the Board to discipline a licensee for violation of any restrictions placed on a nursing
license by the Board.
Accordingly, the Board is authorized to impose one or more of the sanctions as cited in Section
4723.28,ORC.
In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing
in this matter. If you wish to request such hearing, the request must be made in writing and must
be received in the Board office within thirty (30) days of the time of mailing of this notice.
You are hereby further informed that, if you timely request a hearing, you are entitled to appear
at such hearing in person, by your attorney, or by such other representative as is permitted to
practice before the Board, or you may present your position, arguments, or contentions in
writing. At the hearing you may also present evidence and examine witnesses appearing for and
against you.
Should you choose to request a hearing, please mail or deliver the request, in addition to any
other correspondence regarding this matter, to: Lisa Ferguson-Ramos, Compliance Unit
Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, Ohio 43215-
7410, or to the e-mail address.hearing@nursing.ohio.Mv.
If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing
of this notice, the Board may, in your absence and upon consideration of the factual and legal
allegations set forth in this Notice of Automatic Suspension and Opportunity for Hearing, deny,
permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a
Latrina Marie Dotson, L.P.N.
Page 4
licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more
than five hundred dollars ($500.00) per violation.
Sincerely,
Judith A. Church, R.N., C.N.P.
Supervising Board Member
Certified Mail Receipt No. 7012 1010 0002 42574596
cc: Henry G. Appel, Assistant Attorney General
Latrina Marie Dotson, L.P.N.
PageS
PATIENT KEY
(This Key is confidential pursuant to Section 4723.28(1) ofthe Ohio Revised Code, and is to
be withheld from public disclosure)
1. Jimmy Stringer
Case #08-2254
Ohio BOa-Neff N ~ : c d n g .WWw.nutsing;.ohhgov
17South HighStreet, Suite400 ~ Columbus, ohio 43215-7410 (614) 466-3947
CONSENT AGREEMENT
BETWEEN
LATRINA M. DOTSON, L.P.N.
AND
OHIO BOARD OFNURSING
This Consent Agreement is entered into by and between LATRINA M. DOTSON, L.P.N. (MS.
DOTSON) and the Ohio Board of Nursing (Board), the state agency charged with enforcing
Chapter i 4723. of the Ohio Revised Code (ORC), and all administrative rules promulgated
thereunder.
MS. DOTSON voluntarily enters into this Consent Agreement being fully informed of her rights
under Chapter 119, ORC, including the right to representation by legal counsel and the right to a
formal adjudicative hearing on the issues considered herein.
This Consent Agreement contains the entire agreement between the parties, there being no other
agreement of any kind, verbal or otherwise, which varies the terms of this Consent Agreement.
BASIS FORACTION
This Consent Agreement is entered into on the basis of the following stipulations, admissions
and understandings: .
A. The Board is empowered by Section 4723.28, ORC, to deny, permanently
revoke, revoke, suspend, or place restrictions on any license issued by the
Board; reprimand or otherwise discipline a licensee; or impose a fine of
five hundred dollars ($500.00) or less per violation. Section
4723.28(B)(19), ORC, authorizes the Board to discipline a licensee for
failure to practice in accordance with acceptable and prevailing standards
of safe nursing care. Section 4723.28(B)(16), ORC, authorizes the Board
to discipline a licensee for violation of Chapter 4723, ORC, or any rules
adopted under it. Specifically, Rnle 4723-4-06(H), Ohio Administrative
Code, states that a licensed nurse shall implement measures to promote a
safe environment for each client.
B. MS. DOTSON has been licensed to practice nursing as a licensed
practical nurse in the State of Ohio, PN-123838, since September 2006.
c. .0' MS. DOTSON knowingly and voluntarily admits to the factual and legal
allegations set forth in the Notice of Opportunity for Hearing issued to her
Latrina M. Dotson, L.P.N.
Page 2
by the Board on September 25, 2009 (September 2009 Notice), a copy of
which is attached hereto and incorporated herein.
D. MS. DOTSON states to the Board that, during that time, she was enrolled
in the LPN to ADN program at ATS Institute of Technology (ATS) and
taking clinicals while working at Willow Park Convalescent Home
(Willow Park). MS. DOTSON further states that she made arrangements
with an administrator at Willow Park (not her nursing supervisor or
Director of Nursing) to leave her shift early on days she was scheduled for
clinicals.
E. MS. DOTSON graduated from the ADN program at ATS in August 2008
and plans to apply for licensure as a registered nurse after she satisfies an
outstanding balance with ATS.
F. MS. DOTSON apologizes for her actions and explains that she wishes to
demonstrate to the Board that she is dedicated to patient safety and
professionalism.
AGREED CONDITIONS
Wherefore, in consideration of the foregoing and mutual promises hereinafter set forth, and in
lieu of any formal proceedings at this time, MS. DOTSON knowingly and voluntarily agrees
with the Board to the following terms, conditions, and limitations: MS. DOTSON's license to
practice nursing as a licensed practical nurse and any license to practice nursing as a registered
nurse, should the Board issue one, is hereby suspended indefinitely. Such suspension is hereby
stayed, subject to the following PROBATIONARY terms, conditions, and limitations for a
minimum period of two (2) years:
1. MS. DOTSON shall obey all federal, state, and local laws, and all laws and
rules governing the practice of nursing in Ohio.
2. MS. DOTSON shall appear in person fOT interviews before the full Board or
its designated representative as requested by the Board or its designee.
3. By November 1, 2010, MS. DOTSON shall, in addition to the requirements
of licensure renewal, successfully complete and submit satisfactory
documentation of successful completion of the following continuing nursing
education taken subsequent to the effective date of this Consent Agreement:
one (1) of Ohio Nursing Law and Rules; ten (10) hours of Patient Safety; ten
(10) hours of Time Management; and ten (10) hours of Professionalism.
Employment Conditions
4. MS. DOTSON shall notify the Board, in writing, of the name and address of
any current employer within forty-five (45) days following the effective date
Latrina M. Dotson, L.P.N.
Page 3
of this Consent Agreement, or any new employer prior to beginning
employment.
5. MS DOTSON shall have her employer(s), if working in a position where a
nursing license is required, submit written reports regarding job performance
on a quarterly basis beginning within forty-five (45) days following the
effective date of this Consent Agreement. MS. DOTSON shall provide her
employer(s) with a copy of this Consent Agreement and the attached
September 2009 Notice and shall have her employer(s) send documentation to
the Board, along with the first employer report, of receipt of a copy of this
Consent Agreement and the attached September 2009 Notice. Further, MS.
DOTSON is under a continuing duty to provide a copy of this Consent
Agreement and the attached September2009 Notice to any newemployer prior
to acceptingemployment.
Reporting Requirements of Licensee
6. MS. DOTSON shall report to the Board in writing, any violation of this
Consent Agreement within thirty(30) days of the occurrence of the violation.
7. MS. DOTSON shall sign release of information forms allowing health
professionals and other organizations to submit the requested documentation
directlyto the Board.
8. MS. DOTSON shall submit any and all informatiou that the Board may
request regardingher ability to practice according to acceptable and prevailing
standardsof safe nursing practice.
9. MS. DOTSON shall not submit or cause to be submitted any false, misleading,
or deceptive statements, informatiou, or documentation to the Board or to
employers or potential employers.
10. MS. DOTSON shall submit the reports and documentation required by this
Consent Agreement on forms specified by the Board. All reporting and
communications required by this Consent Agreement shall be made to the
ComplianceUnit of the Board.
11. MS. DOTSON shall submit the reports and documentation required by this
Consent Agreement or any other documents required by the Board to the
attention of the Compliance Unit, Ohio Board of Nursing, 17 South High
Street, Suite 400, Columbus, OH43215-7410.
12. MS. DOTSON shall verify that the reports and documentation requiredby this
Consent Agreement are receivedin the Boardoffice.
Latrina M. Dotson, L.P.N.
Page 4
13. MS. DOTSON shall inform the Board within five (5) business days, in
writing, of any change in employment status or of any change in residential or
home address or telephone number.
Nursing Refresher Course
Upon request by the Board or its designee, prior to working in a position where a
nursing license is required, MS. DOTSON shall complete and submit satisfactory
documentation of completion of a refresher course or an extensive orientation to
be approved in advance by the Board.
Temporary Practice Restrictions
MS. DOTSON knowingly and voluntarily agrees with the Board to the following
TEMPORARY PRACTICE RESTRICTIONS for a minimum period of four (4) years:
MS. DOTSON shall not practice nursing (l) for agencies providing home care in the
patient's residence; (2) for hospice care programs providing hospice care in the
patient's residence; (3) for staffing agencies or pools; (4) as an independent provider
where the nnrse provides nursing care and is reimbursed for services by the State of
Ohio through State agencies or agents of the State; or (5) for an individual or group
of individuals who directly engage MS. DOTSON to provide nursing services for
fees, compensation, or other consideration or as a volunteer.
MS. DOTSON shall not function in a position or employment where the job duties
or requirements involve management of nursing and nursing responsibilities, or
supervising and evaluating nursing practice. Such positions include but are not
limited to the following: Director of Nnrsing, Assistant Director of Nursing, Nurse
Manager, Vice President of Nursing.
The TEMPORARY PRACTICE RESTRICTIONS apply to MS. DOTSON's
license to practice nursing as a licensed practical nurse and any license to practice
nursing as a registered nurse, should the Board issue one. After a minimum period
of four (4) years, MS. DOTSON may submit a written request to the Board to have
this restriction removed andlor modified.
FAILURE TO COMPLY
MS. DOTSON agrees that her license to practice nursing as a licensed practical nurse and any
license to practice nursing as a registered nurse will be automatically suspended if it appears to
the Board that MS. DOTSON has violated or breached any terms or conditions of the Consent
Agreement. Following the automatic suspension, the Board shall notify MS. DOTSON via
certified mail of the specific nature of the charges and automatic suspension of her license.
Upon receipt of this notice, MS. DOTSON may request a hearing regarding the charges.
The above described terms and conditions shall constitute "restrictions placed' on a license" for
purposes of Section 4723.28(B), ORC. If, in the discretion of the Board, MS. DOTSON appears
Latrina M. Dotson, L.P.N.
Page 5
to have violated or breached any terms or conditions of this Consent Agreement, the Board
reserves the right to institute formal disciplinary proceedings for any and all possible violations
or breaches, iucluding, but not limited to, alleged violations of the laws of Ohio occurring before
the effective date of this Consent Agreement.
DURATION / MODIFICATION OF TERMS
The terms, limitations and conditions of this Consent Agreement may be modified or terminated,
in writing, at any time upon the agreement of both MS. DOTSON and the Board.
The Board may only alter the probationary period imposed by this Consent Agreement if: (1) the
Board determines that MS. DOTSON has complied with all aspects of this Consent Agreement;
and (2) the Board 'determines that MS. DOTSON is able to practice according to acceptable and
prevailing standards of safe nursing care without Board monitoring, based upon an interview
with MS. DOTSON and review of the reports as required herein. Any period during which MS.
DOTSON does hot work in a position for which a nursing license is required shall not count
toward fulfilling the probationary period imposed by this Consent Agreement.
ACKNOWLEDGMENTS / LIABILITY REl"EASE
MS. DOTSON acknowledges that she has had an opportunity to ask questions concerning the
terms of this Consent Agreement and that all questions asked have been answered in a
satisfactory manner.
MS. DOTSON waives all of her rights under Chapter 119, ORC, as they relate to matters that
are the subject of this Consent Agreement.
MS. DOTSON waives any and all claims or causes of action she may have against the Board,
and its members, officers, employees and/or agents arising out of matters, which are the subject
of this Consent Agreement.
This Consent Agreement shall be considered' a public record as that term is used in Section
149.43, ORe. The information contained herein may be reported to appropriate organizations,
data banks and governmental bodies.
This Consent Agreement is uot an adjudication order within the meaning of Chapter 119, ORC.
Any action initiated by the Board based on alleged violations of this Conseut Agreement shall
comply with the Administrative Procedures Act, Chapter 119, ORe.
AX
Latrina M. Dotson, L.P.N.
Page 6
EFFECTIVE DATE
MS. DOTSON understands that this Consent Agreement is subject to ratification by the Board
prior to signature by the Board President and shall become effective upon the last date of
signature below.
BERTHA LOVELACE, President
Ohlo Board of Nursing
Case #08-2254
0"'1. Board of
.. ;Ie,!, 0 ... _ ... ..... _ ..... ....
17South HighStreet, Suite400 Columbus, ohio 43215-7410 (614)466-3947
September 25, 2009
NOTICE OF OPPORTUNITY FOR HEARING
Latrina M. Dotson, L.P.N.
13200 Grigging Avenue #5
Cleveland, Ohio 44120
AND
23801 Banbury Circle #3
Warrensville, Ohio 44128
Dear Ms. Dotson:
In accordance with Chapter 119. of the Ohio Revised Code (ORC), youare hereby notified that
the Ohio Board of Nursing (Board) proposes under the authority of Section 4723.28, ORC, to
deny, permanently revoke, revoke, suspend or place restrictions on your license to practice
nursing as a licensed practical nurse; reprimand or otherwise discipline you; or Impose a fine of
not more than five hundred dollars ($500.00) per violation for the following reasons:
1. While working as a nurse at Willow Park Convalescent Home in
Cleveland, Ohio, yon left the facility without notifying or obtaining
approval from the nursing supervisor on or about June 27, 2008. You left
the keys to the medication cart unsecured in a desk drawer; Your actions
left 40 patients without a nurse. Your employment was terminated for job
abandonment on or about June 30,.2008.
Section 4723.28(B)(19), ORC, authorizes the Board to discipline a licensee for failure to practice
in accordance with acceptable and prevailing standards of safe nursing care. Section
4723.28(B)(l6), ORC, authorizes the Board to discipline a licensee for violation of Chapter
4723, ORC, or any rules adopted under it. Specifically, Rule 4723-4-06(H), Ohio Administrative
Code, states that a licensed nnrse shall implement measures to promote a safe environment for
each client.
Accordingly, the Board is authorized to impose one or more of the sanctions as cited in Section
4723.28,ORC.
In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing.
in this matter. If you wish to request such hearing, the request must be made in writing and must
be received in the Board office within thirty (30) days of the time of mailing of this notice.
Latrina M. Dotson, L.P.N.
page 2
You are hereby further informed that, if you timely request a hearing, you are entitled to appear
at such hearing in person, by your attorney, or' by such other representative as is permitted to
practice before the Board, or you may present your position, arguments, or contentions in
writing. At the hearing you may also present evidence and examine witnesses appearing for and
against you.
Should you choose to request a hearing, please mail or deliver the request, in addition to any
other correspondence regarding this matter, to: Lisa Ferguson-Ramos, Compliance Manager,
Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, Ohio 43215-7410 or
hearing@nursing.obio.gov.
If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing
of this notice, the Board may, in your absence and upon consideration of the factual and legal
allegations set forth in this Notice of Opportunity for Hearing, deny, permanently revoke,
revoke, suspend or place restrictions on your license to practice nursing as a licensed practical
nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred
dollars ($500.00) per violation.
Sincerely,
Anne Barnett, R.N., E.S.N., C.W.S.
Supervising Board Member
Address #1 Certified Mail Receipt No. 7009 0820 0002 3386 9951
Address #2 Certified Mail Receipt No. 7009 0820 0002 3386 9968
cc: Melissa Wilburn, Assistant Attorney General
Case 12-002354
Ohio Board of Nursing www.nursing:ohio.gov
17 South High Street, Suite 400 Columbus, Ohio 43215-7410 (614) 466-3947
November 16,2012
NOTICE OF OPPORTUNITY FOR HEARING
Cheryl Ann Duvall, R.N.
2351 Eastbrook Drive
Toledo, Ohio 43613
Dear Ms. Duvall:
In accordance with Chapter 119, Ohio Revised Code (ORC), you are hereby notified that the
Ohio Board of Nursing (Board) proposes under authority of Section 4723.28 ORC, to deny,
revoke, permanently revoke, suspend or place restrictions on your license to practice nursing as a
registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five
hundred dollars ($500.00) per violation for the following reasons:
1. On or about May 12,2012, while working as a nurse at Liberty West Nursing
Center of Toledo, in Toledo, Ohio, you submitted a drug screen specimen that
was positive for heroin (6-acetylmorphine). You did not have a current, valid
prescription accounting for this positive result.
Section 4723.28(B)(8), ORC, authorizes the Board to discipline a licensee for self-administering
or otherwise taking into the body any dangerous drug, as defined in Section 4729.01, ORC, in
any way not in accordance with a legal, valid prescription issued for that individual.
Accordingly, the Board is authorized to impose one or more of the sanctions cited in Section
4723.28,ORC.
In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing
in this matter. If you wish to request such hearing, the request must be made in writing and must
be received in the Board office within thirty (30) days of the time of mailing of this notice.
You are hereby further informed that, if you timely request a hearing, you are entitled to appear
at such hearing in person, by your attorney, or by such other representative as is permitted to
practice before the Board, or you may present your position, arguments, or contentions in
writing. At the hearing, you may also present evidence and examine witnesses appearing for and
against you.
Should you choose to request a hearing, please mail or deliver the request, in addition to any
other correspondence regarding this matter, to Lisa Ferguson-Ramos, Compliance Unit
Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, Ohio 43215-
7410 or to the email address, hearing@nursing.ohio.gov.
Cheryl Ann Duvall, R.N.
Page 2
If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing
of this notice, the Board may, in your absence and upon consideration of the factual and legal
allegations set forth in this Notice of Opportunity for Hearing, deny, revoke, permanently
revoke, suspend, or place restrictions on your license to practice nursing as a registered nurse;
reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars
($500.00) per violation.
Sincerely,
Judith A. Church, R.N., C.N.P.
Supervising Board Member
Certified Mail Receipt No. 7012 1010 0002 42573506
cc: Henry G. Appel, Assistant Attorney General
Cases # 12-004986 & 09-0463
Ohio Board of Nursing www.nursing.ohio.gov
17 South HighStreet, Suite400 Columbus, Ohio 43215-7410 (614) 466-3947
November 16,2012
NOTICE OF AUTOMATIC SUSPENSION AND
OPPORTUNITY FOR HEARING
Teresa Ellen Ferguson, R.N.
7913 National Road Lot 7
Pataskala, Ohio 43602
Dear Ms. Ferguson:
You are hereby notified that, on or about November 21, 2008, you entered into a Consent
Agreement (November 2008 Consent Agreement) with the Ohio Board of Nursing (Board), a
copy of which is attached hereto and incorporated herein, in which you agreed with the Board
that upon meeting the requirements for renewal, your license to practice nursing as a registered
nurse in the State of Ohio would be reinstated and suspended indefinitely and that such
suspension would be stayed subject to probationary terms, conditions, and limitations until at
least November 2011. Attached to and incorporated within the November 2008 Consent
Agreement is a September 16, 2005 Consent Agreement (September 2005 Consent Agreement).
Effective March 30,2009, your license was placed on inactive status. On or about February 17,
2011, you requested documents to reactivate and reinstate your license.
A. Item I. of the November 2008 Consent Agreement states, "MS. FERGUSON
shall obey all federal, state, and local laws, and all laws and rules governing
the practice of nursing in Ohio." Item 4. of the November 2008 Consent
Agreement states, "MS. FERGUSON shall abstain completely from the use
of alcohol and/or substances containing alcohol."
Despite these provisions, on or about March 8, 2011, in Licking County
Municipal Court Case No. IO-TRC"10982, you pled guilty and were convicted of
one (I) count of Operating Vehicle Under the Influence of Alcohol or Drugs
(OVI), a first-degree misdemeanor, in violation of 4511.19(A)(I)(a), Ohio
Revised Code (ORC). On or about March 8,2011, in Licking County Municipal
Court Case No. you pled to Resisting Arrest, a misdemeanor of
the second degree, in violation of Section 2921.33(A), ORC.
The acts underlying your conviction occurred on or about November 11, 2010,
and involve you operating a motor vehicle while impaired. You, recklessly or by
force, resisted or interfered with your arrest when officers placed you into custody
for suspicion of OVI. In a statement attached to your application to renew your
nursing license, received by the Board on or about September 12, 2012, you
admitted that your OVI arrest stemmed from you consuming "fresh fruit alcohol
drink" at a family reunion.
Teresa Ellen Ferguson, R.N.
Page 2
Section 4723.28(B)(l7), ORC, authorizes the Board to discipline a licensee for violation of any
restrictions placed on a nursing license by the Board.
B. Item 1. of the November 2008 Consent Agreement states, "MS. FERGUSON
shall obey all federal, state, and local laws, and all laws and rules governing
the practice of nursing in Ohio." Section 4723.28(B)(8), ORC, authorizes the
Board to discipline a licensee for self-administering or otherwise taking into
the body any dangerous drug, as defined in Section 4729.01, ORC, in any way
not in accordance with a legal, valid prescription issued for that individual.
Item 3. of the November 2008 Consent Agreement states, MS. FERGUSON
shall abstain completely from the personal use or possession of drugs, except
those prescribed, administered, or dispensed to her by another so authorized
by law who has full knowledge of MS. FERGUSON's history. MS.
FERGUSON shall self-administer prescribed drugs only in the manner
prescribed." Item 4. of the November 2008 Consent Agreement states, "MS.
FERGUSON shall abstain completely from the use of alcohol and/or
substances containing alcohol." Item 5. of the November 2008 Consent
Agreement states, "MS. FERGUSON shall continue submitting, at her
expense and on the day selected, blood or urine specimens for drug and/or
alcohol analysis at a collection site specified by the Board at such times as the
Board may request. Refusal to submit such specimen, or failure to submit
such specimen on the day she is selected, or in such a manner as the Board
may request, shall constitute a violation of a restriction placed on a license for
purposes of Section 4723.28(B), ORe. This screening shall require a daily
call-in process. The specimens submitted by MS. FERGUSON shall be
negative, except for substances prescribed, administered, or dispensed to her
by another so authorized by law who has full knowledge of MS.
FERGUSON's history."
Despite these provisions, on or about December 11, 2008, you provided a
specimen for analysis to Firstlab, the Board's random drug/alcohol screen
program administrator, that tested positive for Propxyphene. Although your
drug/alcohol specimen was positive for Propoxyphene, on or about December 17,
2008, you sent a statement to the Board acknowledging that you noticed a
"positive urine" and admitted that you went to a Christmas party and "had a
couple of mixed drinks".
Furthermore, on or about the dates set forth in Attachment A, attached hereto and
incorporated herein, you failed to call Firstlab to determine if you had been
selected to provide a specimen for analysis. In addition, on the following dates,
you were selected to provide a specimen for analysis and failed to do so:
December 19,2008; January 22, 2009; February 6,2009; and March 11,2009.
Section 4723.28(B)(8), ORC, authorizes the Board to discipline a licensee for self-administering
or otherwise taking into the body any dangerous drug, as defined in Section 4729.01, ORC, in
any way not in accordance with a legal, valid prescription issued for that individual. Section
Teresa Ellen Ferguson, R.N.
Page 3
4723.28(B)(17), ORC, authorizes the Board to discipline a licensee for violation of any
restrictions placed on a nursing license by the Board.
In accordance with the paragraph under "FAILURE TO COMPLY" of the November 2008
Consent Agreement, you are hereby notified that it appears to the Board that you have violated
Items 1.,3.,4. and 5. of the November 2008 Consent Agreement.
YOU ARE FURTHER NOTIFIED THAT YOUR LICENSE TO PRACTICE NURSING
AS A REGISTERED NURSE, RN256060, IS HEREBY AUTOMATICALLY
SUSPENDED. Continued practice after receipt of this notice of suspension shall be considered
engaging in the practice of nursing as a registered nurse without a current, valid license, which is
a violation of Section 4723.03(A), ORC.
You are further notified that in accordance with Chapter 119 Ohio Revised Code (ORC), you are
hereby notified that the Ohio Board of Nursing (Board) proposes under authority of Section
4723.28, ORC, to deny or permanently deny your application for renewal/reinstatement of your
license to practice nursing as a registered nurse; permanently revoke, revoke, suspend or place
restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise
discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for
the following reasons:
1. On or about November 21, 2008, you entered into a Consent Agreement
(November 2008 Consent Agreement) with the Ohio Board of Nursing
(Board), a copy of which is attached hereto and incorporated herein, in which
you agreed with the Board that upon meeting the requirements for renewal,
your license to practice nursing as a registered nurse in the State of Ohio
would be reinstated and suspended indefinitely and that such suspension
would be stayed subject to probationary terms, conditions, and limitations
until at least November 20I1. Attached to and incorporated within the
November 2008 Consent Agreement is a September 16, 2005 Consent
Agreement (September 2005 Consent Agreement).
2. On or about March 30,2009, you placed your license to practice nursing in
the State of Ohio as a registered nurse on inactive status. On or about
September 12,2012, you submitted an application to reactivate and reinstate
your license.
3. Item I. of the November 2008 Consent Agreement states, "MS. FERGUSON
shall obey all federal, state, and local laws, and all laws and rules governing
the practice of nursing in Ohio." Item 4. of the November 2008 Consent
Agreement states, "MS. FERGUSON shall abstain completely from the use
of alcohol and/or substances containing alcohol."
Despite these provisions, on or about March 8, 2011, in Licking County
Municipal Court Case No. 10TRCI0982, you pled guilty and were convicted of
one (1) count of Operating Vehicle Under the Influence of Alcohol or Drugs
Teresa Ellen Ferguson, R.N.
Page 4
(OVI), a first-degree misdemeanor, in violation of 4511.19(A)(1)(a), Ohio
Revised Code (ORC). On or about March 8,2011, in Licking County Municipal
Court Case No.1O-CRB-253C, you pled to Resisting Arrest, a misdemeanor of
the second degree, in violation of Sectiou 2921.33(A), ORC.
The acts underlying your conviction occurred on or about November 11,2010,
and involve you operating a motor vehicle while impaired. You, recklessly or by
force, resisted or interfered with your arrest when officers placed you into custody
for suspicion of OVI. In a statement attached to your application to renew your
nursing license, received by the Board on or about September 12, 2012, you
admitted that your OVI arrest stemmed from you consuming "fresh fruit alcohol
drink" at a family reunion.
Section 4723.28(B)(l7), ORC, authorizes the Board to discipline a licensee for violation of any
restrictions placed on a nursing license by the Board.
4. Item 1. of the November 2008 Consent Agreement states, "MS. FERGUSON
shall obey all federal, state, and local laws, and all laws and rules governing
the practice of nursing in Ohio." Section 4723.28(B)(8), ORC, authorizes the
Board to discipline a licensee for self-administering or otherwise taking into
the body any dangerous drug, as defined in Section 4729.01, O l ~ C , in any way
not in accordance with a legal, valid prescription issued for that individual.
Item 3. of the November 2008 Consent Agreement states, MS. FERGUSON
shall abstain completely from the personal use or possession of drugs, except
those prescribed, administered, or dispensed to her by another so authorized
by law who has full knowledge of MS. FERGUSON's history. MS.
FERGUSON shall self-administer prescribed drugs only in the manner
prescribed." Item 4. of the November 2008 Consent Agreement states, "MS.
FERGUSON shall abstain completely from the use of alcohol and/or
substances containing alcohol." Item 5. of the November 2008 Consent
Agreement states, "MS. FERGUSON shall continue submitting, at her
expense and on the day selected, blood or urine specimens for drug and/or
alcohol analysis at a collection site specified by the Board at such times as the
Board may request. Refusal to submit such specimen, or failure to submit
such specimen on the day she is selected, or in such a manner as the Board
may request, shall constitute a violation of a restriction placed on a license for
purposes of Section 4723.28(B), ORC. This screening shall require a daily
call-in process. The specimens submitted by MS. FERGUSON shall be
negative, except for substances prescribed, administered, or dispensed to her
by another so authorized by law who has full knowledge of MS.
FERGUSON's history."
Despite these provisions, on or about December 11, 2008, you provided a
specimen for analysis to Firstlab, the Board's random drug/alcohol screen
program administrator, that tested positive for Propxyphene. Although your
drug/alcohol specimen was positive for Propoxyphene, on or about December 17,
Teresa Ellen Ferguson, R.N.
PageS
2008, you sent a statement to the Board acknowledging that you noticed a
"positive urine" and admitted that you went to a Christmas party and "had a
couple of mixed drinks".
Furthermore, on or about the dates set forth in Attachment A, attached hereto and
incorporated herein, you failed to call Firstlab to determine if you had been
selected to provide a specimen for analysis. In addition, on the following dates,
you were selected to provide a specimen for analysis and failed to do so:
December 19,2008; January 22,2009; February 6, 2009; and March 11,2009.
Section 4723.28(B)(8), ORC, authorizes the Board to discipline a licensee for self-administering
or otherwise taking into the body any dangerous drug, as defined in Section 4729.01, ORC, in
any way not in accordance with a legal, valid prescription issued for that individual. Section
4723.28(B)(l7), ORC, authorizes the Board to discipline a licensee for violation of any
restrictions placed on a nursing license by the Board.
Accordingly, the Board is authorized to impose one or more of the sanctions as cited in Section
4723.28,ORC.
In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing
in this matter. If you wish to request such hearing, the request must be made in writing and must
be received in the Board office within thirty (30) days of the time of mailing of this notice.
You are hereby further informed that, if you timely request a hearing, you are entitled to appear
at such hearing in person, by your attorney, or by such other representative as is permitted to
practice before the Board, or you may present your position, arguments, or contentions in
writing. At the hearing you may also present evidence and examine witnesses appearing for and
against you.
Should you choose to request a hearing, please mail or deliver the request, in addition to any
other correspondence regarding this matter, to: Lisa Ferguson-Ramos, Compliance Unit
Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, Ohio 43215-
7410, or to the e-mail address, heariy.g@nursing.ohio.gov.
If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing
of this notice, the Board may, in your absence and upon consideration of the factual and legal
allegations set forth in this Notice of Automatic Suspension and Opportunity for Hearing deny or
permanently deny your application for renewal/reinstatement of your license to practice nursing
as a registered nurse; permanently revoke, revoke, suspend or place restrictions on your license
to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine
of not more than five hundred dollars ($500.00) per violation.
Teresa Ellen Ferguson, R.N.
Page 6
Sincerely,
Judith A. Church, R.N., CN.P.
Supervising Board Member
Certified Mail Receipt No. 70121010 0002 4257 4572
cc: Henry G. Appel, Assistant Attorney General
Case #04-0068, #05-0906, #05-1890, & #08-3336
Ohio Board of Nursing www.nursing.ohio.gov
17 South High Street, Suite 400 Columbus, Ohio (614) 466-3947
08HG-3 PHtt:SI
CONSENT AGREEMEN':t
n
. ; ,-, ,. .
BETIYEEN D." V" v ,
TERESA E. FERGUSON, R.N.
AND
omo BOARD OF NURSING
This Consent Agreement is entered into by and between TERESA E. FERGUSON,
R.N. (MS. FERGUSON) and the Ohio Board of Nursing. (Board), the state agency
charged with enforcing Chapter 4723. of the Ohio Revised Code (ORC), and all
administrative rules promulgated thereunder.
MS. FERGUSON voluntarily enters into this Consent Agreement being fully informed
of her rights under Chapter 119, ORC, including the right to representation by legal
counsel and the right to a formal adjudicative hearing on the issues considered herein.
This Consent Agreement contains the entire agreement between the parties, there being
no other agreement of any kind, verbal or otherwise, which varies the terms of this
Consent Agreement.
BASIS FOR ACTION
This Consent Agreement is entered into on the basis of the following stipulations,
admissions and understandings:
A. The Board is empowered by Section 4723.28, ORC, to deny,
permanently revoke, revoke, suspend, or place restrictions on any
license issued by the Board; reprimand or otherwise discipline a
licensee; or impose a fine of five hundred dollars C$500.00)or less
per violation. MS. FERGUSON admits to violating Section
4723.28, ORC, as set forth in the attached Consent Agreement.
Further, MS. FERGUSON admits' to additional violations of
Section 4723.28, ORC. Specifically, Section 4723.28(B)(17),
ORC, which authorizes the Board to discipline a licensee for
violation of any restrictions placed on a nursing license by the
Board.
B. MS. FERGUSON was initially issued a license to practice' nursing
in Ohio as a registered nurse, RN-256060, in November 1994.
MS. FERGUSON's license has been suspended since on or about
September 16, 2005.
C. MS. FERGUSON's license was indefinitely suspended by a
September 16, 2005 Consent Agreement between MS.
Teresa E. Ferguson, R.N.
Page 2
D.
FERGUSON and the Board, a copy of which is attached hereto
and incorporated herein. .
MS-:-FERGUSON admits' to violating the terms of Paragraphs 7.
and 11. set forth in the September 2005 Consent Agreement On
July 31, 2006, MS. FERGUSON was selected to submit a drug
specimen during a random drug screen and submitted a drug
specimen positive for ethyl glucuronide. On or about August 24,
2006, MS. FERGUSON's physician, Mark Allen Hackman, M.D.
submitted documentation to the Board and reported that MS.
FERGUSON ingested over-the-counter cough medicine that may
have' contained alcohoL Further, on September 10, 2006, MS.
FERGUSON was selected to submit a drug specimen for a
random drug screen, and she failed to do so.
E. On or about September 11, 2006, MS. FERGUSON submitted a
statement to the Board, and MS. FERGUSON reported that she
was voluntarily discontinuing her participation in Board
monitoring. MS. FERGUSON and was placed on inactive Board
monitoring until May 23, 2007.
F. Under the terms of the September 2005 Consent Agreement, MS.
FERGUSON was' eligible to request reinstatement of her license
anytime after September 2007.
G. On or about October 6, 2008, MS. FERGUSON submitted a
written request to the Board to reinstate her license and provided
the Board with the following:
1) Evidence of a psychiatric evaluation performed by Young .
Wung Rhee, M.D., psychiatrist, Board certified in Addiction
Psychiatry, on April 27, 2007. Dr. Rhee reported that MS.
FERGUSON's mental status is stable. Dr. Rhee furtlier
recommended that MS. FERGUSON continue to SUbmit to
random drug testing and to continue participating in
Narcotics Anonymous (NA).
2) Evidence of a second psychiatric evaluation performed by
Dr. Rhee, on August 15, 2008. Dr. Rhee reported to the
Board that MS. FERGUSON's current mental status is
stable. In Dr. Rhee's opinion, MS. FERGUSON is capable
of practicing nursing according to acceptable and prevailing
nursing standards. Dr. Rhee recommended that MS.
FERGUSON continue to submit to random drug testing and
to continue participating in NA. In a October 15, 2008 .
Teresa E. Ferguson, R.N.
Page 3
statement, Dr. Rhee reported that MS. FERGUSON is
diagnosed with degenerative disc disease and that another
treating physician~ e s c r i b e s Celexa, an anti-depressant to
MS. FERGUSON.
3) Evidence of eighteen (18) negative screens for drugs and
alcohol fromMay 23, 2007 until October 1,2008.
4) Evidence of regular attendance at Twelve Step meetings.
H. On October 6, 2008, MS. FERGUSON met with a Board
representative for a personal interview and to review her
.reinstatement documentatiou. MS. FERGUSON reported that her
date of sobriety is July 5, 2005 and that she has not worked as a
nurse since Jnly 2005.
I. MS. FERGUSON understands that any violations of this Consent
Agreement and/or any further violations of the laws and rules
governing the practice of nursing may result in further disciplinary
action, up to and including permanent revocation of her license to
practice nursing as a registered nurse in the State of Ohio.
AGREED CONDITIONS
Wherefore, in consideration of the foregoing and' mutual promises hereinafter set forth,
and in lieu of any formal proceedings at this time, MS. FERGUSON knowingly and
voluntarily agrees with the Board to the following terms, conditions, and limitations:
Upon meeting the requirements for renewal, MS. FERGUSON's license to practice
nursing as a registered nurse shall be reinstated and suspended indefinitely. Such
suspension shall be stayed, subject to the following PROBATIONARYterms, conditions,
and limitations until at least November 2011:
J. MS. FERGUSON shall obey all federal, state, and local laws, and all
laws and rules governing the practice of nursing in Ohio.
2. MS. FERGUSON shall appear in person for interviews before the full
Board or its designated representative as requested by the Board or its
designee.
Monitoring
3. . MS. FERGUSON shall abstain completely from the personal use or
possession of drugs, except those prescribed,' administered, or
dispensed to her by another so authorized by law who has full
Teresa E. Ferguson, R.N.
Page 4
knowledge of MS. FERGUSON's history. MS. FERGUSON shall
self-administer prescribed drugs only in the manner prescribed.
-----------4-.---M S ~ FERGUSON shall abstain 'completely from the 'use orarc"'oh"'o'"l------
andlor substances containing alcohol.
5. MS. FERGUSON shall continue submitting, at her expense and on the
day selected, blood or urine specimens for drug andlor alcohol analysis
at a collection site specified. by the Board at such times as the Board
may request. Refusal to submit such specimen, or failure to submit
such specimen on the day she is selected, or in such a manner as the
Board may request, shall constitute a violation of a restriction placed on
a license for purposes of Section 4723.Z8(B), ORC. This screening
shall require a dally call-in process. The specimens submitted by MS.
FERGUSON shall be negative, except for substances prescribed,
administered, or dispensed to her by another so authorized by law who
has full knowledge of MS. FERGUSON's history.
6. MS. FERGUSON shall attend a minimum of one (I) meeting per week
of a support or peer group meeting approved in advance by the Board,
or a Twelve Step program, and MS. FERGUSON. shall provide
satisfactory documentation of such attendance to the Board every six
(6) months beginning May 1,2009.
7. If. the Board or its designee requests a chemical dependency
evaluation and/or a comprehensive pain management evaluation,
withln sixty (60) days of such request(s), MS. FERGUSON shall; at
her own expense, seek the evaluationis) and shari provide the Board
with complete documentation of the evaluation(s) from professionalts)
approved in advance by the Board. Prior to the evaluation(s), MS,
FERGUSON shall provide the professional(s) with a copy of this
Consent Agreement and the attached September 2005 Consent
Agreement. Further, if the Board or its designee requests a
comprehensive pain management evaluation, MS. FERGUSON shall
also provide thephysician with summaries from her treating physicians
for the past five years, including the types and frequency of drugs she
has been prescribed in that period. Further, MS. FERGUSON shall
execute releases to permit the professional(s) to obtain any information
deemed appropriate and necessary for the evaluation(s). The
evaluating professional(s) shall submit a written opinion to the Board
that includes diagnoses, recommendations for treatment and
monitoring, any additional restrictions that should be placed on MS.
FERGUSON's license' to practice, and stating whether MS.
FERGUSON is capable of practicing nursing according to acceptable
and prevailing standards of safe nursing care. -
Teresa E. Ferguson, R.N.
Page 5
8.
- - - - - - ~ - - . . , - -
In the event that the Board 'or its designee requests evaluations,
MS. FERGUSON .shall provide the Board with satisfactory
gocumeI!tation. of c.s>mpliance with all aspects of the treatment planes)
developed by the professional(s) described above unulreTea:sea:--
Further, MS. FERGUSON agrees that the Board may utilize the
professional's recommendations and conclusions from the evaluation(s)
as a basis for additional terms, conditions, and limitations on MS.
FERGUSON's license and that the terms, conditions, and limitations
shall be incorporatedin an addendumto this Consent Agreement.
Treating Practitioners and Reporting
9. Within sixty (60) days of the execution of this Consent Agreement,
MS. FERGUSON shall provide a copy of this Consent Agreement and
the attached September 2005 Consent Agreement to all treating
practitioners and shall provide to the Board a list of all treating
practitioners, including addresses and telephone numbers. Further, MS.
FERGUSON shall be under a continuing duty to provide a copy of this
Consent Agreement and the attachment, prior to initiating treatment, to
additional treating practitioners, and to update the list of treating
practitioners with the Board within forty-eight (48) hours of being
treated by another practitioner.
10. MS. FERGUSON shall cause all treating practitioners to complete a
medication prescription report that is to be mailed by the practitioner
directly to the Board. The medication report is to be completed for any
and all substances prescribed, administered, or dispensed to MS.
FERGUSON throughout the duration of this Consent Agreement.
11. Within twenty-four (24) hours of release from hospitalization or
medical treatment, MS. FERGUSON shall notify the Board of any and
all medication(s) or prescription(s) received.
Employment Conditions
12. Prior to accepting employment as a nurse, each time with every
employer, MS. FERGUSON shall notify the Board.
13. MS. FERGUSON, within fifteen (15) days of the effective date of
the Consent Agreement, if working in a position in which a nursing
license is required, shall provide her employer(s) with a copy of this
Consent Agreement and the attached September 2005 Consent
Agreement. Further, MS. FERGUSON is under a continuing duty to
provide a copy of this Consent Agreement and the attachment to any
new employer prior to accepting employment. MS. FERGUSON shall
Teresa E. Ferguson, R.N.
Page 6
have her employer(s), if working in a position where a nursing license
is required, submit written reports regarding job performance on a
quarterly basis beginning January 1,2009. MS. FERGUSON shall
have her employer(s) senooocumentation to the BoarQ,"lilong wItlf11ie
first employer report, of receipt of a copy of this Consent Agreement
and the attachment, including the date the Consent Agreement and the
attachment were received.
Reporting Requirements of Licensee'
14. MS. FERGUSON shall report to the Board, in writing, any violation of
this Consent Agreement within thirty (30) days of the occurrence of the
violation.
15. MS. FERGUSON shall sign release of information forms allowing
health professionals and other organizations to submit the requested
documentation directly to the Board.
16. MS. FERGUSON shall submit any and all information that the Board
may request regarding her ability to practice according to acceptable
and prevailing standards of safe nursing practice.
17. MS. FERGUSON shall not submit or cause to be submitted any false,
misleading, or deceptive statements', information, or documentation to
the Board or to employers or potential employers.
18. MS. FERGUSON shall submit the reports and documentation required
by this Consent Agreement on forms specified by the Board. All
reporting and communications required by this Consent Agreement
shall be made to the Compliance Unit of the Board.
19. MS. FERGUSON shall submit the reports and documentation required
by this Consent Agreement or any other documents required by the
Board to the attention of the Compliance Unit, Ohio Board of Nursing,
17 South High Street, Suite 400, Columbus, OB 43215-7410.
20. MS. FERGUSON shall verify that the reports and documentation
required by this Consent Agreement are received in the Board office.
21. MS. FERGUSON shall inform the Board within five (5) business
days, in writing, of any change in employment status or of any change
in residential or home address or telephone number.
Teresa E. Ferguson, R.N.
Page?
Nursing Refresher Course or Orientation
Prior to working in a position where a nursing license is required, MS. FERGUSON .
shan compl-ewalld-subrnirsatisfactOlj documen:tation--of-eompl-etion-of--a-nnrsing----------'
refresher course or an extensive orientationto be approved in advance by the Board or its
designee.
Permaneut Narcotic Restriction
MS. FERGUSON further knowingly and voluntarily agrees with the Board to the
following permanent licensure restrictions:
MS. FERG'USON shall not administer, have access to, or possess (except as prescribed
for MS. FERGUSON's use by another so authorized by law who has full knowledge of
MS. FERGUSON's history) any narcotics, other controlled substances, or mood altering
drugs. In addition, MS. FERGUSON shall not possess or carry any work keys for
locked medication carts, cabinets, drawers, or containers. MS. FERGUSON shall not
count narcotics. MS. FERGUSON shall not call in or order prescriptions or prescription
refills.
Permanent Practice Restrictions
MS. FERGUSON further knowingly and voluntarily agrees with the Board to the
following permanent licensure restrictions:
MS. FERGUSON shall not practice nursing as a registered nurse (1) for agencies
providing home care in the patient's residence; (2) for hospice care programs providing
hospice care in the patient's residence.. (3) for staffing agencies or pools; (4) as an
independent provider where the nurse .provides nursing care and is reimbursed for
services by the State of Ohio through State agencies or agents of the State; or (5) for an
individual or group of individuals who directly engage MS. FERGUSON to provide
nursing services for fees, compensation, or other consideration or as a volunteer.
MS. FERGUSON shall not function in a position or employment where the job duties or
requirements involve management of nursing and nursing responsibilities, or supervising
and evaluating nursing practice. Such positions include, but are not limited to, the
following: Director of Nursing, Assistant Director of Nursing, Nurse Manager, Vice-
President of Nursing.
FAILURE TO COMPLY
MS. FERGUSON agrees that her license to practice nursing as a registered nurse will be
automatically suspended if it appears to the Board that MS. FERGUSON has violated or
breached any terms or conditions of the Consent Agreement. Following the automatic
Teresa E. Ferguson, R.N.
Page 8
suspension, the Board shall notify MS. FERGUSON via certified mail of the specific
nature of the charges and automatic suspension of her license. Upon receipt of this
notice, MS. FERGUSON may request a hearing regarding the charges.
. The above described terms and conditions shall constitute "restrictions placed on a
license" for purposes of Section 4723.28(B), ORC. If, in the discretion of the Board,
MS. FERGUSON appears to have violated or breached any terms or conditions of this
Consent Agreement, the Board reserves the right to institute formal disciplinary
proceedings for any and all possible violations or breaches, including, but not limited to,
alleged violations of the laws of Ohio occurring before the effective date of this Consent
Agreement.
DURATION! MODIFICATION OF TERMS
The terms, limitations, and conditions, of this Consent Agreement, other than the
permanent licensure restrictions, may be modified or terminated, in writing, at any
time upon the agreement of both MS. FERGUSON and the Board.
The Board may only alter the probationary period imposed by this Consent Agreement if:
(1) the Board determines that MS. FERGUSON has complied with all aspects of this
Consent Agreement; and (2) the Board determines that MS. FERGUSON is able to
practice according to acceptable and prevailing standards of safe nursing care without
Board monitoring, based upon an interview with MS. FERGUSON and review of the
reports as required herein. Any period during which MS. FERGUSON does not work in
a position for which a nursing license is required shall not count toward fulfilling the
probationary period imposed by this Consent Agreement.
ACKNOWLEDGMENTSfLIABILITY RELEASE
MS. FERGUSON acknowledges' that she has had an opportunity to ask questions .
concerning the terms of this Consent Agreement and that all questions asked have been'
answered in a satisfactory manner. '.
MS. FERGUSON waives all of her rights under Chapter 119, ORC, as they relate to
matters that are the subject of this Consent Agreement.
MS. FERGUSON waives any and all claims or causes of action she may have against
the Board, and its members, officers, employees and/or agents arising out of matters,
which are the subject of this Consent Agreement.
This Consent Agreement shall be considered a public record as that term is used in
Section 149.43, ORC. The information contained herein may be reported to appropriate
organizations, data banks and governmental bodies. .
Teresa E. Ferguson, R.N.
Page 9
This Consent Agreement is not an adjudication order as discussed in Chapter 119, ORe.
Any action initiated by the Board based on alleged violations of this Consent Agreement
shall comply with the Administrative Procedures Act, Chapter 119, ORC.
EFFECTIVEDATE
MS. FERGUSON understands that this Consent Agreement is subject to ratification by
the Board prior to siguature by the Board President and shall become effective upon the
last date of signature below.
LISAKLENKE, President
OhioBoardof Nursing
t' .
111110'15
DATE
II-aJ-t5
DATE
17 South High Street, Suite 400 Columbus, Ohio 432.15'3413 (614) 466-3947
Case #04--0068, 05-0906; & 05-1890
Ohio Board of Nursing
www.nursing.ohio.gov .
CONSENT AGREEMENT
BETWEEN
TERESA E. FERGUSON, R.N.
. AND
OHIO BOARD OF NURSING
This Consent Agreement is entered into by and between TERESA E; FERGUSON, R.N. (MS.
FERGUSON) and the Ohio Board of Nursing (Board), the state agency charged with enforcing
Chapter 4723. of the Ohio Revised Code (ORC), and all administrative rules promulgated
thereunder.
MS. FERGUSON voluntarily enters into this Consent Agreement being fully informed of her
rights under Chapter 119, ORC, including the right to representation by legal counsel and the
right to a formal adjudicative hearing on the issues considered herein.
This Consent Agreement contains the entire agreement between the parties, there being no other
agreement of any kind; verbal or otherwise, which varies the terms of this Consent Agreement.
BASIS FOR ACTION
This Consent Agreement is entered into on the basis of the following stipulations, admissions
and understandings:
A. The Board is empowered by Section 4723.28, ORC, to deny, permanently
revoke, revoke, suspend, or place restrictions on any license issued by the
Board; reprimand or otherwise discipline a licensee; or impose a fine of five
hundred dollars ($500.00) or less per violation. Section 4723.28(B)(8),
ORC, authorizes the Board to discipline a licensee for self-administering or
otherwise taking into the body any dangerous drug, as defined in Section
4729.01, ORC, in any way not in accordance with a legal, valid prescription
issued for that individual. Section 4723.28(B)(19), ORC, authorizes the
Board to discipline a licensee for failure to practice in accordance with
acceptable and prevailing standards of safe nursing care. Section
4723.28(B)(16), ORC, authorizes the Board to discipline a licensee for
violation of Chapter 4723, aRC, or any rules adopted under it.
Specifically, Rule 4723-4-06(G), Ohio Administrative Code, (OAC), states
that a licensed nurse shall not falsify any client record or any other
document prepared or utilized in the course of, or in conjunction with,
nursing practice. This includes, but is not limited to, case management
_ - ....
. Page 2
documents or reports or time records, reports, and other documents related
to billing for nursing services. Rule 4723-4-06(H), OAC, states that a
.licensed nurse shall implement measures to promote a safe environment for
each client
B. MS. FERGUSON is licensedto practice nursing as a registered nurse, RN-
256060, in the State of Ohio.
C. MS. FERGUSON knowingly and voluntarilyadmits to the following:
l. In or around January 2004, MS. FERGUSON resigned and her
employment was terminated from The Manor at Whitehall in
Whitehall, Ohio, after it was discovered that MS. FERGUSON
had removed Percocet for patients, but failed to chart the
administration of the medication on the Medication
Administration Record (MAR). However, a drug screen was
performed on one patient, and the results of the screen were
negative for Percocet. MS. FERGUSON explained that she did
not know how or whythe patient's screen was negative for
Percocet,
On or about January 30, 2004, MS. FERGUSON spoke with an
investigator from the Boatd and' denied any drug diversion.
Further, MS. FERGUSON provided a typed statement to the
Board, in which she reported that she failed to chart the
medications given to patients.
2. In or around April 2005, while working as a nurse at Columbus
Rehab & Sub Acute Institute in Colnmbus, Ohio, a delivery of
Oxycodone (for a PCA pump) was discovered to be missing.
Upon the medication's arrival, another nurse signed for the
delivery but gave the package (without opening it) to MS.
FERGUSON to place in the medication cart. Later, MS.
FERGUSON reported that there was no Oxycodone in the bag.
In addition, at this facility, during MS. FERGUSON's
employment, there were other missing narcotics. MS.
FERGUSON told her supervisorsthat she thought the narcotics
were taken by nursingstudents.
3. On or about July 5, 2005, whileMS. FERGUSON was working
as a nurse at Lutheran Village of Columbus in Columbus, Ohio,
it was discovered that MS. FERGUSON had taken narcotics
count sheets out of the facility (to her home) and that Percocet
cards were missing. MS. FERGUSON told her supervisor that
two (2) young males had stolen the Percocet and that she took
_._. Teresa E Ferguson,-R..N. _
-Page 3
-- --------------
the narcotic sheets home with her because she was scared. MS.
FERGUSON refused Lutheran Village's request for a drug
screen and later mailed the narcotic sheets back to Lutheran
Village.
4. On or about July 21, ZOOS, MS. FERGUSON spoke with an
investigator from the Board via telephone and admitted to
diverting the Percocet from Lutheran Village. Further, MS.
FERGUSON admitted the following: 1) that she had diverted
narcotics at Columbus Rehab & Sub Acute Institute and that she
had, in fact, taken the Oxycodone in or around April zoos; Z)
that the she self- administered the diverted medications; 3) that
she has been dealing with chronic pain issues; 4) that she
wanted help and that she was sorry for her actions; and 5) that
she did not want to be around narcotics- again.
AGREED CONDITIONS
Wherefore, in consideration of the foregoing and mutual promises hereinafter set forth, and in
lieu of any formal proceedings at this time, MS. FERGUSON knowingly and voluntarily agrees
with the Board to the following terms, conditions, and limitations:
SUSPENSION OF LICENSE
L MS: FERGUSON's license to practice nursing as a registered nurse is hereby
suspended. for an indefinite period of time, but not less than two (Z) years. MS.
FERGUSON may submit a written request for reinstatement anytime after
SEPTEMBER 2007.
z. MS. FERGUSON shall surrender to the Board her Ohio registered nurse license, RN-
256060, immediately.
CONDITIONS FOR REINSTATEMENT
3. MS. FERGUSON shall obey all federal, state, and local laws, and all laws and rules
governing the practice of nursingin Ohio.
4. MS. FERGUSON shall appear in person for interviews before the full Board or ita
designated representative as requested by the Board.
5. Prior to reinstatement, MS. FERGUSON shall enter into a Consent Agreement with
the Board for probationary terms, conditions, and limitations determined by the Board
for a minimumperiodof three (3) years following reinstatement. .
_..Ter.esa-REer.guson,.R.N .. _.
Page 4
Monitoring of Rehabilitation and Treatment
6. MS. FERGUSON shall abstain completely from the personal use or possession of
those J2.rescribed, administered, or dispensed tD __
.--.-------- authorized by law who has full knowledge of MS. FERGUSON's history. MS.
FERGUSON shall self-administer the prescribed drugs only in the mannerprescribed,
7. MS. FERGUSON shall abstain completely from the use of alcohol.
8: Not less than eighteen (18) months prior to seeking reinstatement by the Board,
MS. FERGUSON shall, at her own expense, seek a comprehensive evaluation by a
psychiatrist who is certified by the American Board of Medical Specialties in
Addiction Psychiatry and who is approved in advance by the Board, and shall provide
the Board with complete documentation of this evaluation. Prior to the evaluation,
MS. FERGUSON shall provide the psychiatrist with a copy of this Consent
Agreement. Further, MS. FERGUSON shall execute, releases to permit the
psychiatrist to obtain any information deemed appropriate and necessary for the
evaluation. The psychiatrist shall submit a written opinion to the Board that includes
diagnoses and recommendations for treatment and monitoring.
9. MS. FERGUSON shall provide the Board with satisfactory documentation of
compliance with all aspects of the treatment plan developed by the psychiatrist
described above until released. Purther, MS. FERGUSON agrees that the Board may
utilize the professional's recommendations and conclusions from the evaluation as a
basis for additional terms, conditions, and limitations on MS. FERGUSON's license
and that the terms, conditions, and limitations shall be incorporated in an addendum to
this Consent Agreement.
10. Within three (3) months prior to seeking reinstatement by the Board, MS.
FERGUSON shall, at her own expense, seek a second comprehensive evaluation by a
psychiatrist who is certified by the American Board of Medical Speoialties in
Addiction Psychiatry and who is approved in advance by the Board, and shall provide
the Board with complete documentation of this evaluation. Prior to the evaluation,
MS. FERGUSON shall provide the psychiatrist with a copy of this Consent
Agreement. Further, MS. FERGUSON shall execnte releases tel permit the
psychiatrist to obtain any information deemed appropriate and necessary for the
evaluation. The chemical dependency professional shall submit a written opinion to
the Board that includes any additional restrictions to be placed on MS. FERGUSON's
license to practice, and stating whether MS. FERGUSON is capable of practicing
. nursing according-to acceptable and prevailing standards of safe nursing care.
11. For a minimum, continuous period of eighteen (18) months immediately prior to
requesting reinstatement, MS. FERGUSON shall submit, at her expense and on the
day selected, blood or urine specimens for drug and/or alcohol analysis at a collection
site specified by the Board at such times as the. Board may request Upon and after
._.. Ter... ....---
. Page 5
MS. FERGUSON's initiation of drug screening, refusal to submit such specimen, or
failure to submit such specimen on the day she is selected, or in such a manner as the
Board may request, shall constitute a violation of a restriction placed on a license for
purposes of Section 4723-Z8(B), ORC. This screenigg_shall.J:eguirU dail.Y-..flll-i!L.. ---1
process. The specimens submitted by MS. FERGUSON shall be negative, except for
substances prescribed, administered, or dispensed to her by another so authorized by
law who has full knowledge of MS. FERGUSON's history.
a. Within thirty (30) days prior to MS. FERGUSON initiating drug screening,
MS. FERGUSON shall provide a copy of this Consent Agreement to all
treating practitioners and shall provide to the Board a list of all treating
practitioners, including addresses and telephone numbers and cause all
treating practitioners to complete a medication prescription report that is to be
mailed by the practitioner directly to the Board. The medication report is to be
completed for any and all substances prescribed, administered, or dispensed to
MS. FERGUSON.
b. After initiating drug screening, MS. FERGUSON shall be under a continuing
duty to provide a copy of this Consent Agreement, prior to initiating
treatment, to additional treating practitioners, and to update the list of treating
practitioners with the Board within forty-eight (48) hours of being treated by
another practitioner. Further, MS. FERGUSON shall, notify the Board of any
and all medicatloms) or prescriptioms) received within twenty-four (24) hours
of release from hospitalization or medical treatment.
12. For a minimum, continuous period of one (1) year immediately prior to
requesting reinstatement, MS. FERGUSON shall attend a minimum of one (1)
meeting per week of a support or peer group meeting approved in advance by the
Board, or a Twelve Step program, and licensee shall provide satisfactory
documentation of such attendance to the Board prior to reinstatement.
Reporting Requirements of Licensee
13. MS. FERGUSON shall report to the Board in writing, any violation of this Consent
Agreement within thirty (30) days of the occurrence of the violation.
14. MS. FERGUSON shall sign release of information forms allowing health
professionals and other organizations to submit requested documentation or
information directly to the Board.
15. MS. FERGUSON shall submit any and all information that the Board may request
regarding her ability to practice according to acceptable and prevailing standards of
safe nursing practice.
_ .. ' . - ...T.eresa.E-.F..er.guson.,R.N._--
. Page 6
16. MS. FERGUSON shall not submit or cause to be submitted any false, misleading, or
deceptive statements, information, or documentation to the Board or to employers or
potential employers.
----...17:---n1S. FERGUSUNsnaT!submft the' reports-anef documentation requi;ed' by this ...
Consent Agreement on forms specified by the Board. All reporting and
communications required by this Consent Agreement shall be made to the Monitoring
Unit of the Board.
18. MS. FERGUSON shall submit the reports and documentation' required by this
Consent Agreement to the attention of the Monitoring Unit, Ohio Board of Nursing,
17 South High Street, Suite 400, Columbus, OR 43215...3413.
19. MS. FERGUSON shall verify that the reports and documentation required by this
Consent Agreement are received in the Board office. .
20. MS. FERGUSON shall inform the Board within three (3) business days, in writing, of
any change in address andlor telephone number.
Permanent Narcotic Restriction
MS. FERGUSON further knowingly and voluntarily agrees with the Board to the following
permanent licensure restriction:
MS. FERGUSON shall not administer, have access to, or possess (except as prescribed for MS.
FERGUSON's use by another so authorized by law who has full knowledge of MS.
FERGUSON's history) any narcotics, other controlled substances, or mood altering drugs. In
addition, MS. FERGUSON shall not possess or carry any work keys for locked medication
carts, cabinets, drawers, or containers. MS. FERGUSON shall not count narcotics. .
permanent Practice Restrictions
MS. FERGUSON further knowingly and voluntarily agrees with the Board to the following
permanent licensure restrictions:
MS. FERGUSON shall not practice nursing as a registered nurse (1) for agencies providing
home care in the patient's residence; (2) for hospice care programs providing hospice care in the
patient's residence; (3) as a nurse for staffing agencies or pools; (4) as an independent provider
where the nurse provides nursing care and is reimbursed for services by the State 'of Ohio
through State agencies or agents of the State; or (5) for an individual or group of individuals who
directly engage MS. FERGUSON to provide nursing services for fees, compensation, or other
consideration or as a volunteer. .
MS. FERGUSON shall not function in a position or employment where the job duties or
requirements involve management of nursing, nursing responsibilities, or supervising and
evaluating nursing practice. Suchpositions include but are not limited to the following: Director
of Nursing, Assistant Director of Nursing, Nurse Manager, Vice President of Nursing.
___.. ... ---.-..-----------------
. Page 7
FAILURE TO COMPLY
The above described terms and conditions shall constitute "restrictions placed on a license" for
purposes of Section 4723.28(B), ORC. If, in the discretion of the Board, MS. FERGUSON
appears to have violated or breached any terms or conditions of this Consent Agreement, the
Board reserves the right to institute formal disciplinary proceedings for any and all possible
violations or breaches, including, but not limited to, alleged violations of the laws of Ohio
. occurring before the effective date of this Consent Agreement. . .
DURATION/MODIFICATION OF TERMS
The terms, limitations, and conditions of this Consent Agreement, other than the permanent
licensure restrictions, may be modified or terminated in writing at any lime upon the agreement
of both MS. FERGUSON and the Board.
The Board may only alter the indefinite suspension imposed if: (1) MS. FERGUSON submits a
written request for reinstatement; (2) the Board determines that MS. FERGUSON has complied
with all conditions of reinstatement; C3) the Board determines that MS. FERGUSON is able to
practice according to acceptable and prevailing standards of safe nursing care based upon an
interview with MS. FERGUSON and review of the documentation specified in this Consent
Agreement; and (4) MS. FERGUSON has entered into a Consent Agreement with the Board for
probationary terms, conditions, and limitations determined by the Boardfor a minimum period
of three years following reinstatement.
ACKNOWLEDGMENTSILIABILITY RELEASE
MS. FERGUSON acknowledges that she has had .anopportunity to ask questions concerning the
terms of this Consent Agreement and that all questions asked have been answered in a
satisfactory manner.
MS. FERGUSON waives all of her rights under Chapter 119, ORC, as they relate to matters that
are the subject of this Consent Agreement.
MS. FERGUSON waives any and all claims or causes of action she may have against the Board,
and its members, officers, employees and/or agents arising out of matters that are the subject of
this Consent Agreement
This Consent Agreement is not an adjudication order within the meaning of Section 119.01(D),
ORC, Any action initiated by the Board based on alleged violations of this Consent Agreement
shall comply with the Administrative Procedures Act, Chapter 119, ORC.
___ -" ------
Page 8
This Consent Agreement shall be considered a public record as that term is used in Section
149.43, ORC. The information contained herein may be reported to appropriate organizations,
data banks and governmental bodies.
EFFECTIVE DATE
MS. FERGUSON understands that this Consent Agreement is subject to ratification by the
Board prior to signature by the Board President and shall. become effective upon the last date of
signature below.
'YVONNE SMITH, President
Ohio Board of Nursing
DATE
9- JiJ:r D5
. DATE
ATTACHMENT A
Period From: Friday, 11/21/2008 To: Friday, 04/01/2011
Name: Teresa Ferguson Case ID: 50132 Status: Inactive
Missed call History
Date
Missed
call?
12/20/08 Missed Call
12/21/08 Missed Call
12/22/08 Missed Call
12/23/08 Missed Call
12/24/08 Missed Call
12/25/08 Missed Call
12/26/08 Missed Call
12/27/08 Missed Call
12/28/08 Missed Call
12/29/08 Missed Cali
12/30/08 Missed Call
12/31/08 Missed Call
1/1/09 Missed Call
1/2/09 Missed Call
1/3/09 Missed Call
1/4/09 Missed Call
1/5/09 Missed Call
1/6/09 Missed Call
1/7/09 Missed Call
1/8/09 Missed Call
1/9/09 Missed Call
1/10/09 Missed Call
1/11/09 Missed Call
1/12/09 Missed Call
1/13/09
,
Missed Call
1/14/09 Missed Call
1/15/09 Missed Call
1/16/09 Missed Call
1/17/09 Missed Call
1/18/09 Missed Call
1/19/09 Missed Call
1/20/09 Missed Call
1/21/09 Missed cali
Missed Call
Scheduled
1/22/09 for Testing
1/23/09 Missed Call
1/24/09 Missed Call
1/25/09 Missed Call
1/26/09 Missed Call
1/27/09 Missed Call
1/28/09 Missed Call
1/29/09 Missed Call
1/30/09 Missed Call
1/31/09 Missed Call
2/1/09 Missed Call
. 2/2/09 Missed Call
2/3/09 Missed Call
2/4/09 Missed Call
2/5/09 Missed Call
Missed Call
Scheduled
2/6/09 for Testing
2/7/09 Missed Call
2/8/09 Missed Call
2/9/09 Missed Call
2/10/09 Missed Call
2/11/09 Missed Call
2/12/09 Missed Call
2/13/09 Missed Call
2/14/09 Missed Call
2/15/09 Missed Call
2/16/09 Missed Call
2/17/09 Missed Call
2/18/09 Missed Call
2/19/09 Missed Call
2/20/09 Missed Call
2/21/09 Missed Call
2/22/09 Missed Call
2/23/09 Missed Call
2/24/09 Missed Call
2/25/09 . Missed Call
2/26/09 Missed Call
2/27/09 Missed Call
2/28/09 Missed Call
3/1/09 Missed Call
3/2/09 Missed Call
3/3/09 Missed Call
3/4/09 Missed Call
3/5/09 Missed Call
3/6/09 Missed Call
3/7/09 Missed Call
3/8/09 Missed Call
3/9/09 Missed Call
3/10/09 . Missed Call
Missed Call
Scheduled
3/11/09 for Testing
3/12/09 Missed Call
3/13/09 Missed Call
3/14/09 Missed Call
3/15/09 Missed Call
3/16/09 Missed Call
3/17/09 Missed Call
3/18/09 Missed Call
3/19/09 MIssed Call
3/20/09 Missed Call
3/21/09 MIssed Call
3/22/09 MIssed Call
3/23/09 Missed Call
3/24/09 MIssed Call
3/25/09 MIssed Call
3/26/09 MIssed Call
3/27/09 MIssed Call
3/28/09 MIssed Call
3/29/09 MIssed Call
3/30/09 Missed Call
RowCount: 101
Case #11-005357
Ohio Board of Nursing www.nursing.onio.gov
17South High Street. Suite400. Columbus. Ohio 43215-7410 (614) 466-3947
November 16,2012
NOTICE OF OPPORTUNITY FOR HEARING
Mary Ann Fowler, L.P.N.
608 West Chestnut Street
Mount Vernon, Ohio 43050
Dear Ms. Fowler:
In accordance with Chapter 119 Ohio Revised Code (ORC), you are hereby notified that the
Ohio Board of Nursing (Board) proposes under authority of Sectiou 4723.28, ORC, to deny,
revoke, permanently revoke, suspend or place restrictious on your license to practice nursing as a
licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more
than five hundred dollars ($500.00) per violation for the following reasons:
I. On or about June 8, 2012, in Knox County Court of Commou Pleas Case No.
llCRI2-0209, you pled guilty to and were couvicted of one (I) count of
Vehicular Assault, a fourth-degree felony, in violation of Section
2903.08(A)(2)(b), ORC, one (1) count of Operating a Vehicle While Under the
Influence of Alcohol, a Drug of Abuse, or a Combination of Them, a first-degree
misdemeanor, in violation of Section 4511.19(A)(I)(a), ORC, and one (1) count
of Obstructing Official Business, a fifth-degree felony, in violation of Section
2921.31(A),ORC.
The Ohio State Highway Patrol report (Report), dated December 26, 2011, states
that the acts underlying your convictions occurred on or about December 25,
2011, in Knox County, Ohio, and include you, while you were under the influence
of alcohol, a drug of abuse, or a combination of them, being the driver in a one
vehicle serious injury crash. The Report indicates that your passenger received
serious injuries to his right arm that required Med-Flight transport to OSU
Medical Center. The Report indicates that your conduct at the scene of the crash
included the following behavior: After being arrested, you removed your
handcuff(s), screamed, cursed, kicked and otherwise struggled with the arresting
officer. The Report includes a January 17,2012 statement of your passenger, who
indicated that, prior to the accident, you told him that you obtained a "pain pill"
from a friend and took it.
Section 4723.28(B)(4), ORC, authorizes the Board to discipline a licensee for conviction of, a
plea of guilty to, a judicial finding of guilt of, a judicial finding of guilt resulting from a plea of
Mary Ann Fowler, L.P.N.
Page 2
no contest to, or a judicial finding of eligibility for intervention in lieu of conviction for, any
felony or of any crime involving gross immorality or moral turpitude.
Accordingly, the Board is authorized to impose one or more of the sanctions as cited in Section
4723.280RC.
In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing
on this matter. If you wish to request such hearing, the request must be made in writing and
must be received in the Board office within thirty (30) days of the time of mailing this notice.
You are hereby further informed that if you timely request a hearing, you are entitled to appear at
such hearing in person, by your attorney, or by such other representative as is permitted to
practice before the Board, or you may present you position, argument, or contentions in writing.
At the hearing you may also present evidence and examine witnesses appearing for and against
you.
Should you choose to request a hearing, please mail or deliver the request, in addition to any
other correspondence regarding this matter to: Lisa Ferguson-Ramos, Compliance Unit
Manager, 17 South High Street, Suite 400, Columbus, OH 432157410, or to the email
address,
If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing
of this notice, the Board may, in your absence and upon consideration of the factual and legal
allegations set forth in the Notice of Opportunity for Hearing, deny, revoke, permanently revoke,
suspend or place restrictions on your license to practice nursing as a licensed practical nurse;
reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars
($500.00) per violation.
Sincerely,
Judith A. Church, R.N., C.N.P.
Supervising Board Member
Certified Mail Receipt No. 7012 1010 0002 4257 3766
cc: Henry G. Appel, Assistant Attorney General
Case # 12-005987
Ohio Board of Nursing www.nursing.ohio.gov
17 South High Street, Suite 400 ~ Columbus, Ohio 43215-7410 (614) 466-3947
November 16,2012
NOTICE OF OPPORTUNITY FOR HEARING
Jessica 1. Galaviz, R.N.
1200 N. Forest Hill Rd.
Troy, Ohio 45373
Dear Ms. Galaviz:
In accordance with Chapter 119, Ohio Revised Code (ORC), you are hereby notified that the
Ohio Board of Nursing (Board) proposes under authority of Section 4723.28 ORC, to deny,
revoke, permanently revoke, suspend or place restrictions on your license to practice nursing as a
registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five
hundred dollars ($500.00) per violation for the following reasons:
1. On September 21, 2012, the Board issued a Notice of Automatic Suspension and
Opportunity for Hearing suspending your license to practice as a registered nurse. On
or about September 26,2012, the Board received a Firstlab report indicating that on
orabout September 18,2012, your urine tested positive for FentanyL You did not
have a legal, valid prescription for FentanyL
Section 4723.28(B)(8), ORC, authorizes the Board to discipline a licensee for self-administering
or otherwise taking into the body any dangerous drug, as defined in Section 4729.01, ORC, in
any way not in accordance with a legal, valid prescription issued for that individual.
Accordingly, the Board is authorized to impose one or more of the sanctions cited in Section
4723.28,ORC.
In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing
in this matter. If you wish to request such hearing, the request must be made in writing and must
be received iu the Board office within thirty (30) days of the time of mailiug of this notice.
You are hereby further iuformed that, if you timely request a hearing, you are entitled to appear
at such hearing in person, by your attorney, or by such other representative as is permitted to
practice .before the Board, or you may present your position, arguments, or contentions in
writing. At the hearing, you may also present evidence and examine witnesses appearing for and
against you.
Should you choose to request a hearing, please mail or deliver the request, in addition to any
other correspondence regarding this matter, to Lisa Ferguson-Ramos, Compliance Unit
Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, Ohio 43215-
7410 or to the email address, hearing@nursing.ohio.gov.
Jessica L. Galaviz
Page 2
If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing
of this notice, the Board may, in your absence and upon consideration of the factual and legal
allegations set forth in this Notice of Opportunity for Hearing, deny, revoke, permanently
revoke, suspend, or place restrictions on your license to practice nursing as a registered nurse;
reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars
($500.00) per violation.
Sincerely,
Judith A. Church, R.N., C.N.P.
Supervising Board Member
Certified Mail Receipt No. 7012 1010 0002 42574268
cc: Henry G. Appel, Assistant Attorney General
Case 12-005511 & 12-005847
Ohio Board of Nursing www.nursing.ohio.gov
17 South High Street, Suite 400- Columbus, Ohio 43215:7410 (614) 466"3947
November 16,2012
NOTICE OF OPPORTUNITY FOR HEARING
Pamela Jean Gartrell
5864 Blue Spruce Lane
Cincinnati, Ohio 45224
Dear Ms. Gartrell:
In accordance with Chapter 119, Ohio Revised Code (ORC), you are hereby notified that the
Ohio Board of Nursing (Board) proposes under authority of Section 4723.28, ORC, to deny or
permanently deny your application for renewal/reinstatement of your license to practice nursing
as a registered nurse; permanently revoke, revoke, suspend or place restrictions on your license
to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine
of not more than five hundred dollars ($500.00) per violation for the following reasons:
I. On or about September 21, 2012, you entered into a Consent Agreement
(September 2012 Consent Agreement) with the Ohio Board of Nursing
(Board), a copy of which is attached hereto and incorporated herein, in which
you agreed with the Board that upon meeting the requirements for
reinstatement, your license to practice nursing as a registered nurse in the
State of Ohio would be reinstated and suspended indefinitely and that such
suspension would be stayed subject to probationary terms, conditions, and
limitations for a minimum period of three (3) years. Attached to and
incorporated within the September 2012 Consent Agreement is a November
20, 2009 Consent Agreement and. a July 24, 2009 Notice of Immediate
Suspension and Opportunity for Hearing. Documents are redacted according
to Sections 2953.32 and/or 2953.52, ORe. On or about October 9, 2012, you
submitted an application for renewal/reinstatement of your license.
On or about September 15, 2012, you provided a specimen for analysis to
Firstlab, the Board's random drug/alcohol screen program administrator, that
tested positive for Benzoylecgonine, a Cocaine metabolite. This positive drug
screen was reported to the Board by Firstlab on or about September 25, 2012.
In a written statement to the Board submitted September 27, 2012, you'
indicate that: "I did attend a party on Thursday Sept 13 that ran into Friday
Sept 14 and it is at that time that I ingested cocaine."
Section 4723.28 (B)(8), ORC, authorizes the Board to discipline a licensee for self-administering
or otherwise taking into the body any dangerous drug, as defined in Section 4729.01, ORC, in
any way not in accordance with a legal, valid prescription issued for that individual, or self-
Pamela Jean Gartrell
Page 2
administering or otherwise taking into the body any drug that IS a schedule I controlled
substance.
Accordingly, the Board is authorized to impose one or more of the sanctions cited in Section
4723.28,ORC.
In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing
in this matter. If you wish to request such hearing, the request must be made in writing and must
be received in the Board office within thirty (30) days of the time of mailing of this notice.
You are hereby further informed that, if you timely request a hearing, you are entitled to appear
at such hearing in person, by your attorney, or by such other representative as is permitted to
practice before the Board, or you may present your position, arguments, or contentions in
writing. At the hearing, you may also present evidence and examine witnesses appearing for and
against you.
Should you choose to request a hearing, please mail or deliver the request, in addition to any
other correspondence regarding this matter, to Lisa Ferguson-Ramos, Compliance Unit
Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, Ohio 43215-
7410 or to the email .Q.lliQ.g2Y.
If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing
of this notice, the Board may, in your absence and upon consideration of the factual and legal
allegations set forth in this Notice of Automatic Suspension and Opportunity for Hearing, deny
or permanently deny your application for renewal/reinstatement of your license to practice
nursing as a registered nurse; permanently revoke, revoke, suspend or place restrictions on your
license to practice nursing as a registered nurse; reprimand or otherwise discipline you; or
impose a fine of not more than five hundred dollars ($500.00) per violation.
Sincerely,
Judith A. Church, R.N., C.N.P.
Supervising Board Member
Certified Mail Receipt No. 70121010 0002 42574312
cc: Henry G. Appel, Assistant Attorney General
Case #12-003687
OItio Boardnf
..... ".: ' .. "':" ';.'. :.,' ..:....:.. www.nursing.ohio.gov
. 17South High Street, SUite400 ' . Columbus, Ohio 43215-7410', (614) 466-3947
REINSTATEMENT CONSENT AGREEMENT
BETWEEN
PAMELA JEAN GARTRELL, R.N.
AND
OHIO BOARD OF NURSING
This Consent Agreement is entered into by and between PAMELA JEAN GARTRELL,
R.N. (MS. GARTRELL) and the Ohio Board of Nursing (Board), the state agency
charged with enforcing Chapter 4723. of the Ohio Revised Code (ORC), and all
administrative rules promulgated thereunder.
For purposes of this Agreement, "Consent Agreement" shall be defined as this
Agreement, and the following documents that are attached hereto and incorporated
herein:
Consent Agreement, dated November 20, 2009 (November 2009 Consent
Agreement) with redactions;
Notice ofImmediate Suspension and Opportunity for Hearing, dated July
24, 2009 (July 2009 Notice) with redactions; and
A letter explainingthe redactions.
This Consent Agreement contains the entire agreement between the parties, there being
no other agreement of any kind, verbal or otherwise, which varies the terms of this
Consent Agreement.
BASISFOR ACTION
This Consent Agreement is entered into on the basis of the following stipulations,
admissions and understandings:
A. The Board is empowered by Section 472328, ORC, to deny,
permanently revoke, revoke, suspend, or place restrictions on any
license issued by the Board; reprimand or otherwise discipline a
licensee; or impose a fine of five hundred dollars ($500.00) or less
per violation. MS. GARTRELL admits to Violating Section
4723.28, ORC, as set forth in her November 2009 Consent
Agreement and July 2009 Notice. Further, MS. GARTRELL
admits to additional violations of Section 4723.28, ORC.
Specifically, Section 4723.28(B)(4), ORC, authorizes the Board to
discipline a licensee for conviction of, a plea of gullty to, a judicial
finding of gullt of, a judicial finding of gullt resulting from a plea
of no contest to, or a judicial finding of eligibility for intervention
in lieu of conviction for, any felony or of any crime involving
Pamela Jean Gartrell, R.N.
Page 2
gross immorality or moral turpitude. Section 4723.28(B)(17),
ORC, authorizes the Board to discipline a licensee for violation of
any restrictions placed on a nursing license by the Board.
B. MS. GARTRELL was initially issued a license to practice nursing
in the Ohio as a registered nurse, RN-264501, in April 1996. MS.
GARTRELL's license was immediately suspended in July 2009
and then indefinitely suspended in November 2009.
C. In 2010, MS. GARTRELL completed the community control
ordered terms in Hamilton County Municipal Court Case No.
C/08/CRB/292101A.
D. In March 2011, in Hamilton County Municipal Court, MS.
GARTRELL was convicted of one (1) misdemeanor count of
Theft that stemmed from an October 2010 retail theft incident.
After completing the terms of community control, MS.
GARTRELL was released in March 2012.
E. After reviewing information related to the above noted 2011 theft
conviction, MS. GARTRELL was permitted to continue with the
terms of her (suspension) November 2009 Consent Agreement.
F. MS. GARTRELL has completed a nurse refresher course at
Upper Valley Medical Center as Well as additional continuing
education hours.
G. MS. GARTRELL successfully completed chemical dependency
treatment programs in 2009 and 2010. MS. GARTRELL reported
to the Board that she has not abused any narcotics or used alcohol
since April 10, 2009.
1-1. MS. GARTRELL provided the Board with her March 2012
chemical dependency evaluation that was performed by Denise
Hammond, LSW, LCDC III at 111e Alcoholism Council of the
Cincinnati Area. MS. GARTRELL was diagnosed with Cocaine
Dependence in remission. Ms. Hammond recommended that MS.
GARTRELL attend a relapse treatment program and a group
counseling session at least once (1) per week. Ms. Hannnond also
recommended that MS. GARTRELL undergo individual
counseling at least once (1) per month. In May 2012, Ms.
Hammond submitted a statement to the Board indicating that MS.
GARTRELL is in compliance with her treatment
recommendations.
I. MS. GARTRELL has now met the terms and conditions and has
submitted a written reqnest for licensure reinstatement to the
Board.
Pamela Jean Gartrell, R.N.
Page 3
AGREED CON:QITIONS
Wherefore, in consideration of the foregoing and mutual promises hereinafter set forth,
and in lieu of any formal proceedings at this time, MS. GARTRELL knowingly and
voluntarily agrees with the Board to the following terms, conditions, and limitations:
Uponmeeting the requirements for reinstatement, MS. GARTRELL's license to practice
nursing as a registered nurse shall be reinstated and suspended indefinitely. Such
suspension shall be stayed, subject to the following PROBATIONARYterms, conditions,
and limitationsfor a minimum period of probation term (3) years:
1. MS. GARTRELL shall obey all federal, state, and local laws, and all
laws and rules governingthe practice of nursing in Ohio.
2. MS. GARTRELL shall appear in person for interviews before the full
Board or its designated representative as requested by the Board or its
designee.
Criminal Records Check
3. Within ninety (90) days prior to SUbmitting a reqnest for release
from the probationary terms, conditions and limitations of this
Consent Agreement, MS. GARTRELL agrees that she will submit a
request to the Bureau of Criminal Identification and Investigation
(BCll) to conduct a criminal records check of MS. GARTRELL,
includinga check of Federal Bureau of Investigation (FBI) records, and
shall cause BCll to submit MS. GARTRELL's criminal records check
reports to the Board. MS. GARTRELL agrees that a request for
release from the probationary terms of this Consent Agreement will not
be considered by the Board until the completed criminal records check,
including the FBI check, has been received by the Board.
Monitoring of Rehabilitation and Treatment
4. MS. GARTRELL shall abstain completely from the personal Use or
possession of drugs, except those prescribed, administered, or
dispensed to her by another so authorized by law and who has full
knowledge of MS. GARTRELL's history of chemical dependency and
recovery status and who has received a complete copy of this Consent
Agreement prior to prescribing for MS. GARTRELL. MS..
GARTRELL shall self-administer prescribed drugs only in the manner
prescribed.
5. MS. GARTRELL shall abstaincompletely from the use of alcohol and
productscontaining alcohol.
6. MS. GARTRELL shall continue submitting, at her expense and on the
day selected, breath, hair, blood or urine specimens for drug and/or
alcohol analysis at a collection site specified by the Board at such times
as the Board may request. Refusal to submit such specimen, or failure
to submit such specimen on the day she is selected, or in such a manner
as the Board may request, shall constitute a violation of a restriction
placed on a license for purposes of Section 4723.28(B), ORC. This
Pamela Jean Gartrell, R.N.
Page 4
screening shall require a daily call-in process. The specimens
snbmitted by MS. GARTRELL shall be negative, except for
substances prescribed, administered, or dispensed to her by another so
authorizedby law and who has fu1l knowledge of MS. GARTRELL's
history of chemical dependency and recovery status and who has
received a complete copy of this Conseut Agreement prior to
prescribingfor MS. GARTRELL.
7. MS. GARTRELL shall continue attending a minimum of one (1)
meeting per week of a support or peer group meeting approved in
advance by the Board, or a Twelve Step program, and MS.
GARTRELL shall provide satisfactory documentation of such
attendance to the Board every six (6) months beginning November 1,
2012.
8. MS. GARTRELL shall continue to participate in ongoing individual
counseling sessions and group counseling with Ms. Hammond or
another chemical dependency professional approved in advance by the
Board or its designee, at intervals determined deemed appropriate until
released. MS. GARTRELL shall have the chemical dependency
professional submit written reports regarding MS. GARTRELL's
current diagnosis, progress, status, and compliance with her treatment
plan to the Board on a quarterly basis begiuuing Nov-ember 1, 2012.
MS. GARTRELL shall provide the Chemical dependency professional
with a copy of this Consent Agreement prior to October 22, 2012.
MS. GARTRELL shall ioform the Board, in writing, within five (5)
business days of discontinuing participationin individual and/or group
counseling, and prior to said discontinuation, shall inform the Board, in
writing, of the narne(s) of another chemical dependency professional(s)
and intervals of treatment for approval by the Board.
Treating Practitioners and Reporting
9. Within sixty (60) days of the effective date of this Consent
Agreement, MS. GARTRELL shall provide a.copy of this Consent.
Agreement to all treating practitioners and shall provide to the Board a
list of all treating practitioners, including addresses and telephone
numbers. Further, MS. GARTRELL shall be under a continuing duty
to provide a copy of this Consent Agreement, prior to initiating
treatment, to additional treating practitioners, and to update the list of
treating practitioners with the Board within forty-eight (48) hours of
being treated by another practitioner.
10. MS. GARTRELL shall cause all treating practitioners to complete a
medication prescription report that is to be mailed by the practitioner
directly to the Board. The medicationreport is to be completedfor any
and all substances prescribed, administered, or dispensed to MS.
GARTRELL throughout the durationof this Consent Agreement.
Pamela Jean Gartrell, R.N.
Page 5
II. Within twenty-four (24) hours of release from hospitalization or
medical treatment, MS. GARTRELL shall notify the Boardof any and
all medication(s) or prescription(s) received.
Evaluations
12. Upon request by the Board or its designee aud within ninety (90)
days of such a request(s), MS. GARTRELL shall, at her expense,
obtain a chemical dependeucy evaluation and/or a psychiatric
evaluation. Further, MS. GARTRELL shall provide the Board with
complete documentation of the evaluations from professionals
approved in advance by the Board. Prior to the evaluations, MS.
GARTRELL shall provide the professionals with a copy of this
Consent Agreement. MS. GARTRELL shall execute releases to
permit the professionals to obtain any information deemed appropriate
and necessaryfor the evaluations. The evaluating professionals shall
submit a written opinion to the Board that includes diagnoses,
recommendations for treatment and monitoring, any additional
restrictions that should be placed on MS. GARTRELL's license to
practice, and statements as to whether MS. GARTRELL is capable of
practicingnursing according to acceptable and prevailing standards of
safe nursingcare.
13. If the Board or its designee requests evaluations, MS. GARTRELL
shall provide the Board with satisfactory documentation of compliance
with all aspects of the treatment plans developed by the professionals
describedabove until released. Further, MS. GARTRELL agrees that
the Board may utilize the professional's recommendations and
conclusions from the evaluation(s) as a basis for additional terms,
conditions, and limitations on MS. GARTRELL's license and that the
terms, conditions, and limitations shall be incorporatedin an addendum
to this Consent Agreement.
Employment Conditions
14. Prior to accepting employment as a nurse, each time with every
employer,MS. GARTRELL shall notifythe Board in writing.
15. MS. GARTRELL is under a continuingduty to provide a copy of this
Consent Agreement to any new employer prior to accepting
employment as a nurse. MS. GARTRELL shall have her
employens) submit written reports regarding job performance on a
quarterly basis beginning within thirty (30) days of accepting
nursing employment. Further, MS. GARTRELL shall have her
employer(s) send documentation to the Board, along with the first
employer report, of receipt of a copy of this Consent Agreement,
includingthe date the Consent Agreement was received.
Pamela Jean Gartrell, R.N.
Page 6
Reporting Requirements of Licensee
16. MS. GARTRELL shall report to the Board, in writing, any violation
of this Consent Agreement within thirty (30) days of the occurrence of
the violation.
17. MS. GARTRELL shall sign release of information forms allowing
health professionals and other organizations to submit the requested
documentatioudirectly to the Board.
18. MS. GARTRELL shall submit any and all information that the Board
may request regarding her ability to practice according to acceptable
and prevailingstandards of safe nursing practice.
19. MS. GARTRELL shall not submit or cause to be submitted any false,
misleading, or deceptive statements, information, or documentation to
the Board or to employers or potential employers.
20. MS. GARTRELL shall submit the reports and documentation required
by this Consent Agreement on forms specified by. the Board. All
reporting and commnnications required by this Consent Agreement
shall be made to the Compliance Unit of the Board.
21. MS. GARTRELL shall submit the reports and documentation required
by this Consent Agreement or any other documents required by the
Board to the attention of the Compliance Unit, Ohio Board of Nursing,
17 SouthHigh Street, Suite 400, Columbus, OH43215-7410.
22. MS. GARTRELL shall verify that the reports and documeutation
requiredby this Consent Agreement are received in the Board office.
23. MS. GARTRELL shall inform the Board within five (5) business
days, in writing, of any change in employment status or of any change
in residential or home address or telephone number.
Temporary Narcotic Restriction
MS. GARTRELL shall not administer, have access to, or possess (except as prescribed
for MS. GARTRELL's use by another so authorized by law and who has full knowledge
of MS. GARTRELL's history of chemical dependency and recovery status) any
narcotics, other controlled substances, or mood altering drugs for a minimum of six (6)
month in which MS. GARTRELL is working in a position that requires a nursing
license. At any time after the six (6) month period previously described, MS.
GARTRELL may submit a written request to the Board to have this restriction re-
evaluated. In addition, MS. GARTRELL shall not count narcotics or possess or carry
any work keys for locked medication carts, cabinets, drawers, or containers. MS.
GARTRELL shall not call in or order prescriptions or prescription refills.
Pamela Jean Gartrell, R.N.
Page 7
Permanent Practice Restrictions
MS. GARTRELL further knowingly and voluntarily agrees with the Board to the
following PERMANENT LICENSURE RESTRICTIONS:
MS. GARTRELL shall not practice nursing as a registered nurse (1) for agencies
providing home care in the patient's residence; (2) for hospice care programs providing
hospice care in the patient's residence; (3) for staffing agencies or pools; (4) as an
independent. provider where the nurse provides nursing care and is reimbursed for
services by the State of Ohio through State agencies or agents of the State; or (5) for an
individual or group of individuals who directly engage MS. GARTRELL to provide
nursing services for fees, compensation, or other considerationor as a volunteer.
MS. GARTRELL shall not function in a position or employment where the job dnties or
requirements involve management of nursing and nursing responsibilities, or supervising
and evaluating nursing practice. Such positions include, but are not limited to, the
following: Director of Nursing, Assistant Director of Nursing, Nurse Manager, Vice-
President of Nursing.
MS. GARTRELL shall not be involved in financial activity or financial activities.
FAILURE TO COMPLY
MS. GARTRELL agrees that her license to practice nursing as a registered nurse will be
automaticallysuspended if it appears to the Board that MS. GARTRELL has violated or
breached any terms or conditions of the Consent Agreement. Following the automatic
suspension, the Board shall notify MS. GARTRELL via certified mail of the specific
nature of the charges and automatic suspension of her license. Upon receipt of this
notice, MS. GARTRELL may request a hearing regarding the charges.
The above described terms and conditions shall constitute "restrictions placed on a
license" for purposes of Section 4723.28(B), ORC. If, in the discretion of the Board,
MS. GARTRELL appears to have violated or breached any terms or conditions of this
Consent Agreement, the Board reserves the right to institute formal disciplinary
proceedingsfor any and all possible violations or breaches, including, but not limited to,
alleged violations of the laws of Ohio occurring before the effective date of this Consent
Agreement.
DURATION! MODIFICATION OF TERMS
The terms, limitations, and conditions, of this Consent Agreement, other than the
permanent practice restrictions, may be modified or terminated, in writing, at any time
upon the agreement of both MS. GARTRELL and the Board.
The Board may only alter the probationary period imposed by this Consent Agreement if:
(I) the Board determines that MS. GARTRELL has complied with all aspects of this
Consent Agreement; and (2) the Board determines that MS. GARTRELL is able to
practice according to acceptable and prevailing standards of safe nursing care without
Board monitoring, based upon an interview with MS. GARTRELL and review of the
Pamela Jean Gartrell, R.N.
Page 8
reports as required herein, Any period during which MS. GARTRELL does lot work in
a position for which a nursing license is required shall not count toward ft Ifilling the
probationary period imposed by this Consent Agreement.
ACKNOWL:\!:})GMENTSD-lABILlTY R E L E A . S " ~
MS. GARTRELL acknowledges that she has had an. opportunity to ad; questions
concerning the terms of this Consent Agreement and that all questions asked have been
answered in a satisfactory manner.
MS. GARTRELL waives all of her rights under Chapter 119, ORC, as th"y relate to
matters that are the subject of this Consent Agreement.
MS. GARTRELL waives any and all claims or causes of action she may bnve against
the Board, and its members, offlcel:s, employees and/or agents arising out ){matters,
. which are the subject of this Consent Agreement,
This Consent Agreement shall be considered a public record as that terril. is used in
Section 149.43, ORC, The information contained herein may be reponed to nppropriate
organizations, data banks and governmental bodies. '
This Consent Agreement is not an adjudication order as discussed in Chapter 119, ORC.
Any action initiated by the Board based on alleged violations of this Consent .lI.greement
shall comply with the Administrative Procedures Act, Chapter 119. ORC,
EFFECT)yE DATE
MS. GARTRELL understands that this Consent Agreement is subject to rati lcatlon by
the Board prior to signature by the Board President and shall become effectivl upon the
last e of signature below.
BERTHA LOVELACE, President
Ohio Board of Nursing
-,
"
Ohio Board of Nursing www.nursing.ohio.goY
17 South High Street, Suite 400 Columbus, Ohio 43215-7410 (614) 466-3947
To WhomIt May Concern:
You recently requested records regarding Pamela Jean Gartrell,
RN # 264501. Enclosed are records in response to your request.
Information has been redacted, per Section(s) 2953.32 and/or
2953.52 of the Ohio Revised Code.
If-you-have any further questions or concerns, please contact the
Compliance Unit Manager or a Supervising Attorney.
Thank you.
Compliance Unit
Ohio Board of Nursing
Case #09-1445 & 09-2844
Ohio Board of Nursing WWw,lltll'sing_ohio.gov
17 8011t1l High SWeet, Suite 400 Columbus, Ohio. 43215-7410 (61.4) 466-3947
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~ s . GARTRELL voluntarily enters into this Consent Agreement being fully informed of her
rights under Chapter 119, ORC, including the right to representation by legal counsel and the
right to a formal adjudicativehewingOil the issuesconsideredberein.
This Consent Agreement Clilllll!itis the entire agreement betweenthe parties, there being no dther
agreement of any kind.verbal or otherwise, which varies the termsof this Consent Agreement.
BASIS FORACTION
This Consent Agreement is entered into on the basis of the following stipulations, admissions
and understandings:
A, . The Board is empowered by Section 4723.,28, ORC, to deny, permanently
revoke, revoke, suspend, or place restrictions Oil any license issued by the
Board; reprit\laild 01' otherwisediscipline a licensee; or impose a fine offi'i'e
hundred dollars ($500,00) or less per violation, Section 4723.28(B){';3),
ORC, authorizes the Board to discipline a licensee for conviction of"a plea
of guilty to, a judicial finding of guilt of, a judicial finding of guilt l'esllttmg.
from a, plea of rio contest to, or il judicial finding of eligibttity for
Intervention inHi'll) of conviction for, of a misdemeanor committed In the
course of practice, Section 4723,28(B)(4), ORC, authorizes the 'Soard to
discipline a.licensee for convictionof, a plea of guiltyto, a judicial finding
of guilt of,ajudioial finding of guilt tesulting from a plea of no contest to,
or a judicial finding of eligibility for interventionin lieu of conviction, for,
any felony or of any crime involving gross Immorality or moral turpitude.
Section 4723,$8(B;)(5), ORC, authorizes the Board to discipline a licensee
for convictionof, a plea of guilty to, a judicial finding of guilt of, a judicial
finding of guilt resulting froma plea of no contest to, or a judicial filldlng of
eligibilityforintervention in lieu of conviction for, violating any municipal,
state, county, or federal drug law, Section 4723.28(B)(8), ORC, authorizes
Pamela Jean Gartrell, R.N.
Page 2
the Board to discipline a licensee for self-administering or otherwise taking
into the body any dangerous drug, as defined in Section 4729.01, ORC, in
any way not in accordance with a legal, valid prescription issued for that
individual. Section 4723.28(B)(16), ORC, authorizes the Board to
discipline a licensee for violation of Chapter 4723, ORC, or any rules
adopted under it. Specifically, Rule 4723-4-06(P)(I), Ohio Administrative
Code, states that a licensed nurse shall not make any false, misleading, or
deceptive statements, or submit or cause to be submitted any false,
misleading 01' deceptive information, or documentation to the board 01' any
representativeof the board.
B. MS. GARTRELL's license to practice nursing as a registered nurse in the
State of Ohio, RN-264501, was immediately suspended by the Board on 01'
about July 24, 2009. MS. GARTRELL's Ohio nursing license was
initially issued in April 1996.
C. MS. GARTRELL knowingly and voluntarily admits to the factnal and
legal allegations set forth in the Notice of Immediate Suspension and
Opportunity for Hearing issued to her by the Board on 01' about July 24,
2009 (July 2009 Notice), a copy of which is attached hereto and
incorporated herein.
D. On 01' about August 12, 2009, MS. GARTRELL's mother submitted a
letter to the Board explaining that she, not MS. GARTRELL, renewedMS.
GARTRELL's nursing license online. The mother stated that she was
unaware of MS. GARTRELL's misdemeanor conviction and that MS.
GARTRELL was in treatment at the time and did not know that the mother
had renewed her nursing license.
E. In Hamilton Municipal Court Criminal Case No. CI08/CRBI292101A and
IB, MS. GARTRELL's community control sentence was originally
effective until May 2009, but was extended until May 2010 to allow MS.
GARTRELL additional time to pay her fine and/or other court costs.
F. MS. GARTRELL has been in inpatient treatment for cocaine dependency
since in or around June 2009 and expects to be released in October 2009.
AGREED CONDITIONS
Wherefore, in consideration of the foregoing and mutual promises hereinafter set.forth, and in
lieu of any formal proceedings at this time, MS. GARTRELL knowingly and voluntarily agrees
with the Board to the following terms. conditions, and limitations:
Pamela Jean Gartrell, RoN.
Page 3
SUSPENSION OF LICENSE
1. MS. GARTRELL's license to practice nursing as a registered nurse is hereby
suspended for an indefinite period of time, but 1I0t less than two (2) years, MS.
GARTRELL may submit a written request for reinstatement anytime after
November 2011.
CONDITIONS FOR REINSTATEMENT
2. MS. GARTRELL shall obey all federal, state, and local laws. and all laws and rules
governing the practice of nursing in Ohio.
-"''''-, .,-
3.
4.
5.
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7.
8.
MS. GARTRELL shall comply with all conditions imposed in Hamilton Municipal
Court Criminal Case No. C/08/CRB/2921O/A and lB.
MS. GARTRELL shall appear in person for interviews before the full Board or its
designated representative as requested by the Board.
Prior to requesting reinstatement by the Board, MS. GARTRELL shall, in
addition to the requirements of licensure renewal, successfully complete and submit
satisfactory documentation of successful completion of the following continuing
nursing education taken subsequent to the effective date of this Consent Agreement:
one (1) hour of Ohio Nursing Law and Rules; five (5) hours of Professionalism I
Ethics; and five (5) hours of Professional Boundaries.
Within three (3) months prior to requesting reinstatement, MS. GARTRELL
agrees that she will submit a request to the Bureau of Criminal Identification and
Investigation (BClT) to conduct a crlmlnal records check of MS. GARTRELL,
including a check of Federal Bureau of Investigation (FBI) records, and shall cause
BCIl to submit MS. GARTRELL's criminal records check reports to the Board. MS.
GARTRELL agrees that a request for reinstatement will not be considered by the
Board until the completed criminal records check, including the FBI check, has been
received by the Board.
Prior to reinstatement, MS. GARTRELL shall enter into a Consent Agreement with
the Board for probationary terms, conditions, and limitations determined by the Board
for a minimnmperiod of three (3) years following reinstatement.
Monitoring of Rehabilitation and Treatment
9. MS. GARTRELL shall abstain completely from the personal use or possession of
drugs, except those prescribed, administered, or dispensed to her by another so
authorized by law who has full knowledgeof MS. GARTRELL's history of chemical
Pamela Jean Gartrell, R.N.
Page4
dependency and recovery status. MS. GARTRELL shall self-administer the
prescribed drugs only in the manner prescribed.
10. MS. GARTRELL shall abstain completelyfrom the use of alcohol.
11. Within three (3) months prior to requesting reinstatement by the Board, MS.
GARTRELL shall, at her own expense, obtain a chemical dependency evaluation by
a Board approved chemical dependency professional and shall provide the Board with
complete documentation of this evaluation. Prior to the evaluation, MS. GARTRELL
shall provide the chemical dependency professional with a copy of this Consent
Agreement and the attached July 2009 Notice. Further, MS. GARTRELL shall
execute releases to permit the chemical dependency professional to obtain any
information deemed appropriate and necessary for the evaluation, The chemical
dependency professional shall submit a written opinion to the Board that includes
diagnoses, recommendations for treatment and monitoring. any additional restrictions
to be placed on MS. GARTRELL's license to practice, and stating whether MS.
GARTRELL is capable of practicing nursing according to acceptable and prevailing
standards of safe nursing care.
12. MS. GARTRELL shall provide the Board with satisfactory documentation of
compliance with all aspects of the treatment plan developed by the chemical
dependency professional described above until released. Further, MS. GARTRELL
agrees that the Board may utilize the professional's recommendations and conclusions
from the evaluation as a basis for additional terms, conditions, and limitationson MS.
GARTRELL's license and that the terms, conditions, and limitations may be
incorporatedin an addendumto this Consent Agreement.
13. For a minimum, continuous period of one (1) year immediately prior to
requesting reinstatement, MS. GARTRELL shall submit, at her expense and on the
day selected, blood or urine specimensfor drug and/or alcohol analysis at a collection
site specified by the Board at such times as the Board may request. Upon and after
MS. GARTRELL's initiation of drug screening, refusal to submit such specimen, or
failure to submit such specimen on the day she is selected, or in such a manner as the
Board may request, shall constitute a violation of a restriction placed on a license for
purposes of Section 4723.28(B), ORC. This screening shall require a daily call-in
process. The specimens submitted by MS. GARTRELL shall be negative, except for
substances prescribed, administered, or dispensed to her by another so authorized by
law who has full knowledge of MS. GARTRELL's history of chemical dependency
and recovery status.
a. Within thirty (30) days prior to MS. GARTRELL initiating drug screening,
MS. GARTRELL shall provide a copy of this Conseut Agreement and
attached July 2009 Notice to all treating practitioners and shall provide to the
Board a list of all treating practitioners, including addresses and telephone
numbers and cause all treating practitioners to complete a medication
prescription report that is to be mailed by the practitioner directly to the
Pamela Jean Gartrell, R.N.
PageS
Board. The medication report is to be completed for any and all substances
prescribed, administered, or dispensed to MS. GARTRELL.
b. After initiatingdrug screening. MS. GARTRELL shall be under a continuing
duty to provide a copy of this Consent Agreement and attached July 2009
Notice, prior to initiating treatment, to additional treating practitioners, and to
update the list of treating practitioners with the Board within forty-eight (48)
hours of being treated by another practitioner. Further, MS. GARTRELL
shall notify the Board of any and all medication(s) or prescription(s) received
within twenty-four (24) hours of release from hospitalization or medical
treatment.
14. For a mrmmum, continuous period of one (1) year immediately prior to
requesting reinstatement, MS. GARTRELL shall attend a minimum of one (1)
meeting per week of a support or peer group meeting approved in advance by the
Board, or a Twelve Step program, and MS. GARTRELL shall provide satisfactory
documentation of such attendance to the Board prior to requesting reinstatement.
Reporting Requirements of Licensee
15. MS. GARTRELL shall report to the Board, in writing, any violation of this Consent
Agreement within thirty(30) days of the occurrenceof the violation.
16. MS. GARTRELL shall sign release of information forms allowing health
professionals and other organizations to submit requested documentation or
information directlyto the Board.
17. MS. GARTRELL shall submit any and all information that the Board may request
regarding her ability to practice according to acceptable and prevailing standards of
safe nursing practice.
18. MS. GARTRELL shall not submit or cause to be submitted any false, misleading. or
deceptive statements. information, or documentation to the Board or to employers or
potential employers.
19. MS. GARTRELL shall submit the reports and documentation required by this
Consent Agreement on forms specified by the Board. All reporting and
communications required by this Consent Agreement shall be made to the Compliance
Unit of the Board.
20. MS. GARTRELL shall submit the reports and documentation required by this
Consent Agreement to the attention of the Compliance Unit, Ohio Board of Nursing,
17 South High Street. Suite 400, Columbus, OH43215-7410.
21. MS. GARTRELL shall verify that the reports and documentation required by this
Consent Agreemeut are received in the Boardoffice.
Pamela Jean Gartrell. R.N.
Page 6
22. MS. GARTRELL shall inform the Board within three (3) business days, in writing.
of any change in address and/or telephone number.
Nursing Refresher Course or Orientation
MS. GARTRELL shall, prior to working in a position where a nursing license is
required, complete and submit satisfactory documentation of completion of a
nursing refresher course or an extensive orientation approved in advance by the
Board or its designee.
Temporary Narcotic Restrictions
Upon reinstatement of her license, MS. GARTRELL shall not administer, have
access to, or possess (except as prescribedfor MS. GARTRELL's use by another
so authorized by law who has full knowledge of MS. GARTRELL's history of
chemical dependency) any narcotics, other controlled substances, or mood
altering drugs for a minimum period of six (6) months in which MS.
GARTRELL is working in a position that requiresa nursing license. At any time
after the six-month period previously described. MS. GARTRELL may submit a
written request to the Board to have this restriction re-evaluated. In addition, MS.
GARTRELL shall not count narcotics or possess or carry any work keys for
locked medication carts. cabinets, drawers, or containers. MS. GARTRELL shall
not call in or order prescriptionsor prescriptionrefills.
Permanent Practice RestrictionS.
MS. GARTRELL further knowingly and voluntarily agrees with the Board to the followiug
PERMANENT LICENSURE RESTRICTIONS:
MS. GARTRELL shall not practice nursing as a registered nurse (I) for agencies
providing home care in the patient's residence; (2) for hospice care programs
providing hospice care in the patient's residence; (3) for staffing agencies or
pools; (4) as an independent provider where the nurse provides nursing care and is
reimbursed for services by the State of Ohio through State agencies or agents of
the State; or (5) for an individual or group of individualswho directly engage MS.
GARTRELL to provide nursing services for fees, compensation, or other
consideration or as a volunteer.
Unless otherwise approved in advance by the Board or its. designee, MS.
GARTRELL shall not function in a position or employment where the job duties
or reqnirements involve management of nursing and nursing responsibilities, or
supervising and evaluating nursing practice. Such positions inclnde but are not
limited to the following: Director of Nursing, Assistant Director of Nursing,
Nurse Manager, Vice President of Nursing.
MS. GARTRELL shall not be involved in financial activities or supervise
financial activities.
Pamela Jean Gartrell, R.N.
Page 7
FAIWRE TO COMPLY
The above described terms and conditions shall constitute "restrictions placed on a license" for
purposes of Section 4723.28(B), ORe. If, in the discretion of the Board, MS. GARTRELL
appears to have violated or breached any terms or conditions of this Consent Agreement, the
Board reserves the right to institute formal disciplinary proceedings for any and all possible
violations or breaches, including, but not limited to, alleged violations of the laws of Ohio
occurring before the effective date of this Consent Agreement.
DURATION/MODlFICATION OF TERMS
The terms, limitations, and conditions of this Consent Agreement, other than the permanent
licensure restriction(s), may be modified or terminated in writing at any time upon the
agreement of both MS. GARTRELL and the Board.
The Board may only alter the indefinite suspension imposed if: (I) MS. GARTRELL submits a
written request for reinstatement; (2) the Board determines that MS. GARTRELL has complied
with all conditions of reinstatement; (3) the Board determines that MS. GARTRELL is able to
practice according to acceptable and prevailing standards of safe nursing care based upon au
interview with MS. GARTRELL and review of the documentation specified in this Consent
Agreement; and (4) MS. GARTRELL has entered into a Consent Agreement with the Board for
probationary terms, conditions, and limitations determined by the Board for a minimum period
of three (3) years following reinstatement.
ACKNOWLEDGMENTSILIABILITY RELEASE
MS. GARTRELL acknowledges that she has had an opportunity to ask questions concerning
the terms of this Consent Agreement and that ail questions asked have been answered in a
satisfactory manuel'.
MS. GARTRELL waives all of her rights under Chapter 119, ORC, as they relate to matters
that are the subject of this Consent Agreement.
MS. GARTRELL waives any and all claims or causes of action she may have against the
Board, and its members, officers, employees and/or agents arising out of matters that are the
subject of this Consent Agreement.
This Consent Agreement is not an adjudication order as discussed in Chapter 119, ORe. Any
action initiated by the Board based 011 alleged violations of this Consent Agreement shall comply
with the Administrative Procedures Act, Chapter 119, ORe.
This Consent Agreement shall be considered a public record as that term is used ill Section
149.43, ORC. The information contained herein may be reported to appropriate organizations,
data banks and governmental bodies.
Pamela Jean Gartrell, R.N.
Page B
EFFECTIYE DATE
DATE
JJIat>ltA
LISA KLENKE, .
Ohio Board of Nursing
MS. GARTRELL understands that this Consent Agreement is subject to ratification by the
Board prior to signature by the Board President and shall become effective upon the last date of
signature below.
Cases #{}9-1445: 09-2844
Ohio Board of Nursing wlVw.nursing.ohio.gov
t7SouthHighStreet,Suite400. Columbus, Ohio 43215-7410 (6t4)466-3947
July 24,2009
NOTICE OF IMMEDIATE SUSPENSIONAND
OPPORTUNITY FOR HEARING
Pamela Jean Gartrell
5520 Kirby #2
Cincinnati, Ohio 45239
And
Adapt-Program
1616 Harrison Avenue
Cincinnati, Ohio 45214
And
5864 Blue Spruce Lane
Cincinnati, Ohio 45224
Deal' Ms. Gartrell:
In accordance with Section 2929.42 and/or 3719.12 of the Ohio Revised Code (ORC), the Ohio
Board of Nursin Board) has been notified that
Section 3719.121 (C), ORC, states in pertinent part as follows:
On receiving notification pursuant to Section 2929.42 or 3719.12 of the Revised
Code, the board under which a person has been issued a license, certificate or
evidence of registration immediately shall suspend the license, certificate, 01'
registration of that person on a plea of guilty to a finding by a jury or court of the
person's guilt of, or conviction of, a felony drug abuse offense, a finding by a
court of the person's eligibility for intervention in lieu of conviction, a plea of
guilty to, or a finding by a jury or court of the person's guilt of, or the person's
conviction of an offense in another jurisdiction that is essentially the same as a
felon)' drug abuseoffense, of finding by a court of the person's eligibility for
treatment or intervention in lieu of conviction in another jurisdiction.
Pamela Jean Gartrell, R.N.
Page 2
WHEREFORE, PURSUANT TO SECTION 3719.121(C), ORC, YOU ARE HEREBY
NOTlFIED THAT YOUR LICENSE TO PRACTICE NURSING AS A REGISTERED
NURSE IS HEREBY SUSPENDED. Continued practice after receipt of this notice of
suspension shall be considered engaging in the practice of nursing without a current, valid
license, which is a violation of Section 4723,03(A), ORC. You are hereby ordered to surrender
your Ohio license to practice nursing as a registered nurse, R.N. #264501, to the Board within
ten (10) days of receipt of this notice,
You are further notified that in accordance with Chapter 119, ORC, the Board proposes under
authority of Section 4723.28, ORC, to deny, permanently revoke, revoke, suspend or place
restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise
discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violationfor
the following reasons:
1.
On or about June 6, 2009, a Board investigator interviewed yon
You stated that you have been
using Cocaine for two years and had been previously treated for Cocaine
dependency.
Section 4723.28(B)(4), ORC, authorizes the Board to discipline a licensee who has been
convicted of, pled guilty to, a judicial finding of guilt of, a judicial finding of guilt resultingfrom
a plea of no contest to, or a judicial finding of eligibility for Intervention in Lieu of Conviction
for any felony. Section 4723.28(B)(5), aRC, authorizes the Board to discipline a licensee who
has been convicted of, pled guilty to, a judicial finding of guilt of, a judicial finding of guilt
resulting from a plea of no contest to, or a judicial finding of eligibility for Intervention in Lien
of Conviction for violating any municipal, state, county or federal drug law. Section
4723.28(B)(8), ORC, authorizes the Board to discipline a licensee for self-administering or
otherwise taking into the body any dangerous drug, as defined in Section 4729.01, aRC, in any
way not in accordance with a legal, valid prescription issued for that individual.
2. On or about November 3, 2008, in Hamilton County Municipal Criminal Case
Numbers Cf08fCRBf2921O/A and C/08/CRB/292lOfB, you were convicted of
Misuse of Credit Card, a first-degree misdemeanor in violation of Section
2913.21(B)(2), ORC, and Theft -Without Consent, a first-degree misdemeanor in
violation of Section 2913.02(A)(I), ORC, and were placed on community control
sanctions. On or about April 8,2009, your community control was extended until
May 2,2010.
Pamela Jean Gartrell, R.N.
Page 3
The acts underlying the above referenced convictions occurred on or about July
19,2008 while you were employed as a home care nurse at the address of the
victim's girlfriend. At the time of the incidents, you were providing nursing care
to the girlfriend's child through an agency, International Quality Care. While
working, you removed two (2) credit cards from the victim's wallet without his
permission, and later forged the victim's signature and made purchases in the
amount of $81451 at various locations in Hamilton county.
On or about June 9,2009, you were interviewed by a Board investigator. You
admitted to the crimes and stated that you stole from the boyfriend because you
were angry at the patient's mother for doing drugs with her boyfriend while you
were taking care of her child.
Section 4723.28(B)(3), aRC, authorizes the Board to discipline a licensee for conviction of, a
plea of guilty to, a judicial finding of guilt of, a judicial finding of guilt resulting from a plea of
no contest to, or a judicial finding of eligibility for intervention in lieu of conviction for, of a
misdemeanor committed in the course of practice.
3. On 01' about May 18, 2009, you renewed your license to practice nursing as a
registered nurse by submitting an on-line application to the Board (Application).
Under the Compliance section of the Application, Item l.b., you were asked to
answer whether:
At any time since the submission of your last application for renewal
have you been convicted of, found guilty of, pled guilty to, pled no
contest to, entered an Alford plea, received treatment or intervention
in lieu of conviction or received diversion for any of the following
crimes. This includes crimes that have been expunged if the crime as
a direct and substantial relationship to nursing practice: A
misdemeanor in Ohio, another state, common wealth, territory,
province 01' country?
Despite your misdemeanor convictions on 01' about November 3, 2008, in
Hamilton County Municipal Criminal Case Numbers C/08/CRB/2921O/A and
C/08/CRB/2921O/B, you responded to the above Application question by
answering "No."
Section 4723.28(8)(16), aRC, authorizes the Board to discipline a licensee for violation of
Chapter 4723, aRC, 01' any rules adopted under it. Specifically, Rule 4723-4-06(P), Ohlo
Administrative Code, states that a licensed nurse shall not make any false, misleading, or
deceptive statements, or submit 01' cause to be submitted any false, misleading or deceptive
information, 01' documentation to the board or any representative of the board.
Accordingly, the Board is authorized to impose one 01' more of the sanctions as cited in Section
4723.28, aRC.
Pamela Jean Gartrell, R,N,
Page 4
In accordance with Chapter 119, ORC,yon are hereby informed that yon are entitled to a hearing
on this matter. If you wish to request such hearing, the request must be made in writing and
must be received in the Board office within thirty (30) days of the time of mailing this notice. As
required by Section 3719.l21(C), ORC, the suspension ordered herein shall remain in effect until
this hearing is held.
You are hereby further informed that if you timely request a hearing, you are entitled to appear at
such hearing in person, by your attorney, or by such other representative as is permitted to
practice before the Board, 01' you may present you position, argument, or contentions in writing.
At the hearing you may also present evidence and examine witnesses appearing for and against
you.
Should you choose to request a hearing, please mail or deliver the request, in addition to any
other correspondence regarding this matter to: Lisa Ferguson-Ramos, Compliance Unit
Manager, 17 South High Street, Suite 400, Columbus, OR 43215-7410 or
hearing@nursing.ohio.goY.
If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing
of this notice, the Board may, in your absence and upon consideration of the factual and legal
allegations set forth in the Notice of Immediate Suspension and Opportunity for Hearing, deny,
permanently revoke, revoke, suspend 01' place restrictions on your license to practice nursing as a
registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five
hundred dollars ($500.00) per violation.
Sincerely,
Anne Barnett, RN, BSN, CWS
Supervising Board Member
Address #1 Certified Mail Receipt No. 70083230000326412984
Address #2 Certified Mail Receipt No. 7008 32300003 2641 2991
Address #3 Certified Mail Receipt No. 7008323000032641 3004
cc: Melissa L. Wilburn, Assistant Attorney General
Case #12-003854
Ohio Board of Nursing www.nursing.ohio.gov
17 South High Street, Suite 400' Columbus, Ohio 43215-7410 (614) 466-3947
November 16,2012
NOTICE OF OPPORTUNITY FOR HEARING
Jonetta Gresham, LP,N,
7641 Garden Valley Apt. 6
Cleveland, Ohio 44104
Dear Ms. Gresham:
In accordance with Chapter 119 Ohio Revised Code (ORC), you are hereby notified that the
Ohio Board of Nursing (Board) proposes under authority of Section 4723.28, ORC, to deny,
revoke, permanently revoke, suspend or place restrictions on your license to practice nursing as a
licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more
than five hundred dollars ($500,00) per violation for the following reasons:
L On or about November 24, 2003, in Hamilton County Court of Common Pleas
Case No, B 0308948, you pled no contest to and were subsequently found guilty
of one (1) count of Theft, a fifth-degree felony, in violation of Section
2913.02(A)(3),ORC. The acts underlying your conviction occurred on or about
May 9, 2002, in Hamilton County, Ohio, and consist of you issuing two (2)
checks for deposit totalling $3, 866.63, that were drawn on a closed account.
Section 4723.28(B)(4), ORC, authorizes the Board to discipline a licensee for conviction of, a
plea of guilty to, a judicial finding of guilt of, a judicial finding of guilt resulting from a plea of
no contest to, or a judicial finding of eligibility for intervention in lieu of conviction for, any
felony or of any crime involving gross immorality or moral turpitude.
2, On or about July 2, 2004, you submitted application for the renewal of your
license to practice as a licensed practical nurse (Application), Under the
Compliance section of the Application, you were asked:
"Have you been convicted of, found guilty of, pled guilty, pled no
contest to, entered an Alford plea, received treatment or intervention
in lieu of conviction or received diversion for, , , A felony in Ohio,
another state or U.s, territory."
Jonetta Gresham, L.P.N.
Page 2
Despite your felony guilty plea and criminal conviction in Hamilton County,
referenced above in Item 1., you answered "No" to this question.
Section 4723.28(A), ORC, authorizes the Board to revoke the license or refuse to grant a license
to a person who has been found by the Board to have committed fraud, misrepresentation, or
deception in applying for or securing any license issued by the Board.
3. On or about February 2,2011, in Cuyahoga County Court of Common Pleas Case
No. CR-1O-544753-A, you pled guilty to and were subsequently found guilty of
one (1) count of Passing Bad Checks, a fifth-degree felony, in violation of Section
2913.11(B), ORC. The acts underlying your conviction occurred on or about
August 17,2010, in Cuyahoga County, Ohio, and consist of you, with purpose to
defraud, writing a check for $975.00, that was not honored due to insufficient
funds.
Section 4723.28(B)(4), ORC, authorizes the Board to discipline a licensee for conviction of, a
plea of guilty to, a judicial finding of guilt of, a judicial finding of guilt resulting from a plea of
no contest to, or a judicial finding of eligibility for intervention in lieu of conviction for, any
felony or of any crime involving gross immorality or moral turpitude.
Accordingly, the Board is authorized to impose one or more of the sanctions as cited in Section
4723.280RC.
In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing
on this matter. If you wish to reqnest snch hearing, the request must be made in writing and
must be received in the Board office within thirty (30) days of the time of mailing this notice.
You are hereby further informed that if you timely request a hearing, you are entitled to appear at
such hearing in person, by your attorney, or by such other representative as is permitted to
practice before the Board, or you may present you position, argument, or contentions in writing.
At the hearing you may also present evidence and examine witnesses appearing for and against
you.
Should you choose to request a hearing, please mail or deliver the request, in addition to any
other correspondence regarding this matter to: Lisa Ferguson-Ramos, Compliance Unit
Manager, 17 South High Street, Suite 400, Columbus, OH 43215-7410, or to the email
address, heariug@nursing.ohio.gQ.Y. .
If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing
of this notice, the Board may, in your absence and upon consideration of the factual and legal
allegations set forth in the Notice of Opportunity for Hearing, deny, revoke, permanently revoke,
Jonetta Gresham, L.P.N.
Page 3
suspend or place restrictions on your license to practice nursing as a licensed practical nurse;
reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars
($500.00) per violation.
Sincerely,
Judith Church, R.N., C.N.P.
Supervising Board Member
Certified Mail Receipt No. 7012 1010 0002 42573735
cc: Henry G. Appel, Assistant Attorney General
Case 11-003265
Ohio Board ofNursing www.nursing.ohio.gov
17 South High Street, Suite 40() Columbus. Ohio 43215-7410 (614) 466-3947
November 16,2012
NOTICE OF OPPORTUNITY FOR HEARING
Jennifer Sue Griffin, R.N.
206 W. Hudson Avenue
Dayton, Ohio 45405
Dear Ms. Griffin:
In accordance with Chapter 119, Ohio Revised Code (ORC), you are hereby notified that the
Ohio Board of Nursing (Board) proposes under authority of Section 4723.28 ORC, to deny,
revoke, permanently revoke, suspend or place restrictions on your license to practice nursing as a
registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five
hundred dollars ($500.00) per violation for the following reasons:
1. On or about April 5,2011, you were working as a nurse at the Ohio Department
of Rehabilitation and Correction at Warren Correctional Institution in Lebanon,
Ohio (Warren). At approximately 12:50 pm, Patient #1 was admitted to the
Warren Infirmary with physician orders that required neurological checks to be
conducted every two hours until the patient was fully oriented, with a goal that the
patient be alert and oriented "x 4", and that the physician was to be notified if the
patient was not fully oriented by 5:00 p.m. [See Attached Patient Key - to Remain
Confidential and Not Subject to Public Disclosure]. On the same date, you acted
in the manner described below:
a. You were advised by another nurse that during her 3:00 p.m. assessment,
Patient #1 vomited, and the vomit contained blood, yet you decided not to
report this to the physician. In a written statement to the Board, dated
November 20, 2011, you indicate that "[n]either of us were concerned
over the .blood specks because we had heard [Patient #1] vomiting
forcefully in his cell."
b. At or about 5:15 p.m. and 7:30 p.m. you documented that Patient #1 was
"alert and oriented x3" rather than fully oriented, and failed to notify the
physician of this status.
c. At approximately 7:30 p.m., you documented that Patient #1 complained
of head pain but you did not report this to the physician.
d. At approximately 9:00 p.m., you documented that Patient #1 was oriented
as to person and to place but that he was not oriented as to time. You
Jennifer Sue Griffiu, R.N.
Page 2
documented that Patient #1 twice identified the year as 1988 rather than as
2011. You failed to notify the physician that the patient could not
accurately identify the year and was not fully oriented.
e. In your written statement to the Board, dated November 20, 2011, you
admit that you did recognize Patient #1's change in level of consciousness,
but state that: "I thought he was being a smart-alec ... I did not call the
MD. because I thought pt. was playing around ... "
Patient #1 died on April 6, 2011 with cause of death noted in the Montgomery
County Deputy Coroner's Report as "blunt force injuries of head."
Section 4723.28(B)(19), ORC, authorizes the Board to discipline a licensee for failure to practice
in accordance with acceptable and prevailing standards of safe nursing care. Section
4723.28(B)(16), ORC, authorizes the Board to discipline a licensee for violation of Chapter
4723, ORC, or any rules adopted under it. Specifically, Rule 4723-4-03(B), Ohio Administrative
Code (OAC), states that a registered nurse shall maintain current knowledge of the duties,
responsibilities, and accountabilities for safe nursing practice. Rule 4723-4-03(C), OAC, states
that a registered nurse shall demonstrate competence and accountability in all areas of practice in
which the nurse is engaged which includes, but is not limited to, the following: (I) Consistent
performance of all aspects of nursing care; and (2) Appropriate recognition, referral or
consultation, and intervention, when a complication arises. Rule 4723-4-03(E), OAC, states that
a registered nurse shall, in a timely manner: (1) Implement any order for a client unless the
registered nurse believes or should have reason to believe the order is: (a) Inaccurate; (b) Not
properly authorized; (c) Not current or valid; (d) Harmful, or potentially harmful to a client; or
(e) Contraindicated by other documented information; and (2) Clarify any order for a client when
the registered nurse believes or should have reason to believe the order is: (a) Inaccurate; (b) Not
properly authorized; (c) Not current or valid; (d) Harmful, or potentially harmful to a client; or
(e) Contraindicated by other documented information.
Accordingly, the Board is authorized to impose one or more of the sanctions cited in Section
4723.28,ORC.
In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing
in this matter. If you wish to request such hearing, the request must be made in writing and must
be received in the Board office within thirty (30) days of the time of mailing of this notice.
You are hereby further iuformed that, if you timely request a hearing, you are entitled to appear
at such hearing in person, by your attorney, or by such other representative as is permitted to
practice before the Board, or you may present your position; arguments, or contentions in
writing. At the hearing, you may also present evidence and examine witnesses appearing for and
against you.
Should you choose to request a hearing, please mail or deliver the request, in addition to any
other correspondence regarding this matter, to Lisa Ferguson-Ramos, Compliance Unit
Jennifer Sue Griffin, R.N.
Page 3
Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, Ohio 43215-
7410 or to the email address, hearinK@nUrsing.Qhio.gov.
If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing
of this notice, the Board may, in your absence and upon consideration of the factual and legal
allegations set forth in this Notice of Opportunity for Hearing, deny, revoke, permanently
revoke, suspend, or place restrictions on your license to practice nursing as a registered nurse;
reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars
($500.00) per violation.
Sincerely,
Judith A. Church, R.N., C.N.P.
Supervising Board Member
Certified Mail Receipt No. 7012 1010 0002 4257 4091
cc: Henry G. Appel, Assistant Attorney General
Case #12-000008
Ohio Board of Nursing www.nursing.ohio.gov
17 South HighStreet, Suite400 Columbus, Ohio 43215-7410 (614) 466-3947
November 16,2012
NOTICE OF OPPORTUNITY FOR HEARING
Jennifer Sue Hall
15112 State Route 347
Marysville, Ohio 43040
and
246 Todd Court
Marysville, Ohio 43040
Dear Ms. Hall:
On or about October 3, 2012, the Ohio Board of Nursing (Board) issued to you a Notice of
Immediate Suspension and Opportunity for Hearing, a copy of which is attached hereto and
incorporated herein. Previously, you entered into Consent Agreements with the Board,
effective November 16,2006, and July 20,2007.
You are notified that in accordance with Chapter 119, ORC, the Board proposes under
authority of Section 4723.28 of the Ohio Revised Code, ORC, to deny, permanently revoke,
revoke, suspend or place restrictions on your license to practice nursing as a registered nurse;
reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars
($500.00) per violation for the following reasons:
1. On or about August 20, 2012, in Union County Court of Common
Pleas Case Number 2012-CR-0023, you pled guilty to and were found
guilty of five (5) counts of Theft to wit: Dilaudid, felonies of the fourth
degree, in violation of Section 2913.02(A)(1), ORC.
The acts underlying this case occurred on or about December 27, 28,
and 31, 2011, and January 1, 2012, and involve you obtaining or
exerting control over Dilaudid without the consent of Memorial
Hospital of Union County.
Section 4723.28(B)(4), ORC, authorizes the Board to discipline a licensee for conviction of, a
plea of guilty to, a judicial finding of guilt of, a judicial finding of guilt resulting from a plea
of no contest to, or a judicial finding of eligibility for intervention in lieu of conviction for,
any felony. Section 4723.28(B)(5), ORC, authorizes the Board to discipline a licensee for
conviction of, a plea of guilty to, a judicial finding of guilt of,' a judicial finding of guilt
resulting from a plea of no contest to, or a judicial finding of eligibility for intervention in lieu
of conviction for, violating any municipal, state, county, or federal drug law.
Jennifer Sue Hall
Page 2
2. On or about January 16, 2012, you admitted to a Board Compliance
Agent that, while employed as a nurse at Union County Memorial
Hospital, Marysville, Ohio, you stole four (4), one (1) mg vials of
Dilaudid. You stated that you removed the Dilaudid and carried it
around in your pocket while you contemplated self-administering it.
You stated that after you wasted the stolen Dilaudid in the sharps
container, you would get weak again and steal more Dilaudid. You
stated that you wished to continue nursing, but did not want to be
around narcotics.
Section 4723.28(B)(I3), ORC, authorizes the Board to discipline a licensee for obtaining or
attempting to obtain money or anything of value by intentional misrepresentation or material
deception in the course of practice.
Accordingly, the Board is authorized to impose one or more of the sanctions as cited in
Section 4723.28, ORC.
In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a
hearing in this matter. If you wish to request such hearing, the request must be made in
writing and must be received in the Board office within thirty (30) days of the time of mailing
of this notice.
You are hereby further informed that, if you timely request a hearing, you are entitled to
appear at such hearing in person, by your attorney, or by snch other representative as is
permitted to practice before the Board, or you may present your position, argnments, or
contentions in writing. At the hearing you may also present evidence and examine witnesses
appearing for and against you.
Should you choose to request a hearing, please mail or deliver the request, in addition to any
other correspondence regarding this matter, to: Lisa Ferguson-Ramos, Compliance Unit
Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus OH
43215-7410, or to the email address, hearing@nursing.ohio",gov.
If the Board fails to receive a request for a hearing within thirty (30) days of the time of
mailing of this notice, the Board may, in your absence and upon consideration of the factual
and legal allegations set forth in this Notice of Opportunity for Hearing, deny, permanently
revoke, revoke, suspend or place restrictions on your license to practice nursing as a
registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five
hundred dollars ($500.00) per violation.
Sincerely,
Jennifer Sue Hall
Page 3
Judith A. Church, R.N., CN.P.
Supervising Board Member
Certified Mail Receipt No. 7012 10lO 0002 4257 4701
Second Address Certified Mail Receipt No. 7012 10lO 0002 4257 4718
cc: Henry G. Appel, Assistant Attorney General
Case #12-000008
Ohio Board of Nursing www.nursing.ohio.gov
17South High Street, Suite 400- Columbus, Ohio 43215:7410 (614) 466-3947
October 3, 2012
NOTICE OF IMMEDIATESUSPENSION AND
OPPORTUNITY FOR HEARING
Jennifer Sue Hall, R.N.
15112 State Route 347
Marysville, Ohio 43040
and
246 Todd Court
Marysville, Ohio 43040
Dear Ms. Hall:
In accordance with Sections 2929.42 and/or 3719.12 of the Ohio Revised Code (ORC), the
Ohio Board of Nursing (Board) has been notified that, on or about August 20, 2012, in Union
County Court of Common Pleas Case Number 2012-CR-0023, you pled guilty to and were
found guilty of five (5) counts of Theft to wit: Dilaudid, felonies of the fourth degree, in
violation of Section 2913.02(A)(l), ORC.
Section 3719.121(C), ORC, states in pertinent part as follows:
On receiving notification pursuant to Section 2929.42 or 3719.12 of the
Revised Code, the board under which a person has been issued a
license, certificate or evidence of registration immediately shall
suspend the license, certificate, or registration of that person on a plea
of guilty to, a finding by a jury or court of the person's guilt of, or
conviction of a felony drug abuse offense; a finding by a court of the
person's eligibility for intervention in lieu of conviction; a plea of guilty
to, or a finding by a jury or court of the person's guilt of, or the person's
conviction of an offense in another jurisdiction that is essentially the
same as a felony drug abuse offense; or a finding by a court of the
person's eligibility for treatment or intervention in lieu of conviction in
another jurisdiction.
Theft to wit: Dilaudid, felonies of the fourth degree, in violation' of Section 2913.02(A)(1),
ORC constitute "felony drug abuse offenses" as defined in Section 2925.01, ORC.
WHEREFORE, PURSUANT TO SECTION 3719.121(C), ORC, YOU ARE HEREBY
NOTIFIED THAT YOUR LICENSE TO PRACTICE NURSING AS A REGISTERED
NURSE, RN.294884, IS HEREBY SUSPENDED. Continued practice after receipt of this
Jennifer Sue Hall, R.N.
Page 2
notice of suspension shall be considered engaging in the practice of nursing without a current,
valid license, which is a violation of Section 4723.03(A), ORC.
In accordance with Chapter II9, ORC, you are hereby informed that you are entitled to a
hearing in this matter. If you wish to request such hearing, the request must be made in
writing and must be received in the Board office within thirty (30) days of the time of mailing
of this notice. As required by Section 3719.I21(C), ORC, the suspension ordered herein shall
remain in effect until this hearing is held.
You are hereby further informed that, if you timely request a hearing, you are entitled to
appear at such hearing in person, by your attorney, or by such other representative as is
permitted to practice before the Board, or you may present your position, arguments, or
contentions in writing. At the hearing you may also present evidence and examine witnesses
appearing for and against you.
Should you choose to request a hearing, please mail or deliver the request, in addition to any
other correspondence regarding this matter, to: Lisa Ferguson-Ramos, Compliance
Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, Ohio
43215-7410, or to the e-mail
If the Board fails to receive a request for a hearing within thirty (30) days of the time of
mailing of this notice, the Board may, in your absence and upon consideration of the factual
and legal allegations set forth in this Notice of Immediate Suspension and Opportunity for
Hearing, deny, permanently revoke, revoke, suspend or place restrictions on your license to
practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine
of not more than five hundred dollars ($500.00) per violation.
Sincerely,
Judith A. Church, R.N., C.N.P.
Supervising Board Member
Address I Certified Mail Receipt No. 70121010 0002 4257 2387
Address 2 Certified Mail Receipt No. 7012 1010000242572394
cc: Henry G. Appel, Assistant Attomey General
Case #12-001389
Ohio Board of Nursing www.nursing.ohio.gov
17 South High Street. Suite 400 ~ Columbus. Ohio 43215-7410 (614) 466-3947
November 16,2012
NOTICE OF OPPORTUNITY FOR HEARING
Renee Lyn Hamilton, L.P.N.
3887 Hollybrook Drive
Middletown, Ohio 45044
Dear Ms. Hamilton:
In accordance with Chapter 119, Ohio Revised Code (ORC), you are hereby notified that the
Ohio Board of Nursing (Board) proposes under authority of Section 4723.28, ORC, to deny,
revoke, permanently revoke, suspend or place restrictions on your license to practice nursing as a
licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more
than five hundred dollars ($500.00) per violation for the following reasons:
1. On or about April 19, 2012, you were interviewed by a Board Compliance
Agent. You stated that, while working as a nurse at Sycamore Medical
Center (Sycamore), in Miamisburg, Ohio, you diverted medication that
had been prescribed for patients for your own personal use. You stated
that you had taken more Vicodin and/or Percocet than was prescribed to
you by your medical provider, and that when you ran out of the
medication prescribed to you, you diverted medication that had been
prescribed for patients at Sycamore. In a written statement dated April 19,
2012, you indicated that if a patient only wanted one Percocet you would
take the other for your own benefit, and that you would document
administration of both tablets to the patient. You also reported that on two
occasions, you substituted Tylenol for Percocet or Vicodin ordered for the
patient when your own prescription was running low.
Section 4723.28(B)(8), ORC, authorizes the Board to discipline a licensee for self-administering
or otherwise taking into the body any dangerous drug, as defined in Section 4729.01, ORC, in
any way not in accordance with a legal, valid prescription issued for that individual. Section
4723.28(B)(13), ORC, authorizes the Board to discipline a licensee for obtaining or attempting to
obtain money or anything of value by intentional misrepresentation or material deception in the
course of practice. Section 4723.28(B)(l6), ORC, authorizes the Board to discipline a licensee
for violation of Chapter 4723, ORC, or any rules adopted under it. Specifically, Rule 4723-4-
06(G), Ohio Administrative Code, states that a licensed nurse shall not falsify any client record
or any other document prepared or utilized in the course of, or in conjunction with, nursing
practice. This includes, but is not limited to, case management documents or reports or time
records, reports, and other documents related to billing for nursing services.
Renee Lyn Hamilton, L.P.N.
Page 2
Accordingly, the Board is authorized to impose one or more of the sanctions as cited in Section
4723.280RC.
In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing
in this matter. If you wish to request such hearing, the request must be made in writing and must
be received in the Board office within thirty (30) days of the time of mailing of this notice.
You are hereby further informed that, if you timely request a hearing, you are entitled to appear
at such hearing in person, by your attorney, or by such other representative as is permitted to
practice before the Board, or you may present your position, arguments, or contentions in
writing. At the hearing you may also present evidence and examine witnesses appearing for and
against you.
Should you choose to request a hearing, please mail or deliver the request, in addition to any
other correspondence regarding this matter, to: Lisa Ferguson-Ramos, Compliance Unit
Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, OH 43215-
7410, or to the email address.hf.l!![!!!g@nu_rsiQ.g.!!.I.!!9csgov.
If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing
of this notice, the Board may, in your absence and upon consideration of the factual and legal
allegations set forth in this Notice of Opportunity for Hearing, deny, permanently revoke,
revoke, suspend or place restrictions on your license to practice nursing as a licensed practical
nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred
dollars ($500.00) per violation.
Sincerely,
Judith A. Church, R.N., C.N.P.
Supervising Board Member
Certified Mail Receipt No. 7012 1010000242573780
cc: Henry G. Appel, Assistant Attorney General
Case # 12-001136
Ohio Board of Nursing www.nursing.ohio.gov
17 South High Street, Suite400. Columbus, Ohio 43215-7410 (614) 466-3947
November 16,2012
NOTICE OF OPPORTUNITY FOR HEARING
Justin M. Hashman, R.N., L.P.N.
10 2
nd
St.
Athens, Ohio 45701
Dear Mr. Hashman:
In accordance with Chapter 119, Ohio Revised Code (aRC), you are hereby notified that the
Ohio Board of Nursing (Board) proposes under authority of Section 4723.28 aRC, to deuy,
revoke, permanently revoke, suspend or place restrictions on your licenses to practice nursing as
a registered nurse and licensed practical nurse; reprimand or otherwise discipline you; or impose
a fine of not more than five hundred dollars ($500.00) per violation for the following reasons:
I. On or about March 5, 2012, while working as a registered nurse at Marietta Memorial
Hospital in Marietta, Ohio, you submitted a drug screen specimen that was positive for
Marijuana.
Section 4723.28(B)(8), aRC, authorizes the Board to discipline a licensee for self-administering
or otherwise taking into the body any dangerous drug, as defined in Section 4729.01, aRC, in
any way not in accordance with a legal, valid prescription issued for that individual.
2. As set forth in Attachment A, while working as a registered nurse at Marietta
Memorial Hospital in Marietta, Ohio, you withdrew narcotics without a physician order
and failed to account for the administration of narcotics.
Section 4723.28(B)(19), aRC, authorizes the Board to discipline a licensee for failure to practice
in accordance with acceptable and prevailing .standards of safe nursing care. Section
4723.28(B)(16), aRC, authorizes the Board to discipline a licensee for violation of Chapter
4723, aRC, or any rules adopted under it. Specifically, Rule 4723-4-03(B), Ohio Administrative
Code (OAC), states that a registered nurse shall maintain current knowledge of the duties,
responsibilities, and accountabilities for safe nursing practice. Rule 4723-4-06(E), OAC, states
that a licensed nurse shall, in a complete, accurate, and timely manner, report aud document
nursing assessments or observations, the care provided by the nurse for the client, andthe client's
response to that care. Rule 4723-4-06(H), OAC, states that a licensed nurse shall implement
measures to promote a safe environment for each client.
Accordingly, the Board is authorized to impose one or more of the sanctions cited in Section
4723.28, aRC.
<;1
Justin M. Hashman, R.N., L.P.N.
Page 2
In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing
in this matter. If you wish to request such hearing, the request must be made in writing and must
be received in the Board office within thirty (30) days of the time of mailing of this notice.
You are hereby further informed that, if you timely request a hearing, you are entitled to appear
at such hearing in person,. by your attorney, or by such other representative as is permitted to
practice before the Board, or you may present your position, arguments, or contentions in
writing. At the hearing, you may also present evidence and examine witnesses appearing for and
against you.
Should you choose to request a hearing, please mail or deliver the request, in addition to any
other correspondence regarding this matter, to Lisa Ferguson-Ramos, Compliance Unit
Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, Ohio 43215-
7410 or to the email address.h.ti.[jxing.@.!l\!Xjng.ohjQ.gov.
If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing
of this notice, the Board may, in your absence and upon consideration of the factual and legal
allegations set forth in this Notice of Opportunity for Hearing, deny, revoke, permanently
revoke, suspend, or place restrictions on your licenses to practice nursing as a registered nurse
and licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more
than five hundred dollars ($500.00) per violation.
Sincerely,
Judith A. Church, R.N., C.N.P.
Supervising Board Member
Certified Mail Receipt No. 70121010 0002 42573551
Attorney Certified Mail Receipt No. 7012 1010 0002 42573568
cc: Henry G. Appel, Assistant Attorney General
Rebecca Louks, Esq.
Justin M. Hashman, R.N., L.P.N.
Page 3
ATTACHMENT A
PATIENT Physician Order WITHDRAWAL MAR Comments
# Documentation
Patient #1 No Order Dilaudid
(Hydromorphone)
2/2/12
4 mg. at 19:36 None No waste.
4 mg. unaccounted for.
Patient #2 Dilaudid Dilaudid
(Hydromorphone) (Hydromorphone)
1 mg. IV, one time 2/2/12
only 4 mg. at 23:46 1 mg. at 23:30 No waste.
3 mg. unaccounted for.
Patient #3 Dilaudid Dilaudid
(Hydromorphone) (Hydromorphone)
2 mg. 1M, one time 2/3/12
only 4 mg. at 00:50 2 mg. at 00:44 No waste. 2 mg.
unaccounted for.
1 mg. 1M, one time 4 mg. at 01:33 1 mg. at 01:18 No waste. 3 mg.
only unaccounted for.
Patient #4 No Order Morphine Sulfate
(Morphine)
2/9/12 None No waste.
10 mg. at 15:19 10 mg. unaccounted for.
Patient #5 No Order Morphine Sulfate
(Morphine)
I
2/9/12
10 mg. at 19:19 None No waste. 10 mg
unaccounted for.
10 mg. at22:40 None No waste. 10 mg.
unaccounted for.
Justin M. Hashman, R.N., L.P.N.
Page 4
Patient #6 Morphine Morphine Sulfate Morphine Sulfate
2 mg. IV, one time (Morphine) (Morphine)
only 2/14/12
10 mg. at 23:55 2 mg. at 23:43 No waste.
8 mg. unaccounted for.
No order for Dilaudid Dilaudid
Dilaudid (Hydromorphone) (Hydromorphone)
(Hydromorphone)
2/15/12 None No waste. 4 mg.
4 mg. at 00:06 unaccounted for.
2/15/12
2mg.atOl:13 None No waste. 2 mg.
unaccounted for.
Patient #7 Dilaudid Dilaudid
(Hydromorphone) (Hydromorphone)
2 mg. 1M, one time 2/15/12
only 4mg.at23:31 2 mg. at 23:29
No waste. 2mg. unaccounted for.
2 mg. at 23:40 None
No order for second dose, no
waste, and 2mg unaccounted for.
1 mg. 1M, one time 2/16/12
No waste. 3 mg. unaccounted
only 4 mg. at 00:51 1 mg. at 00:46
for.
Justin M. Hashman, R.N., L.P.N.
Page 5
PATIENT KEY
(This Key is confidential pursuant to Section 4723.28(1) of the Ohio Revised Code, and is to
be withheld from public disclosure)
1. Marjorie Vaughn
2. Delbert Lasure
3. Lawrence Simmons
4. Lisa Suermondt
5. Michael Davis
6. Peggy Williams
7. Lisa Holder
Cases #10-5749; 12-005635
Ohio Boa:rd of Nu:rsing www.nursing.ohio.gov
17 South HighStreet, Suite400 Columbus, Ohio 43215-7410 (614) 466-3947
November 16,2012
NOTICE OF IMMEDIATE SUSPENSION AND
OPPORTUNITY FOR HEARING
Sean Christopher Hinkle, R.N.
5500 Laurent Drive, Apt. 206
Cleveland, Ohio 44129
Dear Mr. Hinkle:
In accordance with Sections 2929.42 and/or 3719.12 of the Ohio Revised Code (ORC), the
Ohio Board of Nursing (Board) has been notified that, on or about September 20, 2012, in
Cuyahoga County Court of Common Pleas Case Number CR-12-561838-A, you pled guilty
to two (2) counts of Theft; Aggravated Theft to wit: Fentanyl and Dilaudid, felonies of the
fourth degree, in violation of Section 2913.02(A)(2), ORC; one (1) count of Illegal Processing
of Drug Documents, a felony of the fourth degree, in violation of Section 2925.23(A), ORC;
and one (1) count of Drug Possession, a felony of the fifth degree, in violation of Section
2925.11(A), ORC, and were found eligible for Intervention in Lieu of Conviction.
Section 3719.121(C), ORC, states in pertinent part as follows:
On receiving notification pursuant to Section 2929.42 or 3719.12 of the
Revised Code, the board under which a person has been issued a
license, certificate or evidence of registration immediately shall
suspend the license, certificate, or registration of that person on a plea
of guilty to, a finding by a jury or court of the person's guilt of, or
conviction of a felony drug abuse offense; a finding by a court of the
person's eligibility for intervention in lieu of conviction; a plea of guilty
to, or a finding by a jury or court of the person's guilt of, or the person's
conviction of an offense in another jurisdiction that is essentially the
same as a felony drug abuse offense; or a finding by a court of the
person's eligibility for treatment or intervention in lieu of conviction in
another jurisdiction.
Theft; Aggravated Theft to wit: Fentanyl and Dilaudid, felonies of the fourth degree, in
violation of Section 2913.02(A)(2), ORC; Illegal Processing of Drug Documents, a felony of
the fourth degree, in violation of Section 2925.23(A), ORC; and Drug Possession, a felony of
the fifth degree, in violation of Section 2925.11(A), ORC, constitute "felony drug abuse
offenses" as defined in Section 2925.01, ORC.
Sean Christopher Hinkle, R.N.
Page 2
WHEREFORE, PURSUANT TO SECTION 37I9.121(C), ORC, YOU ARE HEREBY
NOTIFIED THAT YOUR LICENSE TO PRACTICE NURSING AS A REGISTERED
NURSE, RN354252, IS HEREBY SUSPENDED. Continued practice after receipt of this
notice of suspension shall be considered engaging in the practice of nursing without a current,
valid license, which is a violation of Section 4723.03(A), aRC.
You are further notified that in accordance with Chapter 119, aRC, the Board proposes under
authority of Section 4723.28, aRC, to deny, permanently revoke, revoke, suspend or place
restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise
discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation
for the following reasons:
1. On or about September 20, 2012, in Cuyahoga County Court of
Common Pleas Case Number CR-12-561838-A, you pled guilty to two
(2) counts of Theft; Aggravated Theft to wit: Fentanyl and Dilaudid,
felonies of the fourth degree, in violation of Section 2913.02(A)(2),
aRC; one (1) count of lIIegal Processing of Drug Documents, a felony
of the fourth degree, in violation of Section 2925.23(A), ORC; and one
(1) count of Drug Possession, a felony of the fifth degree, in violation
of Section 2925.11(A), aRC, and were found eligible for Intervention
in Lieu of Conviction.
The acts underlying this case occurred on or about October 1, 2010,
and involve you obtaining or exerting control over Fentanyl and
Dilaudid beyond the scope of consent of the owner Cleveland Clinic.
Further acts underlying this case involve you making a false statement
in any prescription, order, report, or record involving a Schedule I or II
drug, that is not Marihuana. Further acts underlying this case involve
you obtaining, possessing, or using Fentanyl.
Section 4723.28(B)(4), aRC, authorizes the Board to discipline a licensee for conviction of, a
plea of guilty to, a judicial finding of gnilt of, a judicial finding of guilt resulting from a plea
of no contest to, or a judicial finding of eligibility for intervention in lieu of conviction for,
any felony. Section 4723.28(B)(5), aRC, authorizes the Board to discipline a licensee for
conviction of, a plea of guilty to, a judicial finding of guilt of, a judicial finding of guilt
resulting from a plea of no contest to, or a judicial finding of eligibility for intervention in lieu
of conviction for, violating any municipal, state, county, or federal drug law.
2. On or about March 19, 2011, you were interviewed by a Board
Compliance Agent. You admitted that while employed as a nnrse at
The Cleveland Clinic Foundation, Cleveland, you diverted the
following drugs and self-administered the drugs: Fentanyl, Dilaudid
and Percocet. You stated that yon took the drugs home and
administered them 1M. You further admitted that you purchased
Oxycontin off the streets and self-administered the drug by scraping
Sean Christopher Hinkle, R.N.
Page 3
and snorting it. You admitted that on the evening before you were
confronted at work regarding your behavior, on or about December 17,
2010, you self-administered Opana, resulting in a positive drug screen.
You stated that your use of drugs began prior to nursing school and
continued in nursing school, but while in school, yon did not realize
you were addicted.
Section 4723.28(B)(8), ORC, authorizes the Board to discipline a licensee for self-
administering or otherwise taking into the body any dangerous drug, as defined in Section
4729.01, ORC, in any way not in accordance with a legal, valid prescription issued for that
individual. Section 4723.28(B)(13), ORC, authorizes the Board to discipline a licensee for
obtaining or attempting to obtain money or anything of value by intentional misrepresentation
or material deception in the course of practice.
Accordingly, the Board is authorized to impose one or more of the sanctions as cited in
Section 4723.28, ORC.
In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a
hearing in this matter. If you wish to request such hearing, the request must be made in
writing and must be received in the Board office within thirty (30) days of the time of mailing
of this notice. As required by Section 37I9.12I(C), ORC, the suspension ordered herein shall
remain in effect until this hearing is held. .
You are hereby further informed that, if you timely request a hearing, you are entitled to
appear at such hearing in person, by your attorney, or by such other representative as is
permitted to practice before the Board, or you may present your position, arguments, or
contentions in writing. At the hearing you may also present evidence and examine witnesses
appearing for and against you.
Should you choose to request a hearing, please mail or deliver the request, in addition to any
other correspondence regarding this matter, to: Lisa Ferguson-Ramos, Compliance Unit
Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus OH
43215-7410, or to the email address.!1em:i...ng@nursing.ohio.gov.
If the Board fails to receive a request for a hearing within thirty (30) days of the time of
mailing of this notice, the Board may, in your absence and upon consideration of the factual
and legal allegations set forth in this Notice of Immediate Suspension and Opportunity for
Hearing, deny, permanently revoke, revoke, suspend or place restrictions on your license to
practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine
of not more than five hundred dollars ($500.00) per violation.
Sincerely,
Sean Christopher Hinkle, R.N.
Page 4
Judith A. Church, R.N., C.N.P.
Supervising Board Member
Certified Mail Receipt No. 7012 1010 0002 4257 4343
Attorney's Certified Mail Receipt No. 7012 1010000242574350
cc: Henry G. Appel, Assistant Attorney General
Barry Doyle, Esq.
Cases #11-004134; 12-005636
Ohio Boal"d of Nursing www.nursing.ohio.gov
17 South HighStreet, Suite400 Columbus, Ohio 43215-7410 (6]4) 466-3947
November 16,2012
NOTICE OF IMMEDIATE SUSPENSION AND
OPPORTUNITY FOR HEARING
Amy Heather Hudson, R.N.
332 Bruce Drive
Brunswick, Ohio 44212
Dear Ms. Hudson:
In accordance with Sections 2929.42 and/or 3719.12 of the Ohio Revised Code (ORC), the
Ohio Board of Nursing (Board) has been notified that, on or about September 27, 2012, in
Cuyahoga County Court of Common Pleas Case Number CR-12-560395-A, you pled guilty
to three (3) counts of Theft; Aggravated Theft to wit: Oxycodone, Percocet, and Morphine,
felonies of the fourth degree, in violation of Section 2913.02(A)(2), ORC; one (1) count of
Illegal Processing of Drug Documents, a felony of the fourth degree, in violation of Section
2925.23(A), ORC; and one (1) count of Drug Possession, a felony of the fifth degree, in
violation of Section 2925.11(A), ORC, and were found eligible for Intervention in Lieu of
Conviction.
Section 3719.121(C), ORC, states in pertinent part as follows:
On receiving notification pursuant to Section 2929.42 or 3719.12 of the
Revised Code, the board under which a person has been issued a
license, certificate or evidence of registration immediately shall
suspend the license, certificate, or registration of that person on a plea
of guilty to, a finding by a jury or court of the person's guilt of, or
conviction of a felony drug abuse offense; a finding by a court of the
person's eligibility for intervention in lieu of conviction; a plea of guilty
to, or a finding by a jury or court of the person's guilt of, or the person's
conviction of an offense in another jurisdiction that is essentially the
same as a felony drug abuse offense; or a finding by a court of the
person's eligibility for treatment or intervention in lieu of conviction in
another jurisdiction.
Theft; Aggravated Theft to wit: Oxycodone, Percocet, and Morphine, felonies of the fourth
degree, in violation of Section 2913.02(A)(2),ORC; Illegal Processing of Drug Documents, a
felony ofthe fourth degree, in violation of Section 2925.23(A), ORC; and Drug Possession, a
felony of the fifth degree, in violation of Section 2925.11(A), ORC, constitute "felony drug
abuse offenses" as defined in Section 2925.01, ORC.
Amy Heather Hudson, R.N.
Page 2
WHEREFORE, PURSUANT TO SECTION 3719.121(C), ORC, YOU ARE HEREBY
NOTIFIED THAT YOUR LICENSE TO PRACTICE NURSING AS A REGISTERED
NURSE, RN-327128, IS HEREBY SUSPENDED. Continued practice after receipt of this
notice of suspension shall be considered engaging in the practice of nursing without a curreut,
valid license, which is a violation of Section 4723.03(A), aRC.
You are further notified that in accordance with Chapter 119, aRC, the Board proposes under
authority of Section 4723.28, aRC, to deny, permanently revoke, revoke, suspend or place
restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise
discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation
for the following reasons:
1. On or about September 27, 2012, in Cuyahoga County Court of
Common Pleas Case Number CR-12-560395-A, you pled guilty to
three (3) counts of Theft; Aggravated Theft to wit: Oxycodone,
Percocet, and Morphine, felonies of the fourth degree, in violation of .
Section 2913.02(A)(2), aRC; one (1) count of Illegal Processing of
Drug Documents, a felony of the fourth degree, in violation of Section
2925.23(A), aRC; and one (1) count of Drug Possession, a felony of
the fifth degrlee, in violation of Section 2925.l1(A), aRC, and were
found eligible for Intervention in Lieu of Conviction.
The acts underlying this case occurred on or abont October 15, 2011,
and involve you obtaining or exerting control over Oxycodone,
Percocet, and Morphine beyond the scope of consent of University
Hospitals. Further acts underlying this case involve you making a false
statement in any prescription, order, report, or record involving a
Schedule I or II drug, that is not Marihuana. Further acts underlying
this case involve you obtaining, possessing, or using Oxycodone.
Section 4723.28(B)(4), aRC, authorizes the Board to discipline a licensee for conviction of, a
plea of guilty to, a judicial finding of guilt of, a judicial finding of guilt resulting from a plea
of no contest to, or a judicial finding of eligibility for intervention in lieu of conviction for,
any felony. Section 4723.28(B)(5), aRC, authorizes the Board to discipline a licensee for
conviction of, a plea of guilty to, a judicial finding of guilt of, a judicial finding of guilt
resulting from a plea of no contest to, or a judicial finding of eligibility for intervention in lieu
of conviction for, violating any municipal, state, county, or federal drug law.
2. On or about November 30, 2011, you were interviewed by a Board
Compliance Agent and admitted that, while employed as a nurse at
University Hospital, Cleveland on the bone marrow/transplant and
hospice floor, you stole Oxycodone, Oxycontin, Morphine, Methadone
and Codeine from work. You stated that you obtained the drugs by
using a patients' name, and self-administered the drugs rather than
administering them to patients. You stated that you occasionally
documented the administration of the drugs to patients when you did
Amy Heather Hudson, R.N.
Page 3
not administer the drugs to them. You stated that you took
approximately 30-50 pills daily. You stated that in addition to the
above, you diverted Benzodiazepines (Ativan and Xanax) and
"whatever I could get" in an attempt to wean off of naroctics. You
stated that you had been diverting drugs from your employer for
approximately 1-1/2 years.
Section 4723.28(B)(8), ORC, authorizes the Board to discipline a licensee for self-
administering or otherwise taking into the body any dangerous drug, as defined in Section
4729.01, ORC, in any way not in accordance with a legal, valid prescription issued for that
individual. Section 4723.28(B)(13), ORC, authorizes the Board to discipline a licensee for
obtaining or attempting to obtain money or anything of value by intentional misrepresentation
or material deception in the course of practice. Section 4723.28(B)(16), ORC, authorizes the
Board to discipline a licensee for violation of Chapter 4723, ORC, or any rules adopted under
it. Specifically, Ohio Administrative Code (OAC), Rule 4723-4-06(0), states that a licensed
nurse shall not falsify any client record or any other document prepared or utilized in the
course of, or in conjunction with, nursing practice. This includes, but is not limited to, case
management documents or reports or time records, reports, and other documents related to
billing for nursing services. Rule 4723-4-06(H), OAC, states that a licensed nurse shall
implement measures to promote a safe environment for each client.
Accordingly, the Board is authorized to impose one or more of the sanctions as cited in
Section 4723.28, ORC.
In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a
hearing in this matter. If you wish to request such hearing, the request must be made in
writing and must be received in the Board office within thirty (30) days of the time of mailing
of this notice. As required by Section 3719.l21(C), ORC, the suspension ordered herein shall
remain in effect until this hearing is held.
You are hereby further informed that, if you timely request a hearing, you are entitled to
appear at such hearing in person, by your attorney, or by such other representative as is
permitted to practice before the Board, or you may present your position, arguments, or
contentions in writing. At the hearing you may also present evidence and examine witnesses
appearing for and against you.
Should you choose to request a hearing, please mail or deliver the request, in addition to any
other correspondence regarding this matter, to: Lisa Ferguson-Ramos, Compliance Unit
Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus OH
432157410, or to the email address,
If the Board fails to receive a request for a hearing within thirty (30) days of the time of
mailing of this notice, the Board may, in your absence and npon consideration of the factual
and legal allegations set forth in this Notice of Immediate Suspension and Opportunity for
Hearing, deny, permanently revoke, revoke, suspend or place restrictions on your license to
Amy Heather Hudson, R.N.
Page 4
practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine
of not more than five hundred dollars ($500.00) per violation. .
Sincerely,
Judith A. Church, R.N., C.N.P.
Supervising Board Member
Certified Mail Receipt No. 7012 1010000242574374
cc: Henry G. Appel, Assistant Attorney General
Case #12-004623
'Ohio Board of Nursing www.nursing.ohio.gov
17 South High Street, Suite 400 Columbus, Ohio 43215-7410 (614) 466-3947
November 16,2012
NOTICE OF OPPORTUNITY FOR HEARING
Tracy Duvaun Jones (aka "Tracy Duvaun Parker"), L.P.N.
1057 Orchard Street
Toledo, Ohio 43609
Dear Ms. Jones:
In accordance with Chapter 119 Ohio Revised Code (ORC), you are hereby notified that the
Ohio Board of Nursing (Board) proposes under authority of Section 4723.28, ORC, to deny,
revoke, permanently revoke, suspend or place restrictions on your license to practice nursing as a
licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more
than five hundred dollars ($500.00) per violation for the following reasons:
I. On or about September 22, 2006, you entered into a Consent Agreement
(September 2006 Consent Agreement) with the Ohio Board of Nursing (Board), a
copy of which is attached hereto and incorporated herein,in which you agreed
with the Board that your license to practice nursing as a licensed practical nurse in
the State of Ohio would be suspended indefinitely. Your license to practice
nursingas a licensed practical nurse currently remains suspended.
On or about August 5, 2011, in Toledo Municipal Court Case No. CRA-11-
11408-0101, you were found guilty of one (1) count of Attempt to Commit an
Offense (Possession of Cocaine), a misdemeanor of the first degree, in violation
of Section 2923.02(A), ORC, as it relates to Section 2925.lI(A), ORC. The acts
underlying your conviction occurred on or about July 29, 2011, and involve you
attempting to obtain, possess, or use Cocaine.
Section 4723.28(B)(5), ORC, authorizes the Board to discipline a licensee for conviction of, a
plea of guilty to, a judicial finding of guilt of, a judicial finding of guilt resulting from a plea of
no contest to, or a judicial finding of eligibility for intervention in lieu of conviction for,
violating any municipal, state, county, or federal drug law.
On or about September 9, 2009, in Lucas County Common Pleas Court Case No.
G-4801-CR-902471, you pled guilty to were subsequently found guilty of two (2)
counts of Attempt to Commit Grand Theft-Motor Vehicle, felonies of the fifth
degree, in violation of Section 2923.02(A), ORC, as it relates to
2913.02(A)(1)&(B)(5),ORC.
Tracy Duvaun Jones (aka "Tracy Duvaun Parker")
Page 2
The acts underlying this conviction occurred on or about July 22, 2009, and
involve you attempting to obtain or exert control over motor vehicle(s)
without consent of the owner or person authorized to give consent.
Section 4723.28(B)(4), ORC, authorizes the Board to discipline a licensee for conviction of, a
plea of guilty to, a judicial finding of guilt of, a judicial finding of guilt resulting from a plea of
no contest to, or a judicial finding of eligibility for intervention in lieu of conviction for, any
felony or of any crime involving gross immorality or moral turpitude.
Accordingly, the Board is authorized to impose one or more of the sanctions as cited in Section
4723.28 ORe.
In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing
on this matter. If you wish to request such hearing, the request must be made in writing and
must be received in the Board office within thirty (30) days of the time of mailing this notice.
You are hereby further informed that if you timely request a hearing, you are entitled to appear at
such hearing in person, by your attorney, or by such other representative as is permitted to
practice before the Board, or you may present you position, argument, or contentions in writing.
At the hearing you may also present evidence and examine witnesses appearing for and against
you.
Should you choose to request a hearing, please mail or deliver the request, in addition to any
other correspondence regarding this matter to: Lisa Ferguson-Ramos, Compliance Unit
Manager, 17 South High Street, Suite 400, Columbus, OH 43215-7410, or to the email
address, hear!ng<:{!?J),J!Isipg&mQ,gov. .
If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing
of this notice, the Board may, in your absence and upon consideration of the factual and legal
allegations set forth in the Notice of Opportunity for Hearing, deny, revoke, permanently revoke,
suspend or place restrictions on your license to practice nursing as a licensed practical nurse;
reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars
($500.00) per violation.
Sincerely,
Judith A. Church, R.N., C.N.P.
Supervising Board Member
Certified Mail Receipt No. 70121010 0002 42573605
cc: Henry G. Appel, Assistant Attorney General
Case # 05-09%, 05-1008 &, 06-1858

Ohio Board of .Nurs.ing. www.nursing.ohio.gov


17 South High Street, Suite400- Columbus, Ohio 4 3 2 1 5 ~ 7 4 1 O . </ (614) 466-3947
CONSENT AGREEMENT
BETWEEN
TRACYDUVAUN JONES, L.P.N.
AND
OIDOBOARD OFNURSING
This Consent Agreement is entered into by and between TRACY DUVAUN JONES, L.P.N.
(MS. JONES) and the Ohio Board of Nursing (Board), the state agency charged with enforcing
Chapter 47:1.3. of the Ohio Revised Code (ORC), and all administrative rules promulgated
thereunder.
MS. JONES voluntarily enters into this Consent Agreement being fully informed of her rights
under Chapter 119, ORC, including the right to representation by legal counsel and the right to a
formal adjudicative hearing on the issues considered herein.
This Consent Agreement contains the entire agreement between the parties, there beingno other
agreement of any kind, verbal or otherwise, which varies the terms of this Consent Agreement.
BASIS FOR ACTION
This Consent Agreement is entered into on the basis of the following stipulations, admissions
and understandings:
A. The Board is empowered by Section 4723.28, ORC, to deny, permanently revoke,
revoke, suspend, or place restrictions on any license issued by the Board;
reprimand or otherwise discipline a licensee; or impose a fine of five hundred
dollars ($500.00) or less per violation. Section 4723.28(B)(3), ORC, authorizes
the Board to discipline a licensee for conviction of, a plea of guilty to, a judicial
finding of guilt of, a judicial finding of guilt resulting from a plea ofno contest to,
OT a judicial finding of eligibility for intervention in lieu of conviction for, of a
misdemeanor committed in the course of practice. Section 4723.28(B)(8), ORC,
authorizes the Board to discipline a licensee for self-administering or otherwise
taking into the body any dangerous drug, as defined in Section 4729.01, ORC, in
any way not in accordance with a legal, valid prescription issued for that
individual. Section 4723.28(B)(13), ORC, authorizes the Board to discipline a
licensee for obtaining or attempting to obtain money or anything of value by
intentional misrepresentation or material deception in the course of practice.
Section 4723.28(B)(19), ORC, authorizes the Board to discipline a licensee for
failure to practice in accordance with acceptable and prevailing standards of safe
nursing care. Section 4723.28(B)(25), ORC, authorizes the Board to discipline a
licensee for failure to comply with the terms and conditions of participation in the
chemical dependency monitoring program established under Section 4723.35,
Tracy DuVaun Jones, L.P.N.
Page 2
ORC. Section 4723.28(B)(16), ORC, authorizes the Board to discipline a licensee
for violation of Chapter 4723, ORC, or any rules adopted under it. Specifically,
Rule 4723-6-03(A), Ohio Administrative Code, requires a participant in the
Alternative Program for Chemical Dependency to comply with all of the terms
and conditions of the participant's agreement with the Alternative Program for
Chemical Dependency for the time period specified in the agreement.
B. MS. JONES' license to practice nursing as a licensed practical nurse in the State
of Ohio, PN-I05947, is inactive. MS. JONES has been licensed as a nurse in
Ohio since 1999.
C. MS. JONES knowingly and voluntarily admits to the following:
1. On or about July 13, 2005, in Lucas County Court of Common Pleas Case
Number G4801-CR-0200501972, MS. JONES pled guilty to, and was
found guilty of, one (1) count of Petty Theft, a misdemeanor of the first
degree, in violation of section 2913.02(A)(3) & (B)(2), ORC.
The acts underlying MS. JONES' conviction in the above-referenced case
occurred in April 2005, while MS. JONES was employed as a licensed
practical nurse at Foundation Park Care Center in Toledo, Ohio, and
involve MS. JONES' theft of Tylenol #3 with Codeine.
Despite the discontinuation of an order for Tylenol #3 with Codeine for a
patient, MS. JONES signed out and documented administering Tylenol
#3 with Codeine to the patient on eight occasions between March 31 and
April 6, 2005. The patient underwent a drugscreen on April 6, 2005 and
tested negative for Codeine. MS. JONES subsequently admitted to a
Pharmacy Board Agent that she diverted the Tylenol #3 with Codeine
from Foundation Park Care Center for her self-administration. MS.
JONES stated that, prior to taking the Tylenol #3 with Codeine, she had
been prescribed pain medications for a medical problem and had built up a
tolerance to the medications.
MS. JONES made her nursing license inactive in May 2005.
2. On December 21, 2005, effective through December 21, 2009, MS.
JONES entered into an Alternative Program Participant Agreement
(Agreement) with the Board's Alternative Program for Chemical
Dependency (Program).
a. MS. JONES was assessed at Focus Healthcare in Maumee, Ohio, in
. JUly 2005 and was diagnosed with Opiate Dependency and Major
Depressive Disorder. She completed detoxification and began an
intensive outpatient program (lOP) at Focus Healthcare, MS. JONES
was unsuccessfully discharged from Focus Healthcare due to poor lOP
Tracy DuVaun Jones, L.P.N.
Page 3
attendance and after continued use of Tylenol #3 with Codeine
prescribed by a dentist for a toothache.
MS. JONES began the women's non-intensive outpatient substance
abuse treatment program at Fresh Attitude in Toledo, Ohio, in
November 2005. MS. JONES failed to submit Chemical Dependency
Treatment Progress Evaluation Forms from December 2005 through
June 2006 from her chemical dependency treatment provider, in
violation of her Agreement The Board was informed in July 2006 that
MS. JONES, in violation of her Agreement, had failed to comply with
her recommended treatment and had not attended the treatment
program at Fresh Attitude for approximately two months.
b. MS, JQNES, in violation of her Agreement, failed to submit the
following reports to the Board: Probation Report Forms from her
probation officer due every other month; Personal Report Forms for
April, May and June 2006; and Healthcare Provider Evaluation Forms
for February, March and April 2006.
e. In February and April 2006, MS. JONES obtained emergency medical
treatment, but failed to inform her treating physicians of her chemical
dependency and recovery status, in violation of her Agreement. MS.
JONES further failed to submit forms from the treating physicians
regarding medications administered to and prescribed for her, in
violation of her Agreement.
f. On January 26, 2006, MS. JONES tested positive for Codeine,
Oxycodone and Propoxyphene, but did not provide appropriate
documentation of prescriptions for these medications to the Board, in
violation of her Agreement. On April 4, 2006, MS. JONES tested
positive for Benzodiazepines (Nordiazepam and Oxazepam) and
Oxycodone, but did not provide documentation of prescriptions for
these medications to the Board, in violation of her Agreement.
g. On at least 88 occasions since her admission to the Program, MS.
JONES, in violation of her Agreement, failed to telephone FirstLab,
the Program's drug testing agency, to see if she was selected for a drug
screen. MS. JONES, in violation of her Agreement, failed to submit a
specimen for drug screening despite being selected to do so on March
29,2006, May 30, 2006, and June 23, 2006.
h. MS. JONES was terminated from the Alternative Program on or about
July 13, 2006, due to her failure to comply with the terms and
conditions of her Agreement
Tracy DuVaun Jones, L.P.N.
Page 4
AGREED CONDITIONS
Wherefore, in consideration of the foregoing and mutual promises hereinafter set forth, and in
lieu of any formal proceedings at this time, MS. JONES knowingly and voluntarily agrees with
the Board to the following terms, conditions, and limitations:
SUSPENSION OF LICENSE
1. MS. JONES' license to practice nursing as a licensed practical nurse is hereby
suspended for an indefinite period of time, but not less than two (2) years. MS.
JONES may submit a written request for reinstatement anytime after August
2008.
CONDITIONS FOR REINSTATEMENT
2. MS. JONES shall obey all federal, state, and local laws, and all laws and rules
governing the practice of nursing in Ohio.
3. MS. JONES shall appe<lr in person for interviews before the full Board or its
designated representative as requested by the Board.
4. Prior to reinstatement, MS. JONES shall enter into a Consent Agreement with the
Board for probationary terms, conditions, and limitations determined by the Board for
a minimum period of three (3) years following reinstatement
Monitoring of Rehabilitation and Treatment
5. MS. JONES shall abstain completely from the personal use or possession of drugs,
except those prescribed, administered, or dispensed to her by another so authorized by
law who has full knowledge of MS. JONES' history of chemical dependency and
recovery status, MS. JONES shall self-administer the prescribed drugs only in the
manner prescribed.
6. MS. JONES shall abstain completely from the use of alcohol.
7. Not Jess than one (1) year prior to seeking reinstatement by the Board, MS.
JONES shall, at her own expense, seek a chemical dependency evaluation by a Board
approved chemical dependency professional and shall provide the Board with
complete documentation of this evaluation. Prior to the evaluation, MS. JONES shall
provide the chemical dependency professional with a copy of this Consent Agreement.
Further, MS. JONES shall execute releases to permit the chemical dependency
professional to obtain any information deemed appropriate and necessary for the
evaluation. The chemical dependency professional shall submit a written opinion to
the Board that includes diagnoses and recommendations for treatment and monitoring.
8. MS. JONES shall provide the Board with satisfactory documentation of compliance
with all aspects of the treatment plan developed by the chemical dependency
Tracy DuVaun Jones, L.P.N.
PageS
professional described above until released. Further, MS. JONES agrees that the
Board may utilize the professional's recommendations and conclusions from the
evaluation as a basis for additional terms, conditions, and limitations on MS. JONES'
license and that the terms, conditions, and limitations shall be. incorporated in an
addendum to this Consent Agreement.
9. Within three (3) months prior to seeking reinstatement by the Board, MS.
JONES shall, at her own expense, seek a second chemical dependency evaluation by a
Board approved chemical dependency professional and shall provide the Board with
complete documentation of this evaluation. Prior to the evaluation, MS. JONES shall
provide the chemical dependency professional with a copy of this Consent Agreement
Further, MS. JONES shall execute releases to permit the chemical dependency
professional to obtain any information deemed appropriate and necessary for the
evaluation. The chemical dependency professional shall submit a written opinion to
the Board that includes any additional restrictions to be placed on MS. JONES'
license to practice, and stating whether MS. JONES is capable of practicing nursing
according to acceptable and prevailing standards of safe nursing care.
10. For a minimum, continuons period of one (1) year immediately prior to
requesting reinstatement, MS. JONES shall submit, at her expense and on the day
selected, blood or urine specimens for drug andlor alcohol analysis at a collection site
specified by the Board at such times as the Board may request. Upon and after MS.
JONES' initiation of drug screening, refusal to submit such specimen, or failure to
submit such specimen on the day she is selected, or in such a manner as the Board
may request, shall constitute a violation of a restriction placed on a license for
purposes of Section 4723.28(B), ORC. This screening shall require a daily call-in
process. The specimens submitted by MS. JONES shall be negative, except for
substances prescribed, administered, or dispensed to her by another so authorized by
law who has full knowledge of MS. JONES' history of chemical dependency and
recovery status.
a. Within thirty (30) days prior to MS. JONES initiating drug screening, MS.
JONES shall provide a copy of this Consent Agreement to all treating
practitioners and shall provide to the Board a list of all treating practitioners,
including addresses and telephone numbers and cause all treating practitioners
to complete a medication prescription report that is to be mailed by the
practitioner directly to the Board. The medication report is to be completed for
any and all substances prescribed, administered, or dispensed to MS. JONES.
b. After initiating drug screening, MS. JONES shall be under a continuing duty
to provide a copy of this Consent Agreement, prior to initiating treatment, to
additional treating practitioners, and to update the list of treating practitioners
with the Board within forty-eight (48) hours of being treated by another
practitioner. Further, MS. JONES shall notify the Board of any and all
medication(s) or prescription(s) received within twenty-four (24) hours of
release from hospitalization or medical treatment.
Tracy DuVaunJones, L.P.N.
Page 6
11. For a mmnnum, continuous period of one (1) year immediately prior to'
requesting reinstatement, MS. JONES shall attend a minimum of one (1) meeting
per week of a support or peer group meeting approved in advance by the Board, or a
Twelve Step program, and licensee shall provide satisfactory documentation of such
attendance to the Board prior to reinstatement
Reporting Requirements of Liceusee
12. MS. JONES shall report to the Board in writing, any violation of this Consent
Agreement within thirty (30) days of the occurrence of the violation.
13. MS. JONES shall sign release of informationforms allowing health professionals and
other organizations to submit requested documentation or information directly to the
Board.
14. MS. JONES shall submit any and all information that the Board may request
regarding her ability to practice according to acceptable and prevailing standards of
safe nursing practice.
15. MS. JONES shall not submit or cause to be submitted any false, misleading, or
deceptive statements, information, or documentation to the Board or to employers or
potential employers.
16. MS. JONES shall submit the reports and documentation required by this Consent
Agreement on forms specified by the Board. All reporting and communications
required by this Consent Agreement shall be made to the Compliance Unit of the
Board.
17. MS. JONES shall submit the reports and documentation required by this Consent
Agreement to the attention of the Compliance Unit, Ohio Board of Nursing, 17 South
High Street, Suite400, Columbus, OR 43215-7410.
18. MS. JONES shall verify that the reports and documentation required by this Consent
Agreement are receivedin the Board office.
19. MS. JONES shall inform the Board within three (3) business days, in writing, of any
change in address and/or telephone number.
Refresher Course or Orientation
Upon request by the Board or its designee, MS. JONES shall, prior to working in
a position where a nursing license is required, complete and submit satisfactory
documentation of completion of a refresher course or an extensive orientation
approved in advance by the Board or its designee.
Tracy DuVaunJones, L.P.N.
Page 7
Temporary Narcotic Restrictions
Upon reinstatement of her license, MS. JONES shall not administer, have access
to, or possess (except as prescribed for MS. JONES' use by another so authorized
by law who has full knowledge of MS. JONES' history of chemical dependency)
any narcotics, other controlled substances, or mood altering drugs for a minimum
period of eighteen (18) months in which MS. JONES is working in aposition that
requires a nursing license. At any time after the eighteen-month period previously
described, MS. JONES may submit a written request to the Board to have this
restriction re-evaluated. In addition, MS. JONES shall not count narcotics or
possess or carry any work keys for locked medication carts, cabinets, drawers, or
containers. MS. JONES shall not call in or order prescriptions or prescription refills.
Permanent Practice Restrictions
MS. JONES further knowingly and voluntarily agrees with the Board to the following
PERMANENT LICENSURE RESTRICTIONS:
Unless otherwise approved in advance by the Board or its designee, MS. JONES
shall not practice nursing as a licensed practical nurse (1) for agencies providing
home care in the patient's residence; (2) for hospice care programs providing hospice
care in the patient's residence; (3) as a nurse for staffing agencies or pools; (4) as an
independent provider where the nurse provides nursing care and is reimbursed for
services by the State of Ohio through State agencies or agents of the State; or (5) for
an individual or group of individuals who directly engage MS. JONES to provide
nursing services for fees, compensation, or other consideration or as a volunteer.
Unless otherwise approved in advance by the Board or its designee, MS. JONES
shall not function in a position or employment where the job duties or requirements
involve management of nursing, nursing responsibilities, or supervising and
evalnating nursing practice. Such positions include but are not limited to the
following: Director of Nursing, Assistant Director of Nursing, Nurse Manager, Vice
President of Nursing.
FAILURE TO COMPLY
The above described terms and conditions shall constitute "restrictions placed on a license" for
purposes of Section 4723.28(B), ORC. If, in the discretion of the Board, MS. JONES appears to
have violatedor breached any terms or conditions of this Consent Agreement, the Board reserves
the right to institute formal disciplinary proceedings for any and all possible violations or
breaches, including, but not limited to, alleged violations of the laws of Ohio occurring before
the effective date of this Consent Agreement
DURATIONIMODIFICATION OF TERMS
The terms, limitations, and conditions of this Consent Agreement, other than the permanent
licensure restrictions, may be modified or terminatedin writing at any time upon the agreement
of both MS. JONES and the Board.
AUG- 30-2006 WED 12: 50 PI1 LC ADULT PROBATION
Tracy DuYaun Jones, L.P;:r(.
Page 8
FAX NO. 4199368151 P. 01101
The Board may only alter the indefinite suspension imposed if: (1) MS. JONES submits a
written request for reinstatement; (2) the Board determines that MS. JONES has complied with
all conditions of reinstatement; (3) the Board determines that MS, JONES is able to practice
according to acceptable and prevailing standards of safe nursing care based upon an interview
WithMS. JONES and review of the documentation specified in this Consent Agreement; and (4)
MS. JONES has entered into a Consent Agreement with the Board for probationary terms,
conditions, and limitations determined by the Board for a minimum period of three (3) years
following reinstatement.
ACKNQWJJEDGMENTSlIJABIpTY RELEASE
MS. JONES acknowledges that she has had an opportunity to ask questions concerning the
terms of this Consent Agreement and that all questions asked have been answered in a
satisfactory manner.
MS. JONES waives all of her rights under Chapter 119, ORC, as they relate to matters that are
the subject of this Consent Agreement.
MS. JONES waives any and all claims or causes of action she may have against the Board, and
its members, officers, employees and/or agents arising out of matters that are the subject of this
Consent Agreement.
This Consent Agreement is not an adjudication order within the meaning of Section 1I9.01(D),
ORC. Any action initiated by the Board based on alleged violations of this Consent Agreement
shall comply with the Administrative Procedures Act, Chapter 119, ORC.
This Consent Agreement shall be considered a public record as that term is used in Section
149.43, ORC. The information contained herein may be reported to appropriate organizations,
data banks and governmental bodies.
EFF'ECTrvE DATE
MS. JONES understands that this Consent Agreement is subject to ratification by the Board
prior to signature by the Board President and shall become effective upon the last date of
signature below.
,/1
C?\ fi{lc-<
TRACYDUVA JONES,L.P.N.
CY HIA A. KRUEGER,
. Ohio Board of Nursing
DATE
I
08/30/2008 WED 13: 58 (TX/RX NO 7842] 1@001
Case # 11-004563
Ohio Board of Nursing www.nursing.ohio.gov
17 South High Street, Suite400 Columbus, Ohio 43215-7410 (614) 466-3947
November 16,2012
NOTICEOF OPPORTUNITY FOR HEARING
Ryan Alan Kelso, R.N.
163 Margaret Place
Perrysburg, Ohio 43551
Dear Mr. Kelso:
In accordance with Chapter 119, Ohio Revised Code (ORC), you are hereby notified that the
Ohio Board of Nursing (Board) proposes under authority of Section 4723.28 ORC, to deny,
revoke, permanently revoke, suspend or place restrictions on your license to practice nursing as a
registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five
hundred dollars ($500.00) per violation for the following reasons:
I. As set forth in Attachment A, while working as a nurse at the University of Toledo
Medical Center in Toledo, Ohio (UTMC), you withdrew narcotics without a physician
order for Patients #1 - 7 [See attached Patient Key - to remain confidential and not
subject to public disclosure], and with respect to Patients # 5 and 7, failed to account for
the administration or waste of the narcotics.
Section 4723.28(B)(19), ORC, authorizes the Board to discipline a licensee for failure to practice
in accordance with acceptable and prevailing standards of safe nursing care. Section
4723.28(B)(20), ORC, authorizes the Board to discipline a licensee for, in the case of a
registered nurse, engaging in activities that exceed the practice of nursing as a registered nurse.
Accordingly, the Board is authorized to impose one or more of the sanctions cited in Section
4723.28,ORC.
In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing
in this matter. If you wish to request such hearing, the request must be made in writing and must
be received in the Board office within thirty (30) days of the time of mailing of this notice.
You are hereby further informed that, if you timely request a hearing, you are entitled to appear
at such hearing in person, by your attorney, or by such other representative as is permitted to
practice before the Board, or you may present your position, arguments, or contentions in
writing. At the hearing, you may also present evidence and examine witnesses appearing for and
against you.
Should you choose to request a hearing, please mail or deliver the request, in addition to any.
other correspondence regarding this matter, to Lisa Ferguson-Ramos, Compliance Unit
Ryan Alan Kelso, R.N.
Page 2
Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, Ohio 43215-
7410 or to the email address, hearing@nursing.ohio.gov.
If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing
of this notice, the Board may, in your absence and upon consideration of the factual and legal
allegations set forth in this Notice of Opportunity for Hearing, deny, revoke, permanently
revoke, suspend, or place restrictions on your license to practice nursing as a registered nurse;
reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars
($500.00) per violation.
Sincerely,
Judith.A, Church, R.N., C.N.P.
Supervising Board Member
Certified Mail Receipt No. 7012 1010 0002 4257 4282
cc: Henry G. Appel, Assistant Attorney General
Ryan Alan Kelso, R.N.
Page 3
Attachment A
PATIENT Physician Medication MAR Comments
# Order Withdrawal
Patient 1 None Fentanyl
10/19/11
500 meg. at
3:59PM N/A Dose documented as wasted
at 4:32 PM.
Patient 2 None Fentanyl
10/25/11
500 meg. at
3:40PM N/A Dose documented as wasted
at 4:56 PM.
Patient 3 None Fentanyl
10/3111
500 meg. at
12:05 PM N/A Dose documented as wasted
at 1:05 PM
Patient 4 None Fentanyl
10113111
250 meg. at Medication Dispense Report
11:06 AM None indicates miscount.
Patient 5 None Fentanyl
10114/11
500 meg. at None No waste.
10:46 AM
Patient 6 None Fentanyl
10/26/11
500 meg. at
11:46 AM N/A Dose documented as wasted
at2:12 PM.
Patient 7 None Fentanyl
10/14/11
500 meg. at
9:15AM None No waste.
Case# 12-004722 & 12-005366
Ohio Board of Nursing www.nursing.ohio.go\{
17 SouthHigh Street. Suite400 Columbus. Ohio 43215-7410 (614)466-3947
November 16.2012
NOTICE OF AUTOMATIC SUSPENSION AND
OPPORTUNITY FOR HEARING
Kendra Nicole Kuneff, L.P.N.
71864 Hart Road
Martins Ferry. Ohio 43935
Dear Ms. Kuneff:
You are hereby notified that. on or about November 18.2011. you entered into a Consent
Agreement (November 2011 Consent Agreement) with the Ohio Board of Nnrsing (Board). a
copy of which is attached hereto and incorporated herein. in which you agreed with the Board
that your license to practice nnrsing as a licensed practical nurse in the State of Ohio would be
suspended indefinitely and that such suspension would be stayed subject to probationary terms,
conditions, and limitations for a minimum period of one (1) year. Attached to the November
2011 Consent Agreement is an October 20, 2011 Letter ofSupport (October 2011 Letter).
A. Item 1'. of the November 2011 Consent Agreement states, "MS. KUNEFF
shall obey all federal, state, and local laws, and all laws and rules governing
the practice of nursing in Ohio." Section 4723.28(B)(I6), ORC, authorizes the
Board to discipline a licensee for violation of Chapter 4723, ORC, or any
rules adopted under it. Specifically, Section 4723.03(B), ORC, states that no
person shall engage in the practice of nnrsing as a licensed practical nurse,
represent the person as being a licensed practical nurse, or use the title
"licensed practical nurse," the initials "L.P.N." or any other title implying that
the person is a licensed practical nurse, for a fee, salary, or other
consideration, or as a volunteer, without holding a current, valid license as a
licensed practical nurse under this chapter.
Despite this provision, on or about September 2-3, 2012, you worked as a licensed
practical nurse at Interim Healthcare in Bridgeport, Ohio, without holding a
cnrrent, valid license. Your license to practice nursing as a licensed practical
nurse, in the State of Ohio, lapsed on September I, 2012. You renewed your
license on September 5,2012.
Section 4723.28(B)(16), ORC, authorizes the Board to discipline a licensee for violation of .
Chapter 4723, ORC, or any rules adopted under it. Specifically, Section 4723.03(B), ORC,
Kendra Nicole Kuneff, L.P.N.
Page 2
states that no person shall engage in the practice of nursing as a licensed practical nurse,
represent the person as being a licensed practical nurse, or use the title "licensed practical nurse,"
the initials "L.P.N." or any other title implying that the person is a licensed practical nurse, for a
fee, salary, or other consideration, or as a volunteer, without holding a current, valid license as a
licensed practical nurse under this chapter. Section 4723.28(B)(17), ORC, authorizes the Board
to discipline a licensee for violation of any restrictions placed on a nursing license by the Board.
B. Item 3. of the November 2011 Consent Agreement states, "MS. KUNEFF
agrees that she will submit a request to the Bureau of Criminal Identification
and Investigation (BCII) to conduct a criminal records check of MS.
KUNEFF, including a check of Federal Bureau of Investigation (FBI)
records, and shall cause BCII to submit MS. KUNEFF's criminal records
check reports to the Board. MS. KUNEFF's completed criminal records
check, including the FBI check, must be received by the Board within six (6)
months following the effective date of this Consent Agreement."
Despite this provision, as of October 26, 2012, you have failed to submit to the
Board a completed BCIIIFBI criminal background check.
C. Item 12. of the November 2011 Consent Agreement states, "MS. KUNEFF
shall submit any and all information, which the Board or its designee may
request, regarding her ability to practice nursing according to acceptable and
prevailing standards of safe nursing care."
Despite this provision, as of October 26, 2012, you have failed to submit
statements to the Board as requested by a Board Monitoring Agent. In a letter
dated September 6, 2012, you were requested by a Board Monitoring Agent to
submit a statement regarding your past due background check, and a statement
regarding you working as a licensed practical nurse during the time period of
September 1,2012 through September 4, 2012.
Section 4723.28(B)(l7), ORC, authorizes the Board to discipline a licensee for violation of any
restrictions placed on a nursing license by the Board.
In accordance with the paragraph under "FAILURE TO COMPLY" of the November 2011
Consent Agreement, you are hereby notified that it appears to the Board that you have violated
Items 1.,3. and 12. of the November 2011 Consent Agreement.
YOU ARE FURTHER NOTIFIED THAT YOUR LICENSE TO PRACTICE NURSING
AS A LICENSED PRACTICAL NURSE, PN132614, IS HEREBY AUTOMATICALLY
SUSPENDED. Continued practice after receipt of this notice of suspension shall be considered
engaging in the practice of nursing as a licensed practical nurse without a current, valid license,
which is a violation of Section 4723.03(B), ORC.
You are further notified that in accordance with Chapter 119, ORC, the Board proposes under
authority of Section 4723.28, ORC, to deny, permanently revoke, revoke, suspend or place
Kendra Nicole Kuneff, L.P.N.
Page 3
restrictions on your license to practice nursing as a licensed practical nurse; reprimand or
otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per
violationfor the following reasons:
1. On or about November 18, 2011, you entered into a Consent Agreement
(November 2011 Consent Agreement) with the Ohio Board of Nursing
(Board), a copy of which is attached hereto and incorporated herein, in which
you agreed with the Board that your license to practice nursing as a licensed
practical nurse in the State of Ohio would be suspended indefinitely and that
such suspension would be stayed subject to probationary terms, conditions,
and limitations for a minimum period of one (1) year. Attached to the
November 2011 Consent Agreement is an October 20, 2011 Letter of Support
(October 2011 Letter).
2. Item 1. of the November 2011 Cousent Agreement states, "MS. KUNEFF
shall obey all federal, state, and local laws, and all laws and rules governing
the practice of nursing in Ohio." Section 4723.28(B)(16), ORC, authorizes the
Board to discipline a licensee for violation of Chapter 4723, ORC, or any
rules adopted under it. Specifically, Section 4723.03(B), ORC, states that no
person shall engage in the practice of nursing as a licensed practical nurse,
represent the person as being a licensed practical nurse, or use the title
"licensed practical nurse," the initials "L.P.N." or any other title implying that
the person is a licensed practical nurse, for a fee, salary, or other
consideration, or as a volunteer, without holding a current, valid license as a
licensed practical nurse under this chapter.
Despite this provision, on or about September 2-3, 2012, you worked as a licensed
practical nurse at Interim Healthcare in Bridgeport, Ohio, without holding a
current, valid license. Your license to practice nursing as a licensed practical
nurse, in the State of Ohio, lapsed on September 1, 2012. You renewed your
license on September 5, 2012.
Section 4723.28(B)(16), ORC, authorizes the Board to discipline a licensee for violation of
Chapter 4723, ORC, or any rules adopted under it. Specifically, Section 4723.03(B), ORC,
states that no person shall engage in the practice of nursing as a licensed practical nurse,
represent the person as being a licensed practical nurse, or use the title "licensed practical nurse,"
the initials "L.P.N." or any other title implying that the person is a licensed practical nurse, for a
fee, salary, or other consideration, or as a volunteer, without holding a current, valid license as a
licensed practical nurse under this chapter. Section 4723.28(B)(17), ORC, authorizes the Board
to discipline a licensee for violation of any restrictions placed on a nursing license by the Board.
3. Item 3. of the November 2011 Consent Agreement states, "MS. KUNEFF
agrees that she will submit a request to the Bureau of Criminal Identification
and Investigation (BCll) to conduct a criminal records check of MS.
KUNEFF, including a check of Federal Bureau of Investigation (FBI)
records, and shall cause BCll to submit MS. KUNEFF's criminal records
Kendra Nicole Kuneff, L.P.N.
Page 4
check reports to the Board. MS. KUNEFF's completed criminal records
check, including the FBI check, must be received by the Board within six (6)
months following the effective date of this Consent Agreement."
Despite this provision, as of October 26, 2012, you have failed to submit to the
Board a completedBCII/FBI criminal background check.
4. Item 12. of the November 2011 Consent Agreement states, "MS. KUNEFF
shall submit any and all information, which the Board or its designee may
request, regarding her ability to practice nursing according to acceptable and
prevailing standards of safe nursing care."
Despite this provision, as of October 26, 2012, you have failed to submit
statements to the Board as requested by a Board Monitoring Agent. In a letter
dated September 6, 2012, you were requested by a Board Monitoring Agent to
submit a statement regarding your past due background check, and a statement
regarding you working as a licensed practical nurse during the time period of
September 1,2012 through September 4, 2012.
Section 4723.28(B)(17), ORC, authorizes the Board to discipline a licensee for violation of any
restrictions placed on a nursing license by the Board.
Accordingly, the Board is authorized to impose one or more of the sanctions as cited in Section
4723.28,ORC.
In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing
in this matter. If you wish to request such hearing, the request must be made in writing and must
be received in the Board office within thirty (30) days of the time of mailing of this notice.
You are hereby further informed that, if you timely request a hearing, you are entitled to appear
at such hearing in person, by your attorney, or by such other representative as is permitted to
practice before the Board, or you may present your position, arguments, or contentions in
writing. At the hearing you may also present evidence and examine witnesses appearing for and
against you.
Should you choose to reqnest a hearing, please mail or deliver the request, in addition to any
other correspondence regarding this matter, to: Lisa Ferguson-Ramos, Compliance Unit
Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, Ohio 43215-
7410, or to the e-mail address, !:!!larin,g@!!uJ;sil!g,9J!.!9"gQY.
If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing
of this notice, the Board may, in your absence and upon consideration of the factual and legal
allegations set forth in this Notice of Automatic Suspension and Opportunity for Hearing, deny,
Kendra Nicole Kuneff, L.P.N.
Page 5
permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a
licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more
than five hundred dollars ($500.00) per violation.
Sincerely,
Judith A. Church, R.N., C.N.P.
Supervising Board Member
Certified Mail Receipt No. 7012 1010 0002 4257 4633
cc: Henry G. Appel, Assistant Attorney General
Case #10-4426
ObiO Boa:rdot NursiJ:l,g .www.nursing.ohio.goy
17 South High Street, Suite400 '.~ Columbus, Ohio 43215-7410 . (614) 466-3947
--------------------C-DNSEN+-AGREEMEN'i:'T---
BETWEEN
KENDRA NICOLE KUNEFF, L.P.N,
AND
OHIO BOARD OF NURSING
This Consent Agreement is entered into by and between KENDRA NICOLE KUNEFF, L.P.N.
(MS. KUNEFF) and the Ohio Board of Nursing (Board), the state agency charged with
enforcing Chapter 4723. of the Ohio Revised Code (ORC), and all administrative rules
promulgated thereunder.
MS. KUNEFF voluntarily enters into this Consent Agreement being fully informed of her rights
under Chapter 119, ORC, including the right to representation by legal counsel and the right to a
formal adjudicative hearing on the issues considered herein.
This Consent Agreement contains the entire agreement between the parties, there being no other
agreement of any kind, verbal or otherwise, which varies the terms of this Consent Agreement.
BASIS FOR ACTION
This Consent Agreement is entered into on the basis of the following stipulations, admissions
and understandings:
A. The Board is empowered by Section 4723.28, ORC, to deny, permanently
revoke, revoke, suspend, or place restrictions on any license issued by the
Board; reprimand or otherwise discipline a licensee; or impose a fine of five
hundred dollars ($500.00) or less per violation. Section 4723.28(B)(8), ORC,
authorizes the Board to discipline a licensee for self-administering or otherwise
taking into the body any dangerous drug, as defined in Section 4729.01, ORC,
in any way not in accordance with a legal, valid prescription issued for that
individual.
B. MS. KUNEFF has an active license to practice nursing as a licensed practical
nurse, PN-132614, in the State of Ohio. MS. KUNEFF was initially licensed
as a licensed practical nurse in November 2008.
C. MS. KUNEFF knowingly and voluntarily admits to the following:
1) On or about September 22, 2010, while working as a licensed practical
nurse at Shadyside Care Center in Shadyside, Ohio, MS, KUNEFF and
several other nurses were sent for a drug screen after a resident's
Kendra Nicole Kuneff', L.P.N.
Page 2
medication went missing. MS. KUNEFF's drug screen tested positive
for Marijuana and she subsequently resigned her nursing position.
2) On or about October 18,2010, MS. KUNEFF admitted to Board staff
------mtrSill:g1'\7fiTI1juana at party witlJ:Ir1enclS,15unOOed thIS was an Isolated
incident and will not happen again.
3) MS. KUNEFF is currently employed as a licensed practical nurse for
Interim HealthCare of. S.B. Ohio, Inc. (Interim HeaIthCare)in
Bridgeport, Ohio. Interim HealtbCare has submitted a letter of support,
which is attached hereto.
4) MS. KUNEFF apologizes for her actions and is willing to cooperate
with the Board in order to maintain her nursing license.
AGREED CONDITIONS
Wherefore, in consideration of the foregoing and mutual promises hereinafter set forth, and in
lieu of any formal proceedings at this time, MS. KUNEFF knowingly and voluntarily agrees
with the Board to the following terms, conditions, and limitations: MS. KUNEFF's license to
practice nursing as a licensed practical nurse shall be suspended indefinitely. Such suspension is
hereby stayed, subject to the following probationary terms, conditions, and limitations for a
minimum period of one (1) year:
1. MS. KUNEFF shall obey all federal, state, and local laws, and all laws and
rules governing the practice of nursing in Ohio.
2. MS. KUNEFF shall appear in person for an interview before the full Board or
its designated representative, as requested by tbe Board or its designee.
3. MS. KUNEFF agrees that she will submit a request to the Bureau of Criminal
Identification and Investigation (BCll) to conduct a criminal records check of
MS. KUNEFF, including a check of Federal Bureau of Investigation (FBI)
records, and shall cause BCll to. submit MS. KUNEFF's criminal records
check reports to the Board. MS. KUNEFF's completed criminal records
check, including tbe FBI check, must be received by the Board within six (6)
months following the effective date of this Consent Agreement.
Monitoring of Rehabilitation and Treatment
4. MS. KUNEFF shall abstain completely from the personal use or possession of
drugs, except those prescribed, administered, or dispensed to her by another so
autborized by law who has full knowledge of MS. KUNEFF's history. MS.
KUNEFF shall self-administer prescribed drugs only in the manner
prescribed.
Kendra Nicole Kuneff, L.P.N.
Page 3
5. Within forty-five (45) days of the effective date of this Consent Agreement
and continuing throughout the probationary period, MS; KUNEFF shall
submit, at her expense and on the day selected, blood or urine specimens for
drugand/or alcohol analysis at a collection site specified by the Board at such
--n:rn-e-s-a-stlrei'lt;1lfll1ll1lrrequest. RefusanostlDl'iirrs'UCJj specimen, or fifilurerfo"'--
submit such specimen on the day she is selected, or in such a manner as the
Board may request, shall constitute a violation of a restriction placed on a
license for purposes of Section 4723.28(B), ORC. This screening shall require
a daily call-in process. The specimens submitted by MS. KUNEFF shall be
negative, except for substances prescribed, administered, or dispensed to her
by another so authorized by law who has full knowledge of MS. KUNEFF's
history.
__....10
6. Upon request by the Board or its designee and within sixty (60) days of
such request, MS. KUNEFF shall, at her expense, obtain a chemical
dependency by a Board approved chemical dependency professional and shall
provide the Board with complete documentation of this evaluation. Prior to the
evaluation, MS. KUNEFF shall provide the professional with a copy of this
Consent Agreement. Further, MS. KUNEFF shall execute releases to permit
the professional to obtain any information deemed appropriate and necessary
for the evaluation. The 'professional shall submit a written opinion to the
Board that includes diagnoses, recommendationsfor treatment and monitoring,
any additional restrictions that should be placed on MS. KUNEFF's license to
practice, and stating whether MS. KUNEFF is capable of practicing nursing
according to acceptable and prevailing standards of safe nursing care.
7. If a chemical dependency evaluation is requested, MS. KUNEFF shall
provide the Board with satisfactory documentation of compliance with all
aspects of the treatment plan developed by the chemical dependency
professional described above until released. Further, MS. KUNEFF agrees
that the Board may utilize the professional's recommendations and conclusions
from the evaluation as a basis for additional terms, conditions, and limitations
on MS. KUNEFF's license and that the terms, conditions, and limitations shall
be incorporated in an addendum to this Consent Agreement.
Treating Practitioners and Reporting
8. Prior to initiating drug screening and continuing throughout the
probationary period, MS. KUNEFF shall cause all treating practitioners to
complete a medication prescription report that is to be mailed by the
practitioner directly to the Board. The medicationreport is to be completed for
any and all substances prescribed, administered, or dispensed to MS.
KUNEFF after initiating drug screening and throughout the duration of this
Consent Agreement.
Kendra Nicole Kuneff', LP.N.
Page 4
Employment Conditions
9. If working in a position in which a nursing license is reqnired, MS.
KUNEFF shall notify the Board, in writing, of the name and address of any
CUllellt
Consent Agreement, or any new employer prior to accepting employment.
10. MS. KUNEFF, within fifteen (15) days of the effective date of the Consent
Agreement, if working in a position in which a nursing license is required,
shall provide her employer(s) with a copy of this Consent Agreement. Further,
MS. KUNEFF is under a continuing duty to provide a copy of this Consent
Agreement to any new employer prior to accepting employment in a position
in which a nursing license is required. MS. KUNEFF shall have her
employer(s), if working in a position where a nursing license is required,
submit written reports on a quarterly basis regarding job performance
beginning within thirty (30) days of the effective date of the Consent
Agreement or within thirty (30) days of accepting nursing employment.
MS. KUNEFF shall have her employer(s) send documentation to the Board,
along with the first employer report, of receipt of a copy of this Consent
Agreement, including the date the Consent Agreement was received.
Reporting Requirements of Licensee
11. MS. KUNEFF shall report to the Board, in writing, any violation of this
Consent Agreement within thirty (30) days of the occurrence of the violation.
12. MS. KUNEFF shall submit any and all information, which the Board or its
designee may request, regarding her ability to practice nursing according to
acceptable and prevailing standards of safe nursing care.
13. MS. KUNEFF shall not submit or cause to be submitted any false, misleading,
or deceptive statements, information, or documentation to the Board or to
employers or potential employers.
14. MS. KUNEFF shall submit the reports and documentation required by this
Consent Agreement on forms specified by the Board. All reporting and
communications required by this Consent Agreement shall be made to the
Compliance Unit of the Board.
15. MS. KUNEFF shall submit all documentation required by this Consent
Agreement or requested by the Board to the attention of the Compliance Unit,
Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, Ohio
43215-7410.
16. MS. KUNEFF shall verify that the reports and documentation required by this
Consent Agreement are received in the Board office.
Kendra Nicole Kuneff, L.P.N.
Page 5
17. MS. KUNEFF shall inform the Board within five (5) business days, in writing,
of any change in employment status or of any change in residential or home
address or telephone number.
Temporary Practice Restrictions
With the exception of her current position as a licensed practical nurse for
Interim HealthCare and unless otherwise approved in advanced, in writing, by
the Board or its designee, MS. KUNEFF shall not practice nursing as a licensed
practical nurse (l) for agencies providing home care in the patient's residence; (2) for
hospice care programs providing hospice care in the patient's residence; (3) for
staffing agencies or pools; (4) as an independent provider where the nurse provides
nursing care and is reimbursed for services by the State of Ohio through State
agencies or agents of the State; or (5) for an individual or group of individuals who
directly engage MS. KUNEFF to provide nursing services for fees, compensation, or
other consideration or as a volunteer.
Unless otherwise approved in advanced, in writing, by the Board or its designee,
MS. KUNEFF shall not function in a position or employment where the job duties or
requirements involve management of nursing and nursing responsibilities or
supervising and evaluating nursing practice. Such positions include but are not
limited to the following: Director of Nursing, Assistant Director of Nursing, Nurse
Manager, Vice President of Nursing.
FAILURE TO COMPLY
MS. KUNEFF agrees that her license to practice nursing as a licensed practical nurse will be
automatically suspended if it appears to the Board that MS. KUNEFF has violated or breached
any tenus or conditions of the Consent Agreement. Following the automatic suspension, the
Board shall notify MS. KUNEFF via certified mail of the specific nature of the charges and
automatic suspension of her license. Upon receipt of this notice, MS. KUNEFF may request a
hearing regarding the charges.
The above described terms and conditions shall constitute "restrictions placed on a license" for
purposes of Section 4723.28(B), ORC. If, in the discretion of the Board, MS. KUNEFF appears
to have violated or breached any terms or conditions of the Consent Agreement, the Board
reserves the right to institute formal disciplinary proceedings for any and all possible violations
or breaches, including, but not limited to, alleged violations of the laws of Ohio occurring before
the effective date of this Consent Agreement.
DURATION/MODIFICATION OF TERMS
The terms, limitations and conditions of this Consent Agreement may be modified or terminated,
in writing, at any time upon the agreement of both MS. KUNEFF and the Board.
Kendra Nicole Kuneff', L.P.N.
Page 6
The Board shall only alter the probationary period imposed by this Consent Agreement if: (1)
MS. KUNEFF has complied with all aspects of this Consent Agreement; and (2) the Board
determines that MS. KUNEFF is abie to practice according to acceptable and prevailing
standards of safe nursing care without Board monitoring based upon an interview witb-MS,
and-review of the reports reqUired herein. Any period during which MS. KUNEFF
does not work in a position for which a nursing license is required shall not count toward
fulfilling the probationary period imposed by this Consent Agreement.
ACKNOWLEDGMENTS/UABILlTY RELEASE
MS. KUNEFF acknowledges that she has had an opportunity to ask questions concerning the
terms of this Consent Agreement and that all questions asked have been answered in a
satisfactory manner.
MS. KUNEFF waives all of her rights under Chapter 119, ORC as they relate to matters that are
the SUbject of this Consent Agreement.
MS. KDNEFF waives any and all claims or causes of action she may have against the Board,
and members, officers, employees and/or agents of either, arising out of matters that are.the
subject of this Consent Agreement.
This Consent Agreement is not an adjudication order as discussed in Chapter 119, ORe.
However, any action initiated by the Board based on alleged violations of this Consent
Agreement shall comply with the Administrative Procedures Act, Chapter 119, ORC.
This Consent Agreement shall be considered a public record as that term is used in Section
149.43, ORC. The information contained herein may be reported to appropriate organizations,
data banks and governmental bodies.
EFFECTIVE DATE
MS. KUNEFF understands that this Consent Agreement is SUbject to ratification by the Board
prior to signature by the Board President and shall become effective upon the last date of
signature below.

KENDRA NICOLE KUNEFF,L
BfJ,eAlJft,RAl
BERTHA LOVELACE, President
Ohio Board of Nursing
---:,-1",,-0lilllL.lll__-
DATE
DATE
I n f ~ i l n
HEALTliCARE"
October 20, 2011
To WhomIt May Concern:
KendraNicole Kuneff, l.P.N.I. currently employed with Interim HealthCar.ofS.E. Ohio Incorporation.
Interim HealthCare is aware of Kendra NKuneff. license probation andwewill continue to employ
Ms.Kneff.
Please contactmeat (74O) 635-0045 If you haveanyquestions or concerns.
Sincarely,
( & ~
ChantelClifton
Dfreeto.\' ofHumaf\ sescurces
Interim HeillthcareofS.E. Ohf/)
25$North unccln Ave. Stllte 200
Elrldge:p(lrt, ohlQ43912
ccl1ftonlnt<!lim@'@hoo.cam
phone 74Q..68S004S
Fax740.-635.()470
Case #12-004839 & 12-006263
Ohio Boa:rd of Nu:rsing www.nursing.ohio.gov
17South HighStreet, Suite400 Columbus, Ohio 43215-7410 (614) 466-3947
November 16,2012
NOTICE OF IMMEDIATE SUSPENSION AND
. OPPORTUNITY FOR HEARING
Larry Alan Lavender, R.N., C.R.NA.
750 End of Trail Lane
Allardt, TN 38504
Dear Mr. Lavender:
In accordance with Sections 2929.42 andlor 3719.12 of the Ohio Revised Code (ORC), the
Ohio Board of Nursing (Board) has been notified that, on or about October 5, 2012, iu Greene
County Court of Common Pleas Case Number 2012-CR-392, you pled guilty to one (1) count
of Aggravated Possession of Drugs, a felony of the fifth degree, in violation of Section
2925.11(A), ORC; and one (1) count of Theft of Drugs, a felony of the fourth degree, in
violation of Section 2913.02(A)(1), ORC, and were found eligible for Intervention in Lieu of
Conviction.
Section 3719.121(C), ORC, states in pertinent part as follows:
On receiving notification pursuant to Section 2929.42 or 3719.12 of the
Revised Code, the board under which a person has been issued a
license, certificate or evidence of registration immediately shall
suspend the license, certificate, or registration of that person on a plea
of guilty to, a finding by a jury or court of the person's guilt of, or
conviction ,of a felony drug abuse offense; a finding by a court of the
person's eligibility for intervention in lieu of conviction; a plea of guilty
to, or a finding by a jury or court of the person's guilt of, or the person's
conviction of an offense in another jurisdiction that is essentially the
same as a felony drug abuse offense; or a finding by a court of the
person's eligibility for treatment or intervention in lieu of conviction in
another jurisdiction.
Aggravated Possession of Drugs, a felony of the fifth degree, in violation of Section
2925.11(A), ORC; and Theft of Drugs, a felony of the fourth degree, in violation of Section
2913.02(A)(1), ORC, constitute "felony drug abuse offenses" as defined in Section 2925.01,
ORC.
WHEREFORE, PURSUANT TO SECTION 3719.121(C), ORC, YOU ARE HEREBY
NOTIFIED THAT YOUR LICENSE TO PRACTICE NURSING AS A REGISTERED
NURSE, RN376326, AND CERTIFICATE OF AUTHORITY TO PRACTICE AS A
CERTIFIED REGISTERED NURSE ANESTHETIST, COA12937, ARE HEREBY
Larry Alan Lavender, R.N., C.R.N.A
Page 2
SUSPENDED, Continued practice after receipt of this notice of suspension shall be
considered engaging in the practice of nursing without a current, valid license and certificate,
which is a violation of Sections 4723.03(A), ORC, and/or 4723.44(A), ORC.
You are further notified that in accordance with Chapter 119,ORC, the Board proposes under
authority of Section 4723.28, ORC, to deny, permanently revoke, revoke, suspend or place
restrictions on your license to practice nursing as a registered nnrse and certificate ofauthority
to practice as a certified registered nurse anesthetist; reprimand or otherwise discipline you; or
impose a fine of not more than five hundred dollars ($500.00) per violation for the following
reasons:
1. On or about October 5, 2012, in Greene County Court of Common
Pleas Case Number 2012-CR-392, you pled guilty to one (1) count of
Aggravated Possession of Drugs, a felony of the fifth degree, in
violation of Section 2925.1I(A), ORC; and one (1) count of Theft of
Drugs, a felony of the fourth degree, in violation of Section
2913.02(A)(1), ORC, and were found eligible for Intervention in Lieu
of Conviction.
The acts underlying this case occurred on or about March 20,2012, and
involve you obtaining, possessing, or using Fentanyl. Further acts
underlying this case involve you obtaining or exerting control over
Fentanyl without the consent of the owner or person authorized to give
consent.
Section 4723.28(B)(4), ORC, authorizes the Board to discipline a licensee for conviction of, a
plea of guilty to, a judicial finding of guilt of, a judicial finding of guilt resulting from a plea
of no contest to, or a judicial finding of eligibility for intervention in lieu of conviction for,
any felony. Section 4723.28(B)(5), ORC, authorizes the Board to discipline a licensee for
. conviction of, a plea of guilty to, a judicial finding of guilt of, a judicial finding of guilt
resulting from a plea of no contest to, or a judicial finding of eligibility for intervention in lieu
of conviction for, violating any municipal, state, county, or federal drug law.
2. On or about October 23, 2012, you were interviewed by a Board
Compliance Agent. You admitted to the Board Compliance Agent that
on or about March 20, 2012, you self-administered Zofran that you
took from Dayton Gastro, Beavercreek, where you worked as a nurse.
Section 4723.28(B)(8), ORC, authorizes the Board to discipline a licensee for self-
administering or otherwise taking into the body any dangerous drug, as defined in Section
4729.01, ORC, in any way not in accordance with a legal, valid prescription issued for that
individual. Section 4723.28(B)(I3), ORC, authorizes the Board to discipline a licensee for
obtaining or attempting to obtain money or anything of value by intentional misrepresentation
or material deception in the course of practice.
Larry Alan Lavender, R.N., C.R.NA
Page 3
3. In a written statement to the City of Beavercreek Police, dated August
30,2012, you admit to taking Zofran from "Beavercreek Gastro", and
further stated, "I also admit that I have taken narcotic opiates from
Fulton County Hospital where I worked in the last 3 weeks. I have
taken several fentanyl, morphine, and versed containers." Despite this,
on or about October 23, 2012, you were interviewed by a Board
Compliance Agent who asked you if you took any drugs from Fulton
County Health Center where you worked and you stated "No."
Section 4723.28(B)(l6), ORC, authorizes the Board to discipline a licensee for violation of
Chapter 4723, ORC, or any rules adopted under it. Specifically, Rule 4723-4-06(P), Ohio
Administrative Code (OAC), states, in pertinent part, that a licensed nurse shall not make any
false, misleading, or deceptive statements, or submit or cause to be submitted any false,
misleading or deceptive information, or documentation to: I) The board or any representative
of the board.
Accordingly, the Board is authorized to impose one or more of the sanctions as cited in
Section 4723.28, ORC.
In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a
hearing in this matter. If you wish to request such hearing, the request must be made in
writing and must be received in the Board office within thirty (30) days of the time of mailing
of this notice. As required by Section 37I9.I2I(C), ORC, the suspension ordered herein shall
remain in effect until this hearing is held.
You are hereby further informed that, if you timely request a hearing, you are entitled to
appear at such hearing in person, by your attorney, or by such other representative as is
permitted to practice before the Board, or you may present your position, arguments, or
contentions in writing. At the hearing you may also present evidence and examine witnesses
appearing for and against you.
Should you choose to request a hearing, please mail or deliver the request, in addition to any
other correspondence regarding this matter, to: Lisa Ferguson-Ramos, Compliance Unit
Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus OH
43215-7410, or to the email address, hearing@nursing.ohio.gov.
If the Board fails to receive a request for a hearing within thirty (30) days of the time of
mailing of this notice, the Board may, in your absence and upon consideration of the factual
and legal allegations set forth in this Notice of Immediate Suspension and Opportunity for
Hearing, deny, permanently revoke, revoke, suspend or place restrictions on your license to
practice nursing as a registered nurse and certificate of authority to practice as a certified
registered nurse anesthetist; reprimand or otherwise discipline you; or impose a fine of not
more than five hundred dollars ($500.00) per violation.
Sincerely,
Larry Alan Lavender, R.N., C.R.N.A
Page 4
Judith A. Church, R.N., C.N.P.
Supervising Board Member
Certified Mail Receipt No. 7012 1010 0002 4257 4435
Attorney's Certified Mail Receipt No. 70121010000242574442
cc: Henry G. Appel, Assistant Attorney General
Jay Adams, Attorney at Law
Case #05-0302 & 12-005592
Ohio Board of Nursing www.nursing.ohio.gov
17 South HighStreet, Suite 400 " Columbus, Ohio 43215-7410 (614) 466-3947
November 16,2012
NOTICE OF IMMEDIATE SUSPENSION AND
OPPORTUNITY FOR HEARING
Beth Ann Lawson, R.N.
1603 Carolina Street
Middletown, Ohio 45042
Dear Ms. Lawson:
In accordance with Sections 2929.42 and/or 3719.12 of the Ohio Revised Code (ORC), the
Ohio Board of Nursing (Board) has been notified that:
1. On or about September 13,2000, in Warren County Court of Common Pleas Case
Number 00 CR 18763, you pled guilty to and were found guilty of four (4) counts of
Deception to Obtain Dangerous Drugs, felonies of the fifth degree, in violation of
Section 2925.22(A), ORC;
2. On or about October 10,2000, in Montgomery County Court of Common Pleas Case
Number 00-CR-1223, you pled guilty to and were found guilty of one (1) count of
Illegal Processing of Drug Documents, a felony of the fifth degree, in violation of
Section 2925.23(A), ORC;
3. On or about August 15,2000, in Butler County Court of Common Pleas Case Number
you pled guilty to and were found guilty of five (5) counts of
Deception to Obtain a Dangerous Drug, felonies of the fifth degree, in violation of
Section 2925.22(A), ORC; and one (1) count of Illegal Processing of Drug
Documents, a felony of the fifth degree, in violation of Section2925.23(C)(2), ORC;
4. On or about November 26, 2001, in Butler County Court of Common Pleas Case
Number CROl-09-1267, you pled guilty to and were found guilty of one (1) count of
Deception to Obtain a Dangerous Drug, a felony of the fifth degree, in violation of
Section 2925.22(A), ORC;
5. On or about November 7, 2003, in Butler County Court of Common Pleas Case
Number CR03-09-1417, you pled guilty to and were found guilty of four (4) counts of
Deception to Obtain a Dangerous Drug, felonies of the fifth degree, in violation of
Section 2925.22(A), ORC;
6. On or about April 29,2005, in Warren County Court of Common Pleas Case Number
05CR22042, you pled guilty to and were found guilty of four (4) counts of Deception
to Obtain a Dangerous Drug, felonies of the fifth degree, in violation of Section
2925.22(A), ORC; and
Beth Ann Lawson, R.N.
Page 2
7. On or about November 19,2008, in Warren County Court of Common Pleas Case
Number 08CR25300, you pled guilty to and were found guilty of one (I) count of
Deception to Obtain Dangerous Drugs, a felony of the fifth degree, in violation of
Section 2925.22(A), ORC.
Section 3719.121(C), ORC, states in pertinent part as follows:
On receiving notification pursuant to Section 2929.42 or 3719.12 of the
Revised Code, the board under which. a person has been issued a
license, certificate or evidence of registration immediately shall
suspend the license, certificate, or registration of that person on a plea
of guilty to, a finding by a jury or court of the person's guilt of, or
conviction of a felony drug abuse offense; a finding by a court of the
person's eligibility for intervention in lieu of conviction; a plea of guilty
to, or a finding by a jury or court of the person's guilt of, or the person's
conviction of an offense in another jurisdiction that is essentially the
same as a felony drug abuse offense; or a finding by a court of the
person's eligibility for treatment or intervention in lieu of conviction in
another jurisdiction.
Deception to Obtain Dangerous Drugs, felonies .of the fifth degree, in violation of Section
2925.22(A), ORC; Illegal Processing of Drug Documents, a felony of the fifth degree, in
violation of Section 2925.23(A), ORC; and Illegal Processing of Drug Documents, a felony of
the fifth degree, in violation of Section 2925.23(C)(2), ORC, constitute "felony drug abuse
offenses" as defined in Section 2925.01, ORC.
WHEREFORE, PURSUANT TO SECTION 3719.121(C), ORC, YOU ARE HEREBY
NOTIFIED THAT YOUR LICENSE TO PRACTICE NURSING AS A REGISTERED
NURSE, RN-205000, IS HEREBY SUSPENDED. Continued practice after receipt of this
notice of suspension shall be considered engaging in the practice of nursing without a current,
valid license, which is a violation of Section 4723.03(A), ORC.
You are further notified that in accordance with Chapter 119, ORC, the Board proposes under
authority of Section 4723.28, ORC, to deny, permanently revoke, revoke, suspend or place
restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise
discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation
for the following reasons:
1a. On or about September 13,2000, in Warren County Court of Common
Pleas Case Number 00 CR 18763, you pled guilty to and were found
guilty of four (4) counts of Deception to Obtain Dangerous Drugs,
felonies of the fifth degree, in violation of Section 2925.22(A), ORC.
The acts underlying this case occurred on or about January 2000
through April 10, 2000, and involve you using deception to
procure the administration of, a prescription for, or the
Beth Ann Lawson, R.N.
Page 3
dispensing of Vicodin and Hydrocodone, or possessing an
uncompleted preprinted prescription blank used for writing a
for a dangerous drug.
lb. On or about October 10, 2000, in Montgomery County Court of
Common Pleas Case Number OO-CR-1223, you pled guilty to and were
found guilty of one (1) count of lllegal Processing of Drug Documents,
a felony of the fifth degree, in violation of Section 2925.23(A), ORe.
The acts underlying this case occurred on or about February 1,
2000, and involve you making a false statement in any
prescription, order, report or record for Vicodin.
1c. On or about August 15,2000, in Butler County Court of Common Pleas
Case Number CROO-05-0683, you pled guilty to and were found guilty
of five (5) counts of Deception to Obtain a Dangerous Drug, felonies of
the fifth degree, in violation of Section 2925.22(A), ORC; and one (1)
count of lllegal Processing of Drug Documents, a felony of the fifth
degree, in violation of Section 2925.23(C)(2), ORe.
The acts underlying this case occurred in or about January 2000
and February 2000 and involve you using deception to procure
the administration of, a prescription for, or the dispensing of
Hydrocodone and/or Vicodin, or possessing an uncompleted
preprinted prescription blank used for writing a prescription for
a dangerous drug. Further acts underlying this case involve you
using theft to acquire an uncompleted preprinted prescription
blank used for writing prescriptions.
1d. On or about November 26, 2001, in Butler County Court of Common
Pleas Case Number CR01-09-1267, you pled guilty to and were found
guilty of one (1) count of Deception to Obtain a Dangerous Drug, a
felony of the fifth degree, in violation of Section 2925.22(A), ORC.
The acts underlying this case occurred on or about August 27,
2001, and involve you using deception to procure the
administration of, a prescription for, or the dispensing of
Vicadin (sic), or possessing an uncompleted preprinted
prescription blank used for writing a prescription for a
dangerous drug.
l e. On or about November 7, 2003, in Butler County Court of Common
Pleas Case Number CR03-09-1417, you pled guilty to and were found
guilty of four (4) counts of Deception to Obtain a Dangerous Drug,
felonies of the fifth degree, in violation of Section 2925.22(A), ORC.
Beth Ann Lawson, R.N.
Page 4
The acts underlying this case occurred in or about Augnst 2003
and September 2003, and involve you using deception to
procure the administration of, a prescription for, or the
dispensing of Vicodin, or possessing an uncompleted preprinted
prescription blank used for writing a prescription for a
dangerous drug.
If. On or about April 29, 2005, in Warren County Court of Common Pleas
Case Number 05CR22042, you pled guilty to and were found guilty of
four (4) counts of Deception to Obtain a Dangerous Drug, felonies of
the fifth degree, in violation of Section 2925.22(A) , ORC.
The acts underlying this case occurred in or about 2003 and/or
2005, and involve you using deception to procure the
administration of, a prescription for, or the dispensing of a
dangerous drug, or possessing an uncompleted preprinted
prescription blank used for writing a prescription for a
dangerous drug.
19. On or about November 19,2008, in Warren County Court of Common
Pleas Case Number 08CR25300, you pled guilty to and were found
guilty of one (1) count of Deception to Obtain Dangerous Drugs, a
felony of the fifth degree, in violation of Section 2925.22(A), ORC.
The acts underlying this case occurred on or about August 17,
2008, and involve you using deception to deception to procure
the administration of, a prescription for, or the dispensing of
Vicodin, or possessing an uncompleted preprinted prescription
blank used for writing a prescription for a dangerous drug.
Section 4723.28(B)(4), ORC, authorizes the Board to discipline a licensee for conviction of, a
plea of gnilty to, a judicial finding of guilt of, a judicial finding of guilt resulting from a plea
of no contest to, or a judicial finding of eligibility for intervention in lieu of conviction for,
any felony. Section 4723.28(B)(5), ORC, authorizes the Board to discipline a licensee for
conviction of, a plea of guilty to, a judicial finding of guilt of, a judicial finding of guilt
resulting from a plea of no contest to, or a judicial finding of eligibility for intervention in lieu
of conviction for, violating any municipal, state, county, or federal drug law.
2a. On or about November 4, 1997, in Butler County Court of Common
Pleas Case Number CR97-08-0857, you pled guilty to and were found
guilty of one (1) count of Attempted Deception to Obtain Dangerous
Drugs, a misdemeanor of the first degree, in violation of Section
2923.02 and 2925.22(A), ORC..
The acts underlying tbis case occurred on or about June 22,
1997, an involve you attempting to use deception to procure the
Beth Ann Lawson, R.N.
Page 5
administration of, a prescription for, or the dispensing of
Vicodin, or attempting to possess an uncompleted preprinted
prescription blank used for writing a prescription for a
dangerous drug.
2b. On or about July 22, 1998, in Warren County Court of Common Pleas
Case Number 97CR17633, you were convicted of two (2) counts of
Attempted Possession of Drugs, misdemeanors of the first degree, in
violation of Section 2923.02(A) and 2925.11(A), aRC.
Section 4723.28(B)(5), aRC, authorizes the Board to discipline a licensee for conviction of, a
plea of guilty to, a judicial finding of guilt of, a judicial finding of guilt resulting from a plea
of no contest to, or a judicial finding of eligibility for intervention in lieu of conviction for,
violating any municipal, state, county, or federal drug law.
Accordingly, the Board is authorized to impose one or more of the sanctions as cited in
Section 4723.28, aRC.
In accordance with Chapter 119, aRC, you are hereby informed that you are entitled to a
hearing in this matter. If you wish to request such hearing, the request must be made in
writing and must be received in the Board office within thirty (30) days of the time of mailing
of this notice. As required by Section 3719.l21(C), aRC, the suspension ordered herein shall
remain in effect until this hearing is held.
You are hereby further informed that, if you timely request a hearing, you are entitled to
appear at such hearing in person, by your attorney, or by such other representative as is
permitted to practice before the Board, or you may present your position, arguments, or
contentions in writing. At the hearing you may also present evidence and examine witnesses
appearing for and against you.
Should you choose to request a hearing, please mail or deliver the request, in addition to any
other correspondence regarding this matter, to: Lisa Ferguson-Ramos, Compliance Unit
Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus OH
43215.7410, or to the email address, hearing@nursing.ohio.gov.
If the Board fails to receive a request for a hearing within thirty (30) days of the time of
mailing of this notice, the Board may, in your absence and upon consideration of the factual.
and legal allegations set forth in this Notice of Immediate Suspension and Opportunity for
Hearing, deny, permanently revoke, revoke, suspend or place restrictions on your license to
practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine
of not more than five hundred dollars ($500.00) per violation.
Sincerely,
Beth Ann Lawson, R.N.
Page 6
Judith A. Church, R.N., CN.P.
Supervising Board Member
Certified Mail Receipt No. 7012 1010 0002 4257 4411
cc: Henry G. Appel, Assistant Attorney General
Case #12-004249
Ohio Board of Nursing www.nursing.ohio.gov
17 South High Street, Suite 400 Columbus, Ohio 43215-7410 (614) 466-3947
November 16,2012
NOTICE OF AUTOMATIC SUSPENSION AND
OPPORTUNITY FOR HEARING
Patricia Anne Martinez, R.N.
514 Commons Drive
Powell Ohio 43065
Dear Ms. Martinez:
You are hereby notified that, on or about July 18,2008, you entered into a Consent Agreement
(July 2008 Consent Agreement) with the Ohio Board of Nursing (Board), a copy of which is
attached hereto and incorporated herein, in which you agreed with the Board that upon meeting
the requirements for renewal, your license to practice nursing as a registered nurse in the State of
Ohio would be reinstated and suspended indefinitely and that such suspension would be stayed
subject to probationary terms, conditions, and limitations for a minimum until at least July2011.
Attached to and incorporated within the July 2008 Consent Agreement is a September 28, 2007
Consent Agreement (September 2007 Consent Agreement). Also attached is a March 23, 2010
Release from Temporary Narcotic Restrction Letter issued by the Board.
A. Item 5. of the July 2008 Consent Agreement states, "MS. MARTINEZ
shall continue to submit, at her expense and on the day selected, blood
or urine specimens for drug and/or alcohol analysis at a collection site
specified by the Board at such times as the Board may request. Refusal
to submit such specimen, or failure to submit such specimeu on the day
she is selected, or in such a manner as the Board may request, shall
constitute a violation of a restriction placed on a license for purposes of
Section 4723.28(B), ORC. This screening shall require a daily call-in
process. The specimens submitted by MS. MARTINEZ shall be
negative, except for substances prescribed, administered, or dispensed
to her by another so authorized by law who has full knowledge of MS.
MARTINEZ's history of chemical dependency and recovery status."
Despite this provision, on the following dates, you failed to call Firstlab, the
Board's random drug/alcohol screen program administrator, to determine if you
had been selected to provide a urine 'specimen: December 12,2007, December 19,
2007, December 25, 2007, February 8,2008, March 8,2008 through March 16,
2008, July 3,2008, July 6,2008, July 31,2008, August 16,2008, August 29,
2008, August 31, 2008,September 11,2008, September 22, 2008, October 24,
2008, November 4, 2008, December 29, 2008, May 3, 2009, July 25,2009, July
31,2009, October 11,2009, November 15,2009, November 19,2009, February
28,2010, April 25, 2010, May 9,2010, May 16,2010, June 25,2010, June 28,
2010, July 4, 2010, July 17,2010, July 18,2010, August 8, 2010, October 3,
Patricia Anne Martinez, R.N.
Page 2
2010, October 29, 2010, October 30, 2010, November 19,2010, November 27,
2010, December 26, 2010, February 19,2011, February 22, 2011, March 13,
2011, March 20, 2011, June 11, 2011, June 12, 2011, November 13, 2011,
November 18,2011, December23, 2011, March 11,2012, March 17,2012, April
6,2010, May 27 2012, July 1,2012, July 3,2012, July 7, 2012, July 20, 2012
through July 31,2012.
Furthermore, on the following dates, you were selected to provide a urine
specimen for analysis and failed to do so: April 25,2012 and July 31,2012.
Section 4723.28(B)(l7), ORC, authorizes the Board to discipline a licensee for violation of any
restrictions placed on a nursing license by the Board.
In accordance with the paragraph under "FAILURE TO COMPLY" of the July 2008 Consent
Agreement, you are hereby notified that it appears to the Board that you have violated Item 5. of
the July 2008 Consent Agreement.
YOU ARE FURTHER NOTIFIED THAT YOUR LICENSE TO PRACTICE NURSING
AS A REGISTERED NURSE, RN310787, IS HEREBY AUTOMATICALLY
SUSPENDED. Continued practice after receipt of this notice of suspension shall be considered
engaging in the practice of nursing as a registered nurse without a current, valid license, which is
a violation of Section 4723.03(A), ORC.
You are further notified that in accordance with Chapter 119, ORC, the Board proposes under
authority of Section 4723.28, ORC, to deny, permanently revoke, revoke, suspend or place
restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise
discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for
the following reasons:
1. On or about July 18,2008, you entered into a Consent Agreement (July 2008
Consent Agreement) with the Ohio Board of Nursing (Board), a copy of which
is attached hereto and incorporated herein, in which you agreed with the
Board that upon meeting the requirements for renewal, your license to practice
nursing as a registered nurse in the State of Ohio would be reinstated and
suspended indefinitely and that such suspension would be stayed subject to
probationary terms, conditions, and limitations for a minimum until at least
July 2011. Attached to and incorporated within the July 2008 Consent
Agreement is a September 28, 2007 Consent Agreement (September 2007
Consent Agreement). Also attached is a March 23, 2010 Release from
Temporary Narcotic Restrction Letter issued by the Board.
2. Item 5. of the July 2008 Consent Agreement states, "MS. MARTINEZ shall
continue to submit, at her expense and on the day selected, blood or urine
specimens fordrug and/or alcohol analysis at a collection site specified by the
Board at such times as the Board may request. Refusal to submit such
specimen, or failure to submit such specimen on the day she is selected, or in
Patricia Anne Martinez, R.N.
Page 3
such a manner as the Board may request, shall constitute a violation of a
restriction placed on a license for purposes of Section 4723.28(B), ORC. This
screening shall require a daily call-in process. The specimens submitted by
MS. MARTINEZ shall be negative, except for substances prescribed,
administered, or dispensed to her by another so authorized by law who has full
knowledge of MS. MARTINEZ's history of chemical dependency and
recovery status."
Despite this provision, on the following dates, you failed to call Firstlab, the
Board's random drug/alcohol screen program administrator, to determine if you
had been selected to provide a urine specimen: December 12,2007, December 19,
2007, December 25, 2007, February 8,2008, March 8,2008 through March 16,
2008, July 3,2008, July 6, 2008, July 31,2008, August 16,2008, August 29,
2008, August 31, 2008, September 11,2008, September 22, 2008, October 24,
2008, November 4, 2008, December'Z9, 2008, May 3,2009, July 25,2009, July
31,2009, October 11,2009, November 15,2009, November 19,2009, February
28,2010, April 25,2010, May 9,2010, May 16,2010, June 25,2010, June 28,
2010, July 4, 2010, July 17,2010, July 18,2010, August 8, 2010, October 3,
2010, October 29, 2010, October 30, 2010, November 19,2010, November 27,
2010, December 26, 2010, February 19, 2011, February 22,2011, March 13,
2011, March 20, 2011, June 11, 2011, June 12, 2011, November 13, 2011,
November 18,2011, December 23, 2011, March 11,2012, March 17,2012, April
6,2010, May 27 2012, July 1,2012, July 3, 2012, July 7,2012, July 20, 2012
through July 31,2012.
Furthermore, on the following dates, you were selected to provide a urine
specimen for analysis and failed to do so: April 25,2012 and July 31,2012.
Section 4723.28(B)(17), ORC, authorizes the Board to discipline a licensee for violation of any
restrictions placed on a nursing license by the Board.
Accordingly, the Board is authorized to impose one or more of the sanctions as cited in Section
4723.28,ORC.
In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing
in this matter. If you wish to request such hearing, the request must be made in writing and must
be received in the Board office within thirty (30) days of the time of mailing of this notice.
You are hereby further informed that, if you timely request a hearing, you are entitled to appear
at such hearing in person, by your attorney, or by such other representative as is permitted to
practice before the Board, or you may present your position, arguments, or contentions in
writing. At the hearing you may also present evidence and examine witnesses appearing for and
against you.
Should you choose to request a hearing, please mail or deliver the request, in addition to any
other correspondence regarding this matter, to: Lisa Ferguson-Ramos, Compliance Unit
Patricia Anne Martinez, R.N.
Page 4
Manager, Ohio Board of Nnrsing, 17 South High Street, Suite 400, Columbus, Ohio 43215-
7410, or to the e-mail address, hearing@nursing.ohio.gov.
If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing
of this notice, the Board may, in your absence and upon consideration of the factual and legal
allegations set forth in this Notice of Automatic Suspension and Opportunity for Hearing, deny,
permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a
registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five
hundred dollars ($500.00) per violation.
Sincerely,
Judith A. Church, R.N., C.N.P.
Supervising Board Member
Certified Mail Receipt No. 7012 1010 0002 42574589
cc: Henry G. Appel, Assistant Attorney General
Ohio Board of Nursing www.nursing.ohio.gov
17 South High Street, Suite 400 Columbus, Ohio 43215-74 JO (614) 466-3947
March 23, 2010
Patricia A. Martinez, R.N.
514 Connnons Dr.
Powell, OH 43065
Ref: Consent Agreement of September 28, 2007
License # R.N. 310787
Dear Ms. Martinez:
-The Board, considered and approved YOUF request to be released from the narcotic .
restriction that was imposed by your Consent Agreement of September 28, 2007.. The
restriction was lifted effective March 19,2010.
Sincerely,
Betsy J. Houchen, R.N., M.S., J.D.
Executive Director
LFRJdjf
Case #07-0271, #07-0421 & #08-0636
Ohio Board of Nursing www.nursing.ohio.gov
17 South High Street, Suite400 Columbus, Ohio 43215-7410 (614) 466-3947
CONSENT AGREEMENT
BETWEEN
PATRICIA ANNE MARTINEZ, R.N.
AND
OHIO BOARD OFNURSING
This Consent Agreement is entered into by and between PATRICIA ANNE
MARTINEZ, R.N. (MS. MARTINEZ) and the Ohio Board of Nursing (Board), the
state agency charged with enforcing Chapter 4723. of the Ohio Revised Code (ORC), and
all administrative rules promulgated thereunder.
MS. MARTINEZ voluntarily enters into this Consent Agreement being fully informed
of her rights under Chapter 119, ORC, including the right to representation by legal
counsel and the right to a formal adjudicative hearing on the issues considered herein.
This Consent Agreement contains the entire agreement between the parties, there being
no other agreement of any kind, verbal or otherwise, which varies the terms of this
Consent Agreement.
BASIS FORACTION
This Consent Agreement is entered into on the basis of the following stipulations,
admissions and understandings:
A. The Board is empowered by Section 4723.28, ORC, to deny,
permanently revoke, revoke, suspend, or place restrictions on any
license issued by the Board; reprimand or otherwise discipline a
licensee; or impose a fine of five hundred dollars ($500,00) or less
per violation, Section 4723.28(B)(4), ORC, authorizes the Board
to discipline a licensee for conviction of, a plea of guilty to, a
judicial finding of guilt of, a judicial finding of guilt resulting from
a plea of no contest to, or a judicial finding of eligibility for
intervention in lieu of conviction for, any felony or of any crime
involving gross immorality or moral turpitude, Section
4723.28(B)(5), ORC, authorizes the Board to discipline a licensee
for conviction of, a plea of guilty to, a judicial finding of guilt of, a
judicial finding of guilt resulting from a plea of no contest to, or a
judicial finding of eligibility for intervention in lieu of conviction
for, violating any municipal, state, county, or federal drug law.
Section 4723.28(B)(8), ORC, authorizes the Board to discipline a
licensee for self-administering or otherwise taking into the body
Patricia Anne Martinez, R.N.
Page 2
any dangerous drug, as defined in Section 4729.01, ORC, in any
way not in accordance with a legal, valid prescription issued for
that individual. Section 4723.28(B)(9), ORC, authorizes the Board
to discipline a licensee for habitual indulgence in the use of
controlled substances, other habit-forming drugs, or alcohol or
other chemical substances to an extent that impairs ability to
practice. Section 4723.28(B)(I3), ORC, authorizes the Board to
discipline a licensee for obtaining or attempting to obtain money or
anything of value by intentional misrepresentation or material
deception in the course of practice. Section 4723.28(B)(l9), ORC,
authorizes the Board to discipline a licensee for failure to practice
in accordance with acceptable and prevailing standards of safe
nursing care.
B. MS. MARTINEZ was initially issued a license to practice nursing
in Ohio as a registered nurse, RN-310787 iu March 2004. Further,
on January 25, 2007, MS. MARTINEZ placed her nursing license
on inactive status with the Board.
C. MS. MARTINEZ's license was indefinitely suspended by a
September 28, 2007 Consent Agreement (September 2007 Consent
Agreement) between MS. MARTINEZ and the Board, a copy of
which is attached hereto and incorporated herein.
D. On March 27, 2008, in Franklin County Common Pleas Court Case
No. 07CR-07-5180, MS. MARTINEZ was convicted of
misdemeanor Theft of Drugs, in violation of Section 2913.02,
aRc. Further, the underlying basis for MS. MARTINEZ's
conviction was addressed in the September 2007 Consent
Agreement.
E. Under the terms of the September 2007 Consent Agreement, MS.
MARTINEZ was eligible to request reinstatement of her license
anytime after January I, 2008, if all of the terms, conditions and
limitations of the Consent Agreement were met.
F. MS, MARTINEZ submitted a written reqnest to the Board to
reinstate her license and provided the Board with the following:
1) Evidence of a chemical dependency evaluation performed on
February 21, 2008 by Heidi Johnson, MS.Ed. at Focus
HealthCare.
Patricia Anne Martinez, R.N.
Page 3
MS. MARTINEZ was diagnosed with Opioid Dependence
in remission and Alcohol Dependence in remission. No
further treatment recommendations were made.
2) Evidence of psychiatric evaluation on February 22, 2008 by
Michael Schottenstein, M.D.
Dr. Schottenstein reported that he began treating MS.
MARTINEZ in 2006 and that at the time, MS. MARTINEZ
was diagnosed with clinically significant symptoms
consistent with Bipolar Disorder, Post Traumatic Stress
Disorder (PTSD), a history of alcohol dependence in late/full
remission, and a history of polysubstance abuse in late/full
remission.
Dr. Schottenstein further reported that in January 2007, after
MS. MARTINEZ was caught diverting drugs from her place
of employment, she was referred to a diversion program and
was subsequently admitted into the psychiatric unit at
Riverside Methodist Hospital. Dr. Schottenstein also
reported that MS. MARTINEZ participated in chemical
dependency treatment at Focus Healthcare and that she
regularly attends Alcoholic Anonymous (AA) meetings.
Dr. Schottenstein further reported that MS. MARTINEZ is
compliant with treatment that includes: (I) regular
psychiatric office visits; (2) regular counseling session with
Jennifer Schantz, PhD; and (3) taking prescribed
psychotropic medications. Further, MS. MARTINEZ is
prescribed Paxil, Lamietal and Lithium.
Further, Dr. Schottenstein recommended that MS.
MARTINEZ continue with regular psychiatric office visits,
and with regular counseling sessions with Dr. Schantz.
Further, MS. MARTINEZ should continue to attend regular
AA meetings, undergo random toxicology screens, and have
a narcotic restriction on her license.
3) Evidence of fifteen (15) negative screens for drugs and
alcohol from November 2007 until June 2008.
4) Evidence of regular attendance at Twelve Step 'meetings.
5) Evidence of a criminal records check by the Bureau of
Criminal Identification & Investigation (BCIl).
Patricia Anne Martinez, R.N.
Page 4
G. On February 29, 2008, a representative of the Board interviewed
MS, MARTINEZ by telephone and reviewed MS. MARTINEZ's
reinstatement documentation.
H. MS. MARTINEZ reported to Board staff that she is no longer
represented by counsel.
AGREED CONDITIONS
Wherefore, in consideration of the foregoing and mutual promises hereinafter set forth,
and in lieu of any formal proceedings at this time, MS. MARTINEZ knowingly and
voluntarily agrees with the Board to the following terms, conditions, and limitations:
Upon meeting the requirements for renewal, MS, MARTINEZ's license to practice
nursing as a registered nurse shall be reinstated and suspended indefinitely. Such
suspension shall be stayed, subject to the following PROBATIONARY terms, conditions,
and limitations until at least July 2011:
1. MS. MARTINEZ shall obey all federal, state, and local laws, and all
laws and rules governing the practice of nursing in Ohio.
2. MS. MARTINEZ shall appear in person for interviews before the full
Board or its designated representative as requested by the Board or its
designee.
Monitoring of Rehabilitation and Treatment
3. MS. MARTINEZ shall abstain completely from the personal use or
possession of drugs, except those prescribed, administered, or
dispensed to her by another so authorized by law who has full
knowledge of MS. MARTINEZ's history of chemical dependency and
recovery status. MS. MARTINEZ shall self-administer prescribed
drngs only in the manner prescribed.
4. MS. MARTINEZ shall abstain completely from the use of alcohol.
5. MS. MARTINEZ shall continue to submit, at her expense and on the
day selected, blood or urine specimens for drug and/or alcohol analysis
at II collection site specified by the Board at such times as the Board
may request. Refusal to submit such specimen, or failure to submit
such specimen on the day she is selected, or in such a manner as the
Board may request, shall constitute a violation of a restriction placed on
a license for purposes of Section 4723.28(B), ORC. This screening
shall require a daily call-in process. The specimens submitted by MS.
MARTINEZ shall be negative, except for substances prescribed,
Patricia Anne Martinez, R.N.
Page 5
administered, or dispensed to her by another so authorized by law who
. has full knowledge of MS. MARTINEZ's history of chemical
dependency and recovery status.
6. MS. MARTINEZ shall attend a minimumof one (1) meeting per week
of a support or peer group meeting approved in advance by the Board,
or a Twelve Step program, and MS. MARTINEZ shall provide
satisfactory documentation of such attendance to the Board every six
(6) months beginning January 1,2009.
Psychiatric Treatment and Monitoriug
7. MS. MARTINEZ shall continue to participate in psychiatric treatment
and in individual treatment/counseling (counseling) at intervals deemed
appropriate by Dr. Schottenstein or another psychiatrist approved in
advance by the Board or its designee until released. MS. MARTINEZ
shall have Dr. Schottenstein and Dr. Schantz submit written reports to
the Board regarding MS. MARTINEZ's progress, status, and
compliance with her treatment plan on a quarterly basis, beginning
on September 1, 2008. MS. MARTINEZ shall provide Dr.
Schottenstein and Dr. Schantz or another treating mental health
professional(s) with a copy of this Consent Agreement and the attached
September 2007 Consent Agreement prior to August 18, 2008. MS.
MARTINEZ shall have her mental health treating professional(s) send
documentation to the Board, of receipt of a copy of this Consent
Agreement and the attached September 2007 Consent Agreement along
with their first treatment report.
Treating Practitioners and Reporting
8. Within sixty (60) days of the execution of this Consent Agreement,
MS. MARTINEZ shall provide a copy of this Consent Agreement, and
the attached September 2007 Consent Agreement to all treating
practitioners and shall provide to the Board a list of all treating
practitioners, including addresses and telephone numbers. Further. MS.
MARTINEZ shall be under a continuing dnty to provide a copy of this
Consent Agreement, and the attachment, prior to initiating treatment, to
additional treating practitioners, and to npdate the list of treating
practitioners with the Board within forty-eight (48) hours of being
treated by another practitioner.
9. MS. MARTINEZ shall cause all treating practitioners to complete a
medication prescription report that is to be mailed by the practitioner
directly to the Board. The medication report is to be completed for any
Patricia Anne Martinez, R.N.
Page 6
and all substances prescribed, administered, or dispensed to MS.
MARTINEZ throughout the duration of this Consent Agreement.
10. Within twenty-four (24) hours of release from hospitalization or
medical treatment, MS. MARTINEZ shall notify the Board of any and
allmedication(s) or prescriptiorus) received.
Employment Conditions
II. Prior to accepting employment as a nurse, each time with every
employer, MS. MARTINEZ shall notify the Board.
[2. MS. MARTINEZ shall have her employerrs), if working in a position
where a nursing license is required, snbmit written reports regarding
job performance on a quarterly basis beginning September 1, 2008.
MS. MARTINEZ shall provide her employer(s) with a copy of this
Consent Agreement, and the attached September 2007 Consent
Agreement. Further, MS. MARTINEZ shall have her employer(s)
send documentation to the Board, along with the first employer report,
of receipt of a copy of this Consent Agreement and all of the
attachment. Further, MS. MARTINEZ is under a continuing duty to
provide a copy of this Consent Agreement and the attachment to any
new employer prior to accepting employment.
Reporting Requirements of Licensee
[3. MS. MARTINEZ shall report to the Board, in writing, any violation of
this Consent Agreement within thirty (30) days of the occurrence of the
violation.
14. MS. MARTINEZ shall sign release of information forms allowing
health professionals and other organizations to submit the requested
documentation directly to the Board.
15. MS. MARTINEZ shall submit any and all information that the Board
may request regarding her ability to practice according to acceptable
and prevailing standards of safe nursing practice.
16. MS. MARTINEZ shall not submit or cause to be submitted any false.
misleading, or deceptive statements, information, or documentation to
the Board or to employers or potential employers.
17. MS. MARTINEZ shall submit the reports and documentation required
by this Consent Agreement on forms specified by the Board. All
Patricia Anne Martinez, R.N.
Page 7
reporting and communications required by this Consent Agreement
shall be made to the Compliance Unit of the Board.
18. MS. MARTINEZ shall submit the reports and documentation required
by this Consent Agreement or any other doeuments required by the
Board to the attention of the Compliance Unit, Ohio Board of Nursing,
17South High Street, Suite 400, Columbus, OH43215-7410.
19. MS. MARTINEZ shall verify that the reports and documentation
required by this Consent Agreement are received in the Board office.
20. MS. MARTINEZ shall inform the Board withinfive (5) business days,
in writing, of any change in employment status or of any change in
residential or homeaddress or telephone number.
Temporary Narcotic Restriction
MS. MARTINEZ shall not administer, have access to, or possess (except as prescribed
for MS. MARTINEZ's use by another so authorized by law who has full knowledge of
MS. MARTINEZ's history of chemical dependency) any narcotics, other controlled
substances, 01' mood altering drugs for a minimum of period of one (1) year in which
MS. MARTINEZ is working in a position that requires a nursing license. At any time
after the one (1) year period previously described, MS. MARTINEZ may submit a
written request to the Board to have this restriction re-evaluated. In addition, MS.
MARTINEZ shall not count nareotics or possess or carry any work keys for locked
medication carts, cabinets, drawers, 01' containers. MS. MARTINEZ shall not call in or
order prescriptions or prescription refills,
Temporary Practice Restrictions
MS. MARTINEZ shall not, unless otherwise approved in advance by the Board or
its designee, practice nursing as a registered nurse (I) for agencies providing home care
in the patient's residence; (2) for hospice care programs providing hospice care in the
patient's residence; (3) for staffing agencies or pools; (4) as an independent provider
where the nurse provides nursing care and is reimbursed for services by the State of Ohio
through State agencies or agents .of the State; or (5) for an individual 01' group of
individuals who directly engage MS. MARTINEZ to provide nursing services for fees,
compensation, or other consideration or as a volunteer.
MS. MARTINEZ shall not, unless otherwise approved in advance by the Board 01'
its designee, function in a position or employment where the job dnties or requirements
involve management of nursing and nursing responsibilities, or supervising and
evaluating nursing practice. Such positions include but are not limited to the following:
Patricia Anne Martinez, R.N.
Page 8
Director of Nursing, Assistant Director of Nursing, Nurse Manager, Vice President of
Nursing.
FAILURE TO COMPLY
MS. MARTINEZ agrees that her license to practice nursing as a registered nurse will be
automatically suspended if it appears to the Board that MS. MARTINEZ has violated or
breached any terms or conditions of the Consent Agreement. Following the automatic
suspension, the Board shall notify MS. MARTINEZ via certified mail of the specific
nature of the charges and automatic suspension of her license. Upon receipt of this
notice, MS. MARTINEZ may request a hearing regarding the charges.
The above described terms and conditions shall constitute "restrictions placed on a
license" for purposes of Section 4723.28(B), ORe. If, in the discretion of the Board,
MS. MARTINEZ appears to have violated or breached any terms or conditions of this
Consent Agreement, the Board reserves the right to institute formal disciplinary
proceedings for any and all possible violations or breaches, including, but not limited to,
alleged violations of the laws of Ohio occurring before the effective date of this Consent
Agreement.
DURATIQN[ MODIFICATION OF TERMS
The terms, limitations, and conditions, of this Consent Agreement may be modified or
terminated, in writing, at any time upon the agreement of both MS. MARTINEZ and the
Board.
The Board may only alter the probationary period imposed by this Consent Agreement if:
(1) the Board determines that MS. MARTINEZ has complied with all aspects of this
Consent Agreement; and (2) the Board determines that MS. MARTINEZ is able to
practice according to acceptable and prevailing standards of safe nursing care without
Board monitoring, based upon an interview with MS. MARTINEZ and review of the
reports as required herein. Any period during which MS. MARTINEZ does not work in
a position for which a nursing license is reqnired shall not connt toward fulfilling the
probationary period imposed by this Consent Agreement.
ACKNOWLEDGMENTSfLIABILITY RELEASE
MS. MARTINEZ acknowledges that she has had an opportunity to ask questions
concerning the terms of this Consent Agreement and that all questions asked have been
answered in a satisfactory manner.
MS. MARTINEZ waives all of her rights under Chapter 119, ORC, as they relate to
matters that are the subject of this Consent Agreement.
soo (OgS ON XHlXll 301 SOOUBOILO
07/0312008 lS:11 FAX 814 SS5 a8as OHIO aOARO OF NURSINS @J010/019
Patricia Ann" Murtine", R.N.
Page 9
MS. MARTINEZ waive. any and all claims or causes of action she may have against the
Board, and its members, officers, employees and/or agents arlslng Out of matters, which
lire the subject of this Consent Agreement,
This Consent Agreement shall be considered a public record a. that term is used in
Section 149.43. ORC. The information contained herein may be reported to appropriate
organizations, data bank. and governmental bodies.
This Consent Agreement is not I1n Ildjudicalioll order as discussed in Chapter 119. ORC.
Any acdoe [nitiated by l:loard based on alleged violations of this Consent Agreement
shall comply with the Administrative "PrOcedures Act, Cbapter 119, ORC.
MS, MARTINEZ understands tbat tbis Consent Agreement is subject to ratlfication by
the Board prior to sIgnature by the BOlU'd Pr"sident and Shall become effectIve upon the
last date of s; gnature below.
DATE LISA KLJ3;N:KE, President
Oblo Board otNnrslng

PATRIeI EMARTI Z,R.N.
ft/8A. R.J
ST2S-T91.-vT9
80 80 Tnp
Case # 07-0271 & 07-0421
Ohio Board of Nursing IVww.nursing.ohio.gov
17 South HighStreet. Suite 400 Columbus, Ohio 432157410 (614)466-3947
CONSENT AGREEMENT
BETWEEN
PATRICIA ANNE MARTINEZ, R.N.
AND
OHIO BOARD OF NURSING
This Consent Agreement is entered into by and between PATRICIA ANNE MARTINEZ, R.N.
(MS. MARTINEZ) and the Ohio Board of Nursing (Board), the state agency charged with
enforcing Chapter 4723. of the Ohio Revised Code (ORC), and all administrative rules
promulgated thereunder.
MS. MARTINEZ voluntarily enters into this Consent Agreement being fully informed of her
rights under Chapter 119. ORC, including the right to representation by legal counsel and the
right to a formal adjudicative hearing on the issues considered herein.
This Consent Agreement contains the entire agreement between the parties, there being no other
agreement of any kind, verbal or otherwise, which varies the terms of this Consent Agreement.
BASIS FOR ACTION
This Consent Agreement is entered into on the basis of the following stipulations.. admissions
and understandings:
A. The Board is empowered by Section 4723.28, ORC, to deny, permanently
revoke, revoke, suspend. or place restrictions on any license issued by the
Board; reprimand or otherwise discipline a licensee; or impose a fine of five
hundred dollars ($500.00) or less per violation. Section 4723.28(B)(8),
ORC, authorizes the Board to discipline a licensee for self-administering or
otherwise taking into the body any dangerous drug, as defined in Section
4729.01, ORC, in any way not in accordance with a legal, valid prescription
issued for that individual. Section 4723.28(B)(9), ORC, authorizes the
Board to discipline a licensee for habitual indulgence in the use of
controlled substances, other habit-forming drugs, or alcohol or other
chemical substances to an extent that impairs ability to practice. Section
4723.28(B)(I3), ORC, authorizes the Board to discipline a licensee for
obtaining or attempting to obtain money or anything of value by intentional
misrepresentation or material deception in the course of practice. Section
4723.28(B)(19), ORC, authorizes the Board to discipline a licensee for
failure to practice in accordance with acceptable and prevailing standards of
safe nursing care.
Patricia Annc Martinez, R.N.
Page 2
B. MS. MARTINEZ's license to practice nursing as a registered nurse, RN-
310787, in the State of Ohio, is inactive. MS. MARTINEZ has been
licensed to practice nursing in Ohio since March 2004.
C. MS. MARTINEZ knowingly and voluntarilyadmits to the following:
On or about January 25, 2007, while working as a registered nurse in the
Emergency Department of Riverside Methodist Hospital in Columbus,
Ohio, MS. MARTINEZ was questioned by her supervisors and hospital
security regarding narcotics discrepancies. Specifically, MS. MARTINEZ
was obtaining significantly more narcotics from the PYXIS than coworkers,
was obtaining narcotics from the PYXIS under patients' names without
physicians' orders, and was not documenting administration of the
medication to patients. MS. MARTINEZ admitted that since October
2006, she had been diverting narcotics, mainly Percocet, from work, for her
self-administration.
MS. MARTINEZ stopped working as a nurse and placed her nursing
license on inactive status on January 25, 2007. MS. MARTINEZ
subsequently sought treatment for her chemical dependency. She indicated
to a Board Investigator that she was a recovering alcoholic, had been sober
for over 10 years prior to this incident. MS. MARTINEZ reported that she
had been in recovery since June 16, 1996, with this being her first and only
relapse.
MS. MARTINEZ voluntarily reported herself to the Board on January 25,
2007, and was cooperative with the Board's investigation of her.
AGREED CONDITIONS
Wherefore, in consideration of the foregoing and mutual promises hereinafter set forth, and in
lieu of any formal proceedings at this time, MS. MARTINEZ knowingly and voluntarily agrees
with the Board to the following terms, conditions, and limitations:
SUSPENSION OF LICENSE
l. MS. MARTINEZ's license to practice nnrsing as a registered nurse is hereby
suspended for an indefinite period of time, but not less than one (1) year, retroactive to
the date MS. MARTINEZ made her nursing license inactive. MS. MARTINEZ may
submit a written request for reinstatement anytime after January 1, 2008.
CONDITIONS FOR REINSTATEMENT
2. MS. MARTINEZ shall obey all federal, state, and local laws, and all laws and rules
governing the practice of nursing in Ohio.
Patricia Anne Martinez, R.N.
Page 3
3. MS. MARTINEZ shall appear in person for interviews before the full Board or its
designated representative as requested by the Board or its designee.
4. Prior to reinstatement, MS. MARTINEZ shall enter into a Consent Agreement with
the Board for probationary terms, conditions, and limitations determined by the Board
for a minimum period of three (3) years following reinstatement.
Monitoring of Rehabilitation and Treatment
5. MS. MARTINEZ shall abstain completely from the personal use or possession of
drugs, except those prescribed, administered, or dispensed to her by another so
authorized by law who has full knowledge of MS. MARTINEZ's history of chemical
dependency and recovery status. MS. MARTINEZ shall self-administer the
prescribed drugs only in the manner prescribed.
6. MS. MARTINEZ shall abstain completely from the use of alcohol.
7. Within three (3) months prior to seeking reinstatement by the Board, MS.
MARTINEZ shall, at her own expense, seek a chemical dependency evaluation by a
Board approved chemical dependency professional and shall provide the Board with
complete documentation of this evaluation. Prior to the evaluation, MS. MARTINEZ
shall provide the chemical dependency professional with a copy of this Consent
Agreement. Further, MS. MARTINEZ shall execute releases to permit the chemieal
dependency professional to obtain any information deemed appropriate and necessary
for the evaluation. The chemical dependency professional shall submit a written
opinion to the Board that includes diagnoses, recommendations for treatment and
monitoring, any additional restrictions to be placed on MS. MARTINEZ's license to
practice, and stating whether MS. MARTINEZ is capable of practicing nursing
according to acceptable and prevailing standards of safe nursing care.
8. MS. MARTINEZ shall provide the Board with satisfactory documentation of
compliance with all aspects of the treatment plan developed by the chemical
dependency professional described above until released. Further, MS. MARTINEZ
agrees that the Board may utilize the professional's recommendations and conclusions
from the evaluation as a basis for additional terms, conditions, and limitations on MS.
MARTINEZ's license and that the terms, conditions, and limitations shall be
incorporated in an addendum to this Consent Agreement.
9. For a minimum, continuous period of four (4) months immediately prior to
requesting reinstatement, MS. MARTINEZ shall submit, at her expense and on the
day selected, blood or urine specimens for drugand/or alcohol analysis at a collection
site specified by the Board at such times as the Board may request. Upon and after
MS. MARTINEZ's initiation of drug screening, refusal to submit such specimen, or
failure to submit such specimen on the day she is selected, or in such a manner as the
Board may request, shall constitute a violation of a restriction placed ou a license for
purposes of Section 4723.28(B), ORe. This screening shall require a daily call-in
Patricia Anne Martinez, R.N.
Page 4
process. The specimens submitted by MS. MARTINEZ shall be negative, except for
substances prescribed, administered, or dispensed to her by another so authorized by
law who has full knowledge of MS. MARTINEZ's history of chemical dependency
and recovery status.
a. Within thirty (30) days prior to MS. MARTINEZ initiating drug screening,
MS. MARTINEZ shall provide a copy of this Consent Agreement to all
treating practitioners and shall provide to the Board a list of all treating
practitioners, including addresses and telephone numbers and cause all
treating practitioners to complete a medication prescription report that is to be
mailed by tbe practitioner directly to the Board. The medication report is to be
completed for any and all substances prescribed, administered, or dispensed to
MS. MARTINEZ.
b. After initiating drug screening, MS. MARTINEZ shall be under a continuing
duty to provide a copy of this Consent Agreement, prior to initiating
treatment, to additional treating practitioners, and to update the list of treating
practitioners with the Board within forty-eight (48) hours of being treated by
another practitioner. Further, MS. MARTINEZ shall notify the Board of any
and all medication(s) or prescription(s) received within twenty-four (24) hours
of release from hospitalization or medical treatment.
10. For a minimum, continuous period of four (4) months immediately prior to
requesting reinstatement, MS. MARTINEZ shall attend a minimum of one (1)
meeting per week of a support or peer group meeting approved in advance by the
Board, or a Twelve Step program, and licensee shall provide satisfactory
documentation of such attendance to the Board prior to reinstatement.
Psychiatric Evaluation and Treatment
11. Within three (3) months prior to seeking reinstatement by the Board, MS.
MARTINEZ shall, at her own expense, seek a psychiatric evaluation from a Board
approved psychiatrist and shall provide the Board with complete documentation of
such evaluation. Prior to the evaluation, MS. MARTINEZ shall provide the
psychiatrist with a copy of this Consent Agreement and shall execute releases to
permit the psychiatrist to obtain any information deemed appropriate and necessary for
the evaluation. The psychiatrist shall submit a written opinion to the Board that
includes diagnoses, recommendations for treatment and monitoring, any additional
restrictions that should be placed on MS. MARTINEZ's license, and a statement as to
whether MS. MARTINEZ is capable of practicing nursing according to acceptable
and prevailing standards of safe nursing care.
12. MS. MARTINEZ shall provide the Board with satisfactory documentation of
compliance with all aspects of the treatment plan developed by the professional until
released. Further, MS. MARTINEZ agrees that the Board may use the professional
recommendations and conclusions from the evaluation as a basis for additional terms,
Patricia Anne Martinez, KN.
Page 5
conditions, limitations. on MS. MARTINEZ's license and that the terms, conditions,
and limitations shall be incorporated in an addendum to this Consent Agreement.
Reporting Requirements of Licensee
13. MS. MARTINEZ shall report to the Board, in writing, any violation of this Consent
Agreement within thirty (30) days of the occurrence of the violation.
14. MS. MARTINEZ shall sign release of information forms allowing health
professionals and other organizations to snbmit requested documentation or
information directly to the Board.
15. MS. MARTINEZ shall submit any and all information that the Board may request
regarding her ability to practice according to acceptable and prevailing standards of
safe nursing practice.
16. MS. MARTINEZ shall not submit or cause to be submitted any false, misleading, or
deceptive statements, information, or documentation to the Board or to employers or
potential employers.
17. MS. MARTINEZ shall submit the reports and documentation required by this
Consent Agreement on forms specified by the Board. All reporting and
commnnications required by this Consent Agreement shall be made to the Compliance
Unit of the Board.
18. MS. MARTINEZ shall submit the reports and documentation required by this
Consent Agreement to the attention of the Compliance Unit, Ohio Board of Nursing,
17 South High Street, Suite 400, Columbus, Ohio 43215-7410.
19. MS. MARTINEZ shall verify that the reports and documentation required by this
Consent Agreement are received in the Board office.
20. MS. MARTINEZ shall inform the Board within three (3) business days, in writing, of
any change in address and/or telephone number.
Nurse Refresher Course or Orientation
Upon request by the Board or its designee, MS. MARTINEZ shall, prior to
working in a position where a nursing license is required, complete and submit
satisfactory documentation of completion of a nurse refresher course or an extensive
orientation approved in advance by the Board or its designee.
Patricia Anne Martinez, R.N.
Page 6
Criminal Records Check
Within four (4) months prior to requesting reinstatement, MS. MARTINEZ
agrees that she will submit a request to the Bureau of Criminal Identification and
Investigation (BCll) to conduct a criminal records check of MS. MARTINEZ,
including a check of Federal Bureau of Iuvestigation records, and request BCn to
submit the MS. MARTINEZ's completed criminal records check reports to the
Board.
Temporary Practice Restrictions
Upon reinstatement of her license, MS. MARTINEZ shall not, unless otherwise
approved in advance by the board or its designee, practice nursing as a registered
nurse (I) for agencies providing home care.in the patient's residence; (2) for hospice
care programs providing hospice care in the patient's residence; (3) as a nurse for
staffing agencies or pools; (4) as an independent provider where the nurse provides
nursing care and is reimbursed for services by the State of Ohio through State
agencies or agents of the State; or (5) for an individual or group of individuals who
directly engage MS. MARTINEZ to provide nursing services for fees,
compensation, or other consideration or as a volunteer.
Upon reinstatement of her license, MS. MARTINEZ shall not, unless otherwise
approved in advance by the board or its designee, function in a position or
employment where the job duties or requirements involve management of nursing,
nursing responsibilities, or supervising and evaluating nursing practice. Such
positions include but are not limited to the following: Director of Nursing, Assistant
Director of Nursing. Nurse Manager, Vice President of Nursing.
Temporary Narcotic Restrictions
Upon reinstatement of her license, MS. MARTINEZ shall not administer. have
access to, or possess (except as prescribed for MS. MARTINEZ's use by another so
authorized by law who has full knowledge of MS. MARTINEZ's history of
chemical dependency) any narcotics, other controlled substances, or mood altering
drugs for a minimum period of one (1) year in which MS. MARTINEZ is working
in a position that requires a nursing license. At any time after the one-year period
previously described, MS. MARTINEZ may submit a written request to the Board
to have this restriction re-evaluated. In addition, MS. MARTINEZ shall not count
narcotics or possess or carry any work keys for locked medication carts, cabinets,
drawers, or containers. MS. MARTINEZ shall not call in or order prescriptions or
prescription refills.
FAILURE TO COMPLY
The above described terms and conditions shall constitute "restrictions placed on a license" for
purposes of Section 4723.28(B), ORe. If, in the discretion of the Board, MS. MARTINEZ
appears to have violated or breached any terms or conditions of this Consent Agreement, the
Board reserves the right to institute formal disciplinary proceedings for any and all possible
violations or breaches, including, but not limited to, alleged violations of the laws of Ohio
occurring before the effective date of this Consent Agreement.
Patricia Anne Martinez, R.N.
Page?
DURATIONiMODIFICATION OFTERMS
The terms, limitations, and conditions of this Consent Agreement may be modified or terminated
in writing at any time upon the agreement of both MS. MARTINEZ and the Board.
The Board may only alter the indefinite suspension imposed if: (1) MS. MARTINEZ submits a
written request for reinstatement; (2) the Board determines that MS. MARTINEZ has complied
with all conditions of reinstatement; (3) the Board determines that MS. MARTINEZ is able to
practice according to acceptable and prevailing standards of safe nursing care based upon an
interview with MS. MARTINEZ and review of the documentation specified in this Consent
Agreement; and (4) MS. MARTINEZ has entered into a Consent Agreement with the Board for
probationary terms, conditions, and limitations determined by the Board for a minimum period
of three (3) years following reinstatement.
ACKNOWLEDGMENTS/LIABILITY RELEASE
MS. MARTINEZ acknowledges that she has had an opportunity to ask questions concerning the
terms of this Consent Agreement and that all questions asked have been answered in a
satisfactory manner.
MS. MARTINEZ waives all of her rights under Chapter 119, ORC, as they relate to matters that
are the subject of this Consent Agreement.
MS. MARTINEZ waives any and all claims or causes of action she may have against the Board,
and its members, officers, employees and/or agents arising out of matters that are the subject of
this Consent Agreement.
This Consent Agreement is not an adjndication order within the meaning of Section 1I9.01(D),
ORe. Any action initiated by the Board based on alleged violations of this Consent Agreement
shall comply with the Administrative Procedures Act, Chapter 119, ORe.
This Consent Agreement shall be considered a public record as that term is used in Section
149.43, ORe. The information contained herein may be reported to appropriate organizations,
data banks and governmental bodies.
08/17/2007 08:42 FAX S14 8S5 GSBS
Patricia Anne Martinez. R.N.
PageS
OHIO BOARD OF NURSING
EFFECTIVE DATE
+ BETH COLLIS @008/008
MS. MARTINEZ understands that this Consent Agreement is subject to ratification by the
Board prior to signature by the Board President and shall become effective upon the last date of
signature below.
~
. Attorney forMs. Martinez
~ . Cl. ~ . tnSA) fW
CYNTHIA A. KRUEGER, President
Ohio Board of Nursing
DATE
~ ~ [ [ -
DATE
Case # 12-001205
Ohio Board of Nursing www.nursing.ohio.gov
17 South High Street. Suite 400- Columbus, Ohio 43215-7410 (614) 466-3947
November 16,2012
NOTICE OF OPPORTUNITY FOR HEARING
Mary Faith Marvin, R.N.
6531 Center Road
Ashtabula, Ohio 44004
Dear Ms. Marvin:
In accordance with Chapter 119, Ohio Revised Code (ORC), you are hereby notified that the
Ohio Board of Nursing (Board) proposes under authority of Section 4723.28 ORC, to deny,
revoke, permanently revoke, suspend or place restrictions on your license to practice nursing as a
registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five
hundred dollars ($500.00) per violation for the following reasons:
1. While working as the floor supervising nurse at Carrington Park, Ashtabula, on or
about February 13-14, 2012, the following occurred during your 10:00 pm - 6:00 am
shift:
a) Patient #1 [see attached Patient Key, to Remain Confidential and Not Subject to
Public Disclosure]'s had physician orders for Oxygen, including but not limited to orders
to "check and record 02 SAT on 02 pm - as needed." In a written statement to the Board,
dated June 6,2012, you indicate that at 11:00 pm, you observed that Patient #l's blood
oxygen level had dropped, you switched the patient to a nasal cannula, and that: "1
checked this resident throughout my shift. At each check, the resident was breathing with
the nasal cannula and appeared fine." Despite this, Progress Notes indicate you failed to
document any information about Patient #1 until 6:15 am, when you document that the
patient was "diaphoretic ... SP02 62%." In the June 6, 2012 statement, you indicate that
at the end of your shift, "1 discovered that I had not charted the care I provided to the
resident between 11:00 pm - 6:00 am."
Section 4723.28(B)(19), ORC, authorizes the Board to discipline a licensee for failure to practice
in accordance with acceptable and prevailing standards of safe nursing care. Section
4723.28(B)(16), ORC, authorizes the Board to discipline a licensee for violation of Chapter
4723, ORC, or any rules adopted under it. Specifically, Ohio Administrative Code (OAC), Rule
4723-4-06(E), states that a licensed nurse shall, in a complete, accurate, and timely manner,
report and document nursing assessments or observations, the care provided by the nurse for the
client, and the client's response to that care.
b) Patient #l's advanced directives specified that his status was "FULL CODE" as of
February 13, 2012. Despite this, at 6:15 am on February 14, 2012, you documented that
Mary Faith Marvin, R.N.
Page 2
you were "Summoned to res room per stna, res skin color blue tinged, diaphoretic ...
SP02 62%." At this time, you did not call 911 despite the patient's full code status.
Instead, you document that at 6:20 am, you called the patient's guardian to notify her of
the patient's status, and note that the guardian "requests res sent to hospital." At 6:25 am,
you document "Request for 911 services called." On or about February 14, 2012, the
Director of Nursing interviewed you regarding your actions. You stated that you did not
immediately call 911 or "code blue", and did not indicate that you asked anyone else to
call 911. Rather, you stated that you left the patient's room, looked for an 02 mask for
approximately seven (7) minutes, and called the patient's guardian. You stated that you
called the guardian prior to calling 911 because you wanted to ask the guardian if the
patient should become a DNR or be transferred to ER. You were terminated from
employment effective on or about February 24, 2012 based on your conduct.
Section 4723.28(B)(19), ORC, authorizes the Board to discipline a licensee for failure to practice
in accordance with acceptable and prevailing standards of safe nursing care. Section
4723.28(B)(16), ORC, authorizes the Board to discipline a licensee for violation of Chapter
4723, ORC, or any rules adopted under it. Specifically, Rule 4723-4-03(C), OAC, states that a
registered nurse shall demonstrate competence and accountability in all areas of practice in
which the nurse is engaged which includes, but is not limited to, the following: (1) Consistent
performance of all aspects of nursing care; and (2) Appropriate recognition, referral or
. consultation, and intervention, when a complication arises.
Accordingly, the Board is authorized to impose one or more of the sanctions cited in Section
4723.28,ORC.
In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing
in this matter. If you wish to request such hearing, the request must be made in writing and must
be received in the Board office within thirty (30) days of the time of mailing of this notice.
You are hereby further informed that, if you timely request a hearing, you are entitled to appear
at such hearing in person, by your attorney, or by such other representative as is permitted to
practice before the Board, or you may present your position, arguments, or contentions in
writing. At the hearing, you may also present evidence and examine witnesses appearing for and
against you.
Should you choose to request a hearing, please mail or deliver the request, in addition to any
other correspondence regarding this matter, to Lisa Ferguson-Ramos, Compliance Unit
Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, Ohio 43215-
7410 or to the email address, hearing@nursing.ohio.gov.
If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing
of this notice, the Board may, in your absence and upon consideration of the factual and legal
allegations set forth in this Notice of Opportunity for Hearing, deny, revoke, permanently
revoke, suspend, or place restrictions on your license to practice nursing as a registered nurse;
reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars.
($500.00) per violation.
Mary Faith Marvin, R.N.
Page 3
Sincerely,
Judith A. Church, R.N., C.N.P.
Supervising Board Member
Certified Mail Receipt No. 7012 1010 0002 42573483
Attorney Certified Mail Receipt No. 7012 1010 0002 42573490
cc: Henry G. Appel, Assistant Attorney General
Elizabeth Y.