BEFORE THE WYOMING STATE BOARD OF NURSING IN THE DISCIPLINARY MATTER OF TARRA DeGARMO, CERTIFIED NURSING ASSISTANT CERTICATE NO. 19458 Docket No. 10-122 - CDIMH SETTLEMENT AGREEMENT, STIPULATION AND ORDER FOR VOLUNTARY SURRENDER COMES NOW the Disciplinary Committee ("PETITIONER" of the Wyoming State Board of Nursing (hereinafter "Board" and TARRA DeGARMO ("RESPONDENT", pursuant to WYo. STAT. 16-3-107(n of the Wyoming Administrative Procedure Act ("WAPA" and WYO. STAT. 33-21-122(c(x of the Wyoming Nurse Practice Act ("NPA", and Chapter 8, Section 4 [Disciplinary Committee and Review of Original Complaint] of the Administrative Rules and Regulations of the Wyoming State Board of Nursing ("Board's Rules", and do hereby enter into this Settlement Agreement, Stipulation and Order for Voluntary Surrender ("Agreement", subject to acceptance and approval ofthe Board. FINDINGS OF FACT: I. RESPONDENT is a Certified Nursing Assistant in the State of Wyoming, holding certificate number CNA 19458, which according to Board records expired on December 31, 2010. RESPONDENT was initially certified on March 4, 2008. The Application Review Committee provided a letter of awareness the same date related to a 2007 conviction for DUI, which she disclosed on her application. Factual Allegations RE: WSBN Docket No. 10-122 2. On or about December 8, 2010, Board compliance staff initiated an administrative complaint with respect to RESPONDENT, which was assigned Case No. 10-122 and referred to PETITIONER for investigation and disciplinary recommendation, if any. Specifically, RESPONDENT disclosed on her renewal application for the 2011-2012 biennium that she was the subject of a criminal arrest related to a driving while under the influence incident that occurred on August I, 20 I O. RESPONDENT also provided a copy of court records reflecting that on or about September 14, 2010, RESPONDENT was convicted in Case No. M-IO-252 in the Superior Court of California, County of Modoc, located in Alturas, California, entitled the People of the State of California v. Tarra DeGarmo, for a violation of California Vehicle Code ("VC" Section 23152(b, related to "Driving Under Influence of Alcohol or Drugs," that provides that "[i]t is unlawful for any person who has 0.08 percent or more, by weight, of alcohol in his or her blood to drive a vehicle." RESPONDENT was placed on three (3 years probation and required to pay. fines. IN THE DISCIPLINARY MATTER OF TARRA DeGARMO,CNA 19458 -- Case No. 10-122 - CD/MH SETTLEMENT AGREEMENT, STIPULATION AND ORDER FOR VOLUNTARY SURRENDER Page 1 of6
3. On December 13, 2010, RESPONDENT was sent a Notice of Complaint ("NOC" letter regarding the administrative complaint in Case No. 10-122, which also included a request that she submit to a clinical substance abuse evaluation. 4. On December 20, 2010, RESPONDENT sent a response to the Case No. 10-122 administrative complaint, received by the Board acknowledging the substance of the complaint regarding the alcohol-related criminal offense, as well as providing explanations. 5. In addition to the allegations of the above-referenced administrative complaint, based upon its investigation, on December 20, 2010, RESPONDENT provided a copy of a written report dated October 25,2010, by Brianna Morzov of Curran-Seeley Foundation, representing a clinical substance abuse assessment, which indicated that RESPONDENT met DSM-IV -TR criteria for Alcohol Dependence, Early Full Remission based upon selfreport. In addition, pursuant to American Society of Addiction Medicine ("ASAM" criteria, it was recommended that RESPONDENT participate in treatment, including successful completion of a state-certified Level II Intensive Outpatient Program, followed by 35 sessions of continuing care, as well as continuing mental health counseling with a licensed provider, following the recommendations of that provider. Grounds and Recommendation for Discipline RE: WSBN Docket No. 10-122 6. PETITIONER alleges that RESPONDENT's conduct described in Paragraphs 2 and 5 hereinabove constitnte violations of the NPA found at WYO. STAT. 33-21-146(a(i [act inconsistent with standards of nursing practice], WYO. STAT. 33-21-146(a(ii [guilty plea relating adversely to the practice of nursing], and WYO. STAT. 33-21-146(a(a(iv(A and (B [unfitness due to use of drugs/failure to conform to the standards of prevailing nursing practice]. 7. PETITIONER further alleges that RESPONDENT's conduct described in Paragraphs 2 and 5 hereinabove constitute violations of various provisions of the Board's Rules contained in Chapter 7, Section 13 [Disciplinary Grounds for Certified Nursing Assistants]. Specifically, the following provisions may be alleged to apply to the conduct described above: Chapter 7, Section 13(b(i(J [Criminal conviction]; Chapter 7, Section J3(b(i(N(Il, (IV [alcohol abuse]; and Chapter 7, Section \3(b(ii [Failure to conform to the standards of prevailing nursing and nursing assistant practice]. 8. Violation of the foregoing statutory and rule provisions are subject to discipline, including suspension or revocation of RESPONDENT's certificate for nursing assistant. Notwithstanding, PETITIONER recommends that Voluntary Surrender of RESPONDENT's certificate CNA 19458, for discipline, is an appropriate alternative to a formal disciplinary proceeding per W AP A for other forms of discipline. [CONTINUED ON THE FOLLOWING PAGE] IN THE DISCIPLINARY MATTER OF TARRA DeGARMO. CNA 19458 -- Case No. 10-122 - CD/MH SETTLEMENT AGREEMENT, STIPULATION AND ORDER FOR VOLUNTARV SURRENDER Page 2 of6
9. Such recommendations are authorized by Chapter 8, Section 4( c (ii of the Board's Rules, which provides that Petitioner, as the Disciplinary Committee, may "[r]ecommend the board approve a settlement agreement in accordance with the board's authority set forth in the [NPA], the rules and regulations, and the [WAPA]. Such agreements may include the imposition of restrictions, conditions, reprimand, discipline, or a combination thereof[.]" CONCLUSIONS OF LAW 1. Paragraphs 1-9 of the Findings of Fact are incorporated herein by reference. 2. The Board has jurisdiction in this matter and over Respondent pursuant to the NPA, WYO. STAT. 33-21-119 et seq., the Board's Rules, and the WAPA, WYO. STAT. 16-3- 101 et seq. 3. The Board concludes that RESPONDENT's conduct described in Paragraphs 2 and 5 of the Findings of Fact hereinabove constitute violations of the NPA found at WYo. STAT. 33-21-l46(a(i [act inconsistent with standards of nursing practice]; WYO. STAT. 33-21-146(a(ii [guilty plea relating adversely to the practice of nursing], and WYO. STAT. 33-21-146(a(iv(A and (B [unfitness due to use of drugs/failure to conform to the standards of prevailing nursing practice], as well as various provisions of the Board's Rules contained in Chapter 7, Section 13 [Disciplinary Grounds for Certified Nursing Assistants]. Specifically, the following provisions may be alleged to apply to the conduct described above: criminal conviction [Chapter 7, Section 13(b(i(J]; alcohol/chemical abuse [Chapter 7, Section 13(b(i(N(IV]; and failure to conform to the standards of prevailing nursing and nursing assistant practice, in which case actual injury need not be established [Chapter 7, Section 13(b(ii]. 4. The applicable statutory and rule provisions state in pertinent part as follows: WYO. STAT. 33-21-146. Disciplining licensees; gronnds. (a The board of nursing may... suspend or revoke the license, certificate or temporary permit of any person, or to otherwise discipline a licensee, upon proof that the person: (i (ii Has engaged in any act inconsistent with uniform and reasonable standards of nursing practice as defined by board rules and regulations; Has been found guilty by a court... to a misdemeanor or felony that relates adversely to the practice of nursing or to the ability to practice nursing; * * * [and] [CONTINUED ON THE FOLLOWING PAGE] IN THE DISCIPLINARY MATTER OF TARRA DeGARMO, CNA 19458 -- Case No. 10-122 - CDlMH SETTLEMENT AGREEMENT, STIPULATION AND ORDER FOR VOLUNTARY SURRENDER Page 3 of6
(iv Is unfit or incompetent to practice nursing by reason of negligence, habits or other causes including but not limited to: [1] (A Being unable to practice nursing with reasonable skill and safety to patients by reason of... mind-altering material; [1] (B Performance of unsafe nursing practice or failure to conform to the essential standards of acceptable and prevailing nursing practice, in which case actual injury need not be established [.] Chapter 7, Section 13(b [Disciplinary Procednres (for Certified Nnrsing Assistants] of the Board's Rules: Grounds for Discipline: (i (ii Engaging in any act inconsistent with uniform and reasonable standards of nursing practice, including but not limited to: * * [1] (J Criminal conviction; * * * [1] (N Impairment; * * * [1] (IV Chemical or alcohol impairment/abuser;] * * [and] Failure to conform to the standards of prevailing nursing and nursing assistant practice, in which case actual injury need not be established. 5. Pursuant to Chapter 8, Section 4(d [Disciplinary Committee and Review of Original Complaint] of the Board's Rules, the Hoard may resolve a complaint by: "(i Approving the [Petitioner's] recommendations; [or] (ii Conducting a contested case hearing. Following the hearing and deliberation of all evidence admitted at a contested case hearing, the board may: * * * [1] (C Impose discipline by revocation, suspension, reprimand, restriction, condition, non-renewal, or a combination thereofl.]" 6. The Board concludes, therefore, that violation of the foregoing statutory and rule provisions are subject to discipline of RESPONDENT's nurse license. Alcohol or drugimpaired medical practitioners present a clear and obvious danger to the public. Firman v. Department, State Bd. of Medicine, 697 A.2d 291,296 (Pa. Cmwlth. 1997. Moreover, the accessibility to controlled substances by medical practitioners presents a great danger to the public. Id. Therefore, the Board possesses authority to act where the acts of a nurse threaten the health and safety of the general public. Id. Also see, Frank v. State By and Through Wyoming Bd. of Dental Examiners, 965 P.2d 674, 679 (Wyo. 1998; Slagle v. Wyoming State Board of Nursing, 954 P.2d 979, 982 (Wyo. 1998. 7. The Board concludes, therefore, that RESPONDENT's Voluntary Surrender of her Certified Nursing Assistant certificate number CNA 19458, for discipline, is an appropriate alternative to a disciplinary proceeding for the revocation of RESPONDENT's certificate as determined in Conclusions of Law Nos. 1 through 6, inclusive. [CONTINUED ON THE FOLLOWING PAGE] IN l1ie DISCIPLINARY MATTER OF TARRA DeGARMO, CNA 19458 -- Case No. 10-122 - CDlMH SETTLEMENT AGREEMENT, STJPULA TJON AND ORDER FOR VOLUNTARY SURRENDER Page 4 of6
ORDER IT IS THEREFORE HEREBY SETTLED, STIPULATED AND ORDERED: 'I. Voluntary Snrrender of CNA Certificate. The Board accepts this Agreement, which constitutes RESPONDENT's Voluntary Surrender of her Certified Nursing Assistant certificate number CNA 19458, for discipline, based on all Findings of Fact and Conclusions of Law set forth in this Agreement. 2, Reporting by Board of Discipline. This Agreement constitutes authorized and final disciplinary action of the Board and, as such, shall become a part of RESPONDENT's permanent record with the Board. It, as well as the information that is part of Case/Docket No. 10-122, constitutes public records within the meaning of the Wyoming' Public Records Act [WYo. STAT. 16-4-201 et seq.], and therefore, upon proper request shall be available for inspection and dissemination in accordance with or except as otherwise provided by applicable state and/or federal law, and RESPONDENT's Voluntary Surrender of her Certified Nursing Assistant certificate number CNA 19458, for discipline, shall be reported to such public or private entities as required by law. 3, Continuing Jurisdiction. The Board shall retain continuing jurisdiction in this matter to take further action as may be necessary to conclude this matter or other actions permitted by law. 4, Entire Agreement; Waiver of Contested Case Hearing. RESPONDENT's execution of this Agreement includes her representation and acknowledgement that she has read and understands the terms and conditions of this Agreement, has been given an opportunity to consult and/or has consulted with counsel of her choice, and accordingly voluntarily enters into this Agreement of her own choosing and shall be bound by the terms and conditions thereof, until the Board issues any order to the contrary, RESPONDENT has been given no additional inducement to enter into and execute this Agreement. 5. Effective Date; Enforcement. This Agreement shall become effective upon full and complete execution by all signatories below. This Agreement constitutes the full and entire understanding between the parties, including RESPONDENT, Petitioner and the Board. This Agreement shall be enforceable in the Laramie County District Court in and for the State of Wyoming according to the laws of the State of Wyoming. [SIGNATURES APPEAR ON THE FOLLOWING PAGE] IN THE DISCIPLINARY MATTER OF TARRA DeGARMO. CNA 19458 -- Case No. 10-122 - CD/MH SETTLEMENT AGREEMENT, STIPULA non AND ORDER FOR VOLUNTARY SURRENDER Page50f6
I, Tarra DeGarmo, RESPONDENT herein, swear that I have read the foregoing Agreement and agree to its terms and conditions as provided above. :.sqitj AGREED TO AND ACCEPTED BY RESPONDENT Date STATE OF WYOMING COUNTY OF TGro;'/ SS T~«. f9,fegoing document was subscribed and sworn to before me by ~1'4 I/e (;-wm-(, personally known to me or having established his/her identity by means of sufficient documentation, purporting to be the person signing the document, and the ~ignajure on the foregoing document was made in my presence, on the '2 day of ~,2011. M_com. s o- _~'re._._. CHRISTOPHER S. LEIGH _: _.- NOTARY PUBLIC COUNTY OF TETON MY COMMISSION EXPIRES 05/15/2013 No ry Public AGREED TO AND ACCEPTED BY PETITIONER, DISCIPLINARY COMMITTEE: Carne Deselms, MSN, APRN, FNP-BC, and/or Marguerite Herman BA, MAT, MMC Dati APPROVED BY AND FOR THE WYOMING STATE BOARD OF NURSING: Date IN THE DISCIPLINARY MATTER OF TARRA DeGARMO, CNA 19458 -- Case No.1 0-122 - CD/MH SETTLEMENT AGREEMENT, STIPULATION AND ORDER FOR VOLUNTARV SURRENDER Page 6 of6