Lisa F. Sims, Nurse: "BEFORE THE ARIZONA STATE BOARD OF NURSING"

"BEFORE THE ARIZONA STATE BOARD OF NURSING

IN THE MATTER OF THE APPLICATION FOR THE ADVANCED PRACTICE CERTIFICATION OF AND PROFESSIONAL NURSE LICENSE NO.: RN092768 AND ADVANCED PRACTICE CERTIFICATE NO.: AP0856 ISSUED TO:

LISA FRANCES SIMS
APPLICANT/RESPONDENT [...]

A complaint charging LISA FRANCES SIMS ("Applicant/Respondent") with violation of the Nurse Practice Act has been received by the Arizona State Board of Nursing ("Board" [...] Based on the evidence before it, Board makes the Following Findings of Fact and Conclusions of Law: [...]

2. In or about May 2006 Applicant/Respondent accepted employment as a psychiatric mental health nurse practitioner at Verde Valley Guidance Clinic, Cottonwood, Arizona [... The] Applicant/Respondent did not apply for or receive certification in the specialty area from the Board.  Applicant/Respondent practiced until in or about June 2007 without board certification in the specialty area.

CONCLUSIONS OF LAW

Pursuant to A.R.S. 32-1606, 32-1663 and 32-1664, the Board has subject matter and personal jurisdiction in this matter.

The conduct and circumstances described in the paragraphs above constitute sufficient cause pursuant to A.R.S. 32-1663 (A) as defined in A.R.S. 32-1601 (16) (d), (h) and (j) to deny Applicant/Respondent certification as a psychiatric mental health nurse practitioner."

Source: Arizona State Board of Nursing Licensure & Certification, "IN THE MATTER OF THE APPLICATION FOR THE ADVANCED PRACTICE CERTIFICATION OF AND PPROFESIONAL NURSE LICENSE NO.: RN092768 AND ADVANCED PRACTICE CERTIFICATE NO.: AP0856 ISSUED TO: LISA FRANCES SIMS, APPLICANT/RESPONDENT."

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Letter from Arizona State Prison

5-16-10

… I have been spending a  lot of time in my Bible lately.  Some good scripture are Matt. 13:43, Matt. 18:21-35, John 12:44:50, 2 Cor. 10:3-5, Heb. 5:7-9.  I have been spending a lot more time in prayer lately too.  If God sees fit to parole me from here in the future I plan to join a religious order of some type.  I’m thinking probably  a Monastic community where I could pray and mediate a lot.  I don’t know exactly how, but I want God to use me for His kingdom in some capacity.  The Holy Spirit fills me in a way that I never [felt] before.  I am reminded of what Deacon Sheffer wrote me in our first letter saying: “let us being our journey with the peace of Jesus for it will be in finding Jesus that we find our true self.” 

I find that to be very true.  In finding Jesus I have found the door to who I am,  and my relationship with God and existence.  No longer do I have to live in darkness and slavery to sin and hopelessness.  With good reason did Christ refer to Himself as the gate in John 10:9 and the light of the world in John 8:12.  With good reason have I wrote you previously about how I feel more free now than I ever was before I came to Jesus.  I don’t mean my life is easier or less painful, but now I am attached to God and I am not dealing with it by myself.  Now my pain has purpose and I have real comfort, real direction, and real hope.  Now, it doesn’t mater if I am imprisoned, or any external circumstances that used to determine my ‘happiness.’ No longer do I try to arrange my circumstances to make myself happy.  I have real happiness and freedom now.  Only in Christ is there any real happiness.  Only in God’s love do our lives find real fulfillment.  After all we were created to know and love God and in that love to find happiness.  Anything that deters or hinders us on our path to God is merely a distraction or a form of blindness …

In Heb. 5:8-9 that I shared previously it speaks of Christ learning obedience from what he suffered and it perfecting Him (in his humanity).  I believe that in enduring my sufferings and hardships it only brings me  closer to our Lord and that God is molding me.  Our savior told us to take up our cross and follow Him in Matt. 16:24-26.  True discipleship is following Jesus to the Cross if necessary  and that is why I stay out of the evil that goes on in here [the prison]. I follow Christ and as the Apostle Paul says “For his sake I have accepted the loss of all things and I consider them so much rubbish, that I may gain Christ.”  Phill. 3:86 … I have been watching less t.v. lately too. Even  [while you are] locked down [here in prison, there] are much better things to do then stare at nonsense all day …

I miss you and love you.  Keep faith and hope alive.

-------------

“I went to places spiritually with him [Jeremy] that not everybody gets to go to. I had a front row seat, watching a love relationship with Jesus grow. I witnessed him and the Bishop on their knees in a cell, separated by bars, tears streaming down Jeremy’s face as he received the Sacraments. I was inspired by [Jeremy’s] hunger for Jesus. Inspired also by how his personal experience with Jesus changed him. I bore witness to the reality of the Eucharist being food for his soul. I can attest to a man deemed lost saved by grace, becoming the best version of himself. In the end Jeremy chose to love God, to love himself, and to love humanity with all its failings. He gave up his life revealing the deepest love possible: There is no greater love than to lay one’s life down for another.”  Deacon Ed Sheffer, July 6, 2011

Prescription Drugs, Guidance Clinic - Dr. Collins, Phone Interview

Prescription Drugs, Verde Valley Guidance Clinic - Dr. Collins, Phone Interview

Q: It looks from my interpretation, that one of the reasons that you had him [Jeremy] admitted [for treatment in jail], is that you wanted to wean him off  some of these medications, and wanted to make sure that it was medically safe to do so?  Am I interpreting that correct?

Dr. Collins: Well, I think we wanted to get the medical clearance at first to get him medically stabilized …  I really tried to remain neutral, and stay away from the legal stuff, because if I do that, it really clouds what I am seeing in patients under my care; the people in detention.  When he [Jeremy] came into detention, I was made aware immediately what was going on, what happened, and that would have been the first thing I am told.   They don’t call me and say, its Joe-Blow here and he committed homicide, or alleged homicide, and this is what’s going on.  When people call me, the nurses call me, and they give me a list of medicines, the medicines the person is on … they give me a brief, a mental state of what’s going on, and what they think - because I don’t see them [the patients] immediately; usually within couple of days.  When they gave me the list of the medicines he [Jeremy] was on; number one, I was really worried, and then number two, when they told me that there was alleged drug abuse, I was really worried, and then when they told me what happened, it was really concerning  - that I had a concern- that the medicine he [Jeremy] was on, which it seems to me there were five or six, that’s five or six Psychotropics [emphasis added] maybe not, but at least four, that combined with illicit substances, whether be it an amphetamine or something else, I was really concerned about his metal status, and the possibility of a delirium. So, I believe this is the reason I went for a medical clearance.

Q:  What role, were you concerned, the Psychotropic medications were playing in this?

Dr. Collins: […] I was concerned that he was in a delirium.  A delirium is different than a psychosis.  You can have psychosis with delirium, and you can have just psychosis on its own.  But, a delirium is where you have really lost your ability for orientation, you have lost your ability to form a clear thought process,  you don’t know where you are, you don’t know what date it is, you don’t know what happened.  [emphasis added] And that was my concern […] put some drugs on the top of that, he was in a state delirium […] You have to make sure that somebody is medically stable before I can treat the psychiatric issues.   I was worried that what was going on with him [Jeremy], was medication-induced, in addition to drug withdrawal on top of it.

Q: Ok, so psychosis is a psychological term, and delirium is a medical term?

Dr. Collins: It is. And that is what we all try to sort out when somebody comes in.  Are they in a delirium; because if they are in a delirium, this is a medical issue, and I’ve got a get to the bottom of what’s going on medically, before I can treat them from the psychiatric perspective.

Q: Now, the records show that he [Jeremy] was, like,  seeing, squirrels, or something coming out of  toilets, and …

Dr. Collins: Yes

Q: There were definitely some hallucinations, and you were aware that he had attempted an overdose, so his prescribed medications …  See, he was in that kind of mental state when he got to the jail.  What [do you] sense was causing it?

Dr. Collins: I kind a eluded to that, and again, my concern was that the state that he was in; when he came to the jail, and that’s all I can say, [his mental state] at that time,  that when he was in a delirium,  that this delirium was induced by psychotropic medications on top of drugs. [emphasis added …]

Q: The information to us, and based on his records at Verde Valley [Guidance Clinic] is that he probably had been clean of meth like about thirteen months, but he was  on a lot of  psychotropic meds.  [emphasis added]

Dr. Collins: A lot!  A lot!

Q: I am trying to see if it is possible to distinguish his metal state when he showed up at the jail, whether the ethology was that medications that he took to overdose himself […] to what degree the medications that he took on daily basis was causing his mental state?  […]

Dr. Collins: I was really, really, really concerned about the number of Psychotropics he was on […] I was appalled.  Appalled by how many Psychotropics this kid was on.   [emphasis added] He is sick,  Bob.  He is sick. He’s got a real significant psychiatric disorder.  I have been; what we had done in the jail, he is on Clozaril right now,  which is essentially, in our treatment algorithm, the last medicine that we can use for psychosis and schizoaffec[ive] disorder […] I was so upset by what had happened to this young man, and not excusing what he did, and I am not a bleeding-heart leftist, or anything like that, or a liberal, I am not at all, but I am so upset that he had been on all of these medicines, nobody had been watching drugs for him, and that there is a loss of a life.  And, and you know, I am not making any comments about, that’s not my business; there is bad things that happen with the combination of legal drugs and illegal [drugs].   And I was just pissed off about [this], to be honest with you.  [emphasis added]

Q: This mixture of drugs can cause problems with aggression, impulse control, things like that? [emphasis added]

Dr. Collins: It sure can!  It sure can! [emphasis added …]

Q:  We left off kind a saying that this cocktail of medications that Mr. Pompeneo was on could affect his aggression and impulse control. [emphasis added]  Is that right?

Dr. Collins: Yes.  It is correct. [emphasis added]

Q:  Why do you think that, what is it about this mixture of medications that makes you think that?

Dr. Collins: I think, me to go through over that […] He was on a mixture of mood stabilizers and antidepressants, and psychotics, and ADD [Attention Deficit Disorder] medications; that’s what I am remembering form the top of my head.  And he was on … I think, two ADD meds, one antidepressant,  one atypical psychotic, and one mood stabilizer. While back ago, we did a chart, long time ago.  But, what happens, he was on multiple drugs,  from multiple classes of medications.  Antidepressants are different from psycho-stimulants, antidepressants are different than mood stabilizers,  antidepressants are different than atypical anti-psychotics.   And each time you add a medication on top of another, you run a risk of drug-drug interaction.  You also run the risk of exacerbating a primary disorder when you trying treat maybe the secondary disorder.  Jeremy’s primary diagnosis would have been schizoaffective, or bi-polar. A typical antipsychotic or mood stabilizer would have been an appropriate treatment for that.  And that would have been fine.  But, if he is then treated with an antidepressant, that can make the primary disorder worse, or for depression, or  if he is treated for ADD with a psycho-stimulant, or Strattera, that can make the primary disorder worse.  So, you run the drug-drug interaction, you run the risk of the additional medication used to treat every symptom, and Jeremy comes with a ton of symptoms. And you know, he and I have had several talks in detention.  I said – “Jeremy, this is what I’m going to treat,  this is how we are going to do it.  We are going to get you to the best stability I can. I cannot […] and I don’t care, eradicate  the 100% of the symptoms, we can treat 50 to 60 percent, that’s what about we can do.” […] What had happened, may have not happened,  if he would have reasonable mental health treatment. We have a loss of life, we have a kid who is going to be in jail,  at least for the rest of his life, [emphasis added] and I just said to him – “Jeremy,  I will do the best I can to make you feel better, and help you to get thorough this thing while here in detention.  I will not over-medicate you,  I will not under-medicate you. “ And that’s where we got to the Clozaril;  that’s how I look at his record, or what he’d been through; Clozaril is a difficult medicine to use, and extremely dangerous medicine at that,  if not used appropriately.  This is kind a end-of-the-line. And he stays on it pretty well,  I mean, he has responded pretty darn well to the medicine, and you know, he has not killed himself, which I think is probably a good feat for the stress, depression, he has been under.  And the psychiatric diagnosis, just his psychiatric diagnosis, runs the risk of completed suicide.  And you take everything else,  you know, you are doing reasonably well.  And he is better, and I have told him every time – “Jeremy, I’m not going to make you worse,  I am not going to give you extra medicine, and you know, if I get you to 50 to 60-percent better,  that’s all I can do.  And he is pretty accepting of that.  You know, he has been accepting; I did rework his meds a little bit recently for, a … at the trial, but they were going in front of the [Sherris’] family members, and he was just up-front, and we’ve got a social worker to see him too,  and he said “I am just really anxious about this”, and that’s real, and this is what we can do during this time, because  you know, I myself want him to be stable […]

Q: We did interview some people at the Verde Valley Guidance Clinic, regarding the treatment and care there given to Jeremy.  I think there is a lawsuit against them by the victim’s family, but I think there is also, some Tarasoff [duty to warn] issues going on there. But, what we are told is that, it is the nurse practitioners that are prescribing the medications […]

Dr. Collins: Nurse practitioners must practice within their boundaries, within their expertise, and their level of ability.  Jeremy should’ve never, ever been treated by nurse practitioner; with his issues he should have had  treatment by a psychiatrist […] With his level of pathology, he should have never seen a nurse practitioner. Once you got two, three meds on Jeremy, there should have been a consultation with the psychiatrist – with the medical director.  And, there should have been ongoing consultation; he is on four, five,  six different meds, that should have set off a warning sign, a flag,  somewhere – you know we’ve got a really complex case, we better get a board-certified psychiatrist to take a look at that.  And I know Lisa [Sims], and I know Frank [Gagliardi], and I like them, but it is a bad, bad thing that happened.  [emphasis added]

Q: You know, I appreciate your perspective. In my job I’ve interviewed other nurse practitioners who practice unsupervised [… When] I interview a nurse practitioner – one, they don’t have any idea what they don’t know, they operate based on the law that says they can, therefore they do.  I had a nurse practitioner who [once] told me “I could do a brain surgery, if I wanted to.”

Dr. Collins: Yeah, and that’s kind a separate issue, but it is an important issue, that they suppose to practice within the bounds of their ability.

Q: But they don’t think of it this way; they think of it is, “I practice under the limits of my licensing.”

Dr. Collins: And they didn’t go to the medical school.

Q: Do you think it is O.K?

Dr. Collins: Well, and we have physicians like that to.  They physician community is not immune, that we have people practicing outside of their boundaries. But Verde Valley [Guidance Clinic] should have had; even if Lisa [Sims] was practicing outside of … as she was practicing outside of her ability, there should have been an internal mechanism within Verde Valley Guidance Center [Guidance Clinic], to identify hi-risk cases. And that’s what pisses me off! [ … emphasis added]

Q: So, the way you think the system works, that it [Jeremy’s treatment plan] was never brought to him [Francis Gagliardi] to review […]

Dr. Collins: I don’t know if it was ever brought to him or not brought to him, but I don’t think there were enough internal mechanisms to identify what could have, or what did go wrong, because they should have identified this earlier.  I can’t [imagine] somebody on two, three Psychotropic medications not come to the attention of the medical director.  And there should be some supervision going on. Once you get to five six medications, and with the psycho-stimulant there,  and with somebody with methamphetamine abuse, that should have definitely go in front of the doc [medical doctor] who was trained to deal with this […]  [emphasis added]

Q: We have a Dr. Potts, I don’t know if you know Jack Potts at all?

Dr. Collins: You know, I met him, he’s out of Phoenix?

Q: Yeah, yeah.

Dr. Collins: I met him just quickly, when he was in detention seeing Jeremy one day, and I met him for five minutes. 

Q: We had him look at this case, and we gave him all Verde’s [Verde Valley Guidance Clinic] records, his [Jeremy’s] list of meds, and the Mingus records.  And his main concern is that at his level of expertise, was specific to the Concerta.

Dr. Collins: And that’s the psycho-stimulant.

Q: O.K., because he says, “look, I got his [Jeremy’s] Mingus records and I got his Verde [Valley Guidance Clinic] records, and every time you put him on Concerta, there he is at Mingus self-reporting [a patient admits himself for treatment], because he can’t control his rage”.  And he goes “Three times is a charm, once is a third time, its clear this guy’s got a problem with this medication, why are you giving it to him again?” [emphasis added]

Dr. Collins: Yeah, and he’s [Dr. Potts] is talking about the psycho-stimulant. You are treating bi-polar, than you’re adding something anti-depressant on top of the routine bi-polar medicine, and than you add Strattera, and than you add Concerta, which is a psycho-stimulant, and it’s a cocktail anyone would go crazy on. But, you know Jeremy [was] methamphetamine abuser, and you’ve got history that he uses, and that he also gets psychotic maniac, that is a no brainer!  I mean, a third-year resident  wouldn’t have given him Concerta. [emphasis added] He would just have said, you know what … and that’s what I say to him – “Jeremy, ADD is not gonna kill you. You’re gonna live through it.  Yeah, you’re little bit impulsive,  you’ve got poor concentration – voices, mood instability, mania, and depression, that will kill you Jeremy”.

--- End of Phone Interview ---

Jeremy was murdered in prison on May 31, 2011.

Jeremy Pompeneo, Arizona State Prison, Letter, April 17, 2011

4/17/11

[Deacon Ed Sheffer ...] a thousand times thank you for visiting and bringing me the precious Body, Blood, Soul, and Divinity of Jesus to me. There are no words that express how much it means to be able to be sacramentally united to Christ in the Eucharist. I pray every day God’s abundant blessing and grace may be upon you for how you help me and the impact you have had on my life. Thank you also for the reality check on being a man of peace. I have many voices coming at me advocating the necessity to use violence to protect myself, and it is all too easy to be sucked into the prevailing mentality … I also had a realization about how our sins could hurt an omnipotent God. … I understand clearly how our sins hurt Christ in his Passion. The realization I had is that because God exists outside of time; and past, present, and future are all present to Him at once, then Jesus’ sacrifice is always before Him, hence with every sin I commit in my present, in God the Fathers now, they are imputed to Christ. So, basically, every sin I commit now, my sins are being laid upon Christ in His crucifixion. This was a powerful realization for me.

Verde Valley Guidance Clinic Lawsuit - Jeremy Pompeneo, July 14, 2010

7-14-10

I have learned to appreciate everyday as a gift from God and use it to serve Him and help others. I continue to spend a lot of time in prayer and study and the Holy Spirit fills me and moves me like nothing ever has […]

A fire has been kindled in my soul and I have a passion for Christ and helping others to know his light and his love […] I have a scripture for you. Isaiah 40:31: “They that hope in the LORD will renew their strength, they will soar as with eagles wings; They will run and not grow weary, walk and not grow faint.” (N.A.B)

Thank you for your efforts with my lawsuit. It is my hope also they [The Verde Valley Guidance Clinic] pay up. Not with money! I don’t care about the money. I just want them to admit where they were wrong. I have taken responsibility for my actions and it would be nice if they [VVGC] took responsibility for their part in some way, shape or form […]

There is nothing I can do to change the past but I will honor Sherris in the way I live.

[…] Keep faith and hope alive and know you are in my heart, thoughts, and prayers. I miss you and love you.

Love, Jeremy

Verde Valley Guidance Clinic, Lisa Sims, Zach Duran, Francis Gagliardi, and others.

What do the court papers tell us?

“On September 25, 2007, the Arizona State Board of Nursing concluded that [Lisa Frances] Sims had engaged in professional misconduct accepting employment with VVCG [Verde Valley Guidance Clinic] as psychiatric nurse practitioner without the requisite license in that field.  The Board cited Sims for Violating A.R.S.  32-1601 (16)(d), (h), and (j) […] These subsections of ARS 32-1601 describe Sims’ professional misconduct as follows:

(c) Any conduct or practice that is or might be harmful or dangerous to the health of a patient or the public.

…

(h) Committing an act that deceives, defrauds or harms the public.

…

(j) Violating a rule that is adopted by the board pursuant to this chapter.

The Board fined Sims $1,000.00 for  her misconduct.  VVGC’s [Verde Valley Guidance Clinic] institutional failures with regard to Jeremy and Sherris didn’t go unnoticed either.  The Arizona Department of Health Services (ADHS) conducted an inspection of VVGC on January 24 and 25, 2007.   


ADHS [Arizona Department of Health Services] issued 12 citations against VVGC for its deficiencies, and threatened to suspend its license. Three of these citations were directly related to VVGC’s role in Sherris’s death.  Chief among these deficiencies was VVGC’s failure to have adequate policies and duties to comply with its duty to warn under A.R.S. 36-517.02.  (See Arizona Department of Health Services citations against VVGC, dated January 25, 2007 […].  As discussed in Part III.B.1, infra, this statute requires [Zach] Duran to take immediate precautions  to warn both Sherris and law enforcement of Jeremy’s threat to kill her.  Had [Zach] Duran done so, [both Jeremy and] Sherris [would] still be alive today.

ADHS also cited VVGC for violating Ariz. Admin. Code 9-20-204.F by failing to verify that its staff members had the requisite skills and knowledge to perform their jobs.  Here, a simple online check of [Lisa] Sims’ license with the the Arizona State Board of Nursing would have revealed that she lacked a license to practice as a psychiatric nurse practitioner. 

Finally, ADHS cited VVGC for violating Ariz. Admin. Code 9-20-408 for failing to property assist its patients with the self-administration of medication. [We will touch upon this later]. Such assistance is crucial with patients such as Jeremy, because he was admittedly at risk to abuse his medications.

L.  Sims lacked the legal authority to prescribe Concerta.

As a nurse practitioner, [Lisa] Sims could only prescribe medications within the scope of her certified practice area.  Ariz. Admin. Code 4-19-511.  When she prescribed the Concerta, Sims was licensed as a family nurse practitioner, but not as a psychiatric nurse practitioner.

Prior to Sherris’s death, the Arizona State board of Nursing issued an advisory opinion on this topic.  It contained an eight-step decision tree for determining the scope of practice for a nurse practitioner.  (See advisory Opinion: Scope of Practice Decision  Tree, attached as Exhibit L).

Sims deviated from the flow of this decision tree in at least four areas. First , her act of prescribing Concerta to a patient with a history of methamphetamine abuse and psychosis was not ‘supported by … research data in nursing and health literature.’  (Third decision point). As discussed above, the FDA [Federal Drug Administration] and PDR [Physician Desk Reference]  specifically advised against this.  Second, [Lisa] Sims did not ‘possess the appropriate knowledge’ to prescribe the Concerta.  (Fifth decision point).  [Lisa] Sims testified at Jeremy’s sentencing hearing that, prior to prescribing the Concerta, she did not review records of Jeremy’s in-patient treatment at the Mingus Center.  The Mingus Center records specifically documented how Adderall - a stimulant that was functionally equivalent to Concerta – adversely affected Jeremy’s psychosis and anxiety.  Sims inexplicably made the decision to prescribe Concerta in an information vacuum.  Third, because Sims lacked a psychiatric nurse practitioner license, she lacked ‘documented evidence of competency and skill’.  (Sixth decision point) Fourth, the expert testimony presented at Jeremy’s sentencing hearing established that no ‘reasonable and prudent’ nurse practitioner would prescribe Concerta to an individual whith a history of methamphetamine abuse and psychosis.  (Seventh decision)

M.  If this matter were to proceed to trial, Sims’ credibility and truthfulness would be easily impeached.

Sims commenced employment at VVGC [Verde Valley Guidance Clinic] in May 2006.  VVGC has refused to release the bulk of Sims’ employment file, based on a questionable claim of privilege.  The circumstances of Sims’ initial employment therefore remain hazy.

However,  one document has emerged which reveals that Sims knowingly and fraudulently held herself out as a licensed Psychiatric Nurse Practitioner when she commenced employment. 


On my 30, 2006, Sims singed a document entitled “Verde Valley Guidance Clinic Job Title:  ‘Psychiatric Nurse Practitioner.’  This document contains the basic qualifications for her position.  Among them was a required that Sims be ‘[c] certified as a Psychiatric Nurse Practitioner in Arizona.’  Sims was also required to have one year of psychiatric nurse practitioner clinical experience.  (See Verde Valley Guidance Clinic Job Title: Psychiatric Nurse Practitioner, attached as Exhibit M).  In reality, Sims was not licensed in Arizona, and had just got her degree that same month.  This document also contains the signature of Sims’ supervisor, but it is illegible.  It is unclear if VVGC knew Sims lacked an Arizona license, or if VVGC simply acquiesced to her lack of qualifications.  It should be noted, however, that the job description signed by Sims is identical to documents VVGC submitted to ADHS [Arizona Department of Health Services] in its original licensing application.  These licensing documents represented to ADHS that the individual occupying the ‘Psychiatric Nurse Practitioner’ slot would be licensed as such in Arizona.

In response to the investigation against her, Sims submitted a letter to the Arizona State Aboard of Nursing on July 6, 2007.  This letter further exposes Sims’ lack of credibility and truthfulness.  Sims claimed that she did not work independently as a psychiatric nurse practitioner until December 2, 2006, when she received her national certification (but still before she had her Arizona license).  Until that time, Sims claimed she worked directly under the supervision  of VVGC Medical Director Dr. Francis Gagliardi.  Sims wrote ‘Dr. Gagliardi signed all the medication orders until I received my ANCC certification as a Family Psychiatric Mental Health Nurse Practitioner [on] 12/2/06.’  […]

The documentary evidence reveals this statement to be disingenuous.  Sims signed as either the ordering physician  or ordering psychiatrist in most of Jeremy’s medication orders from summer 2006 forward.  More important, Sims signed the October 11, 2006 order for Concerta as the prescribing physician.   (See Physician Medication Instructions/Orders, dated October 11, 2006, attached as Exhibit O).  Walgreens Pharmacy records also list Sims as the prescribing physician for the Concerta and several other prescription drugs in the preceding months […] "A prescription [for Concerta, aSchedule II controlled substance] may only be issued by a physician, dentist, podiatrist, veterinarian, mid-level practitioner, or other registered practitioner who is: 1) Authorized to prescribe controlled substances by the jurisdiction in which the practitioner is licensed to practice" (U.S. Department of Justice, Drug Enforcement Administration, Office of Diversion Control).

Jeremy’s Concerta prescription instructed him to ingest one 18 mg pill each morning, and there is no evidence to suggest that the deviated  from this on October 17, 2006.  Every component of Jeremy’s supposed negligence - the asking for, obtaining, and ingesting the Concerta, right down to the very last Concerta pill he took that morning - occurred before [Zach] Duran’s final malfeasance of failing to warn.  Simply put, any negligence by Jeremy was penultimate to [Zach] Duran’s conclusive act of negligence [… The] VVGC [Verde Valley Guidance Clinic] acted negligently both before and after Jeremy supposedly embarked on his negligent course of conduct.   VVGC’s failure to have sufficient procedures and policies regarding the duty to warn is the first brick  on the path to Sherri’s death.  [Lisa] Sims’ negligent prescription of the Concerta is the next.  Jeremy could not have obtained the Concerta but for Sims’ prescription, since it is a Schedule II controlled substance.  The final act of negligence leading to Sherris’ death was [Zach] Duran’s failure to warn her or law enforcement of Jeremy’s homicidal plan.  Jeremy’s supposed negligent conduct of asking for/obtaining/ingesting Concerta is sandwiched between these three dominating acts of negligence by VVGC [Verde Valley Guidance Clinic].

All of the other factors enumerated in 452 cmt. F. are present.  By virtue of her professional schooling and position,  [Lisa] Sims knew or should have known the inherent danger of prescribing Concerta to Jeremy, yet inexplicably issued the prescription anyway.  [Zach] Duran ignored, or was ignorant  of, his duty to warn Sherris and/or inform law enforcement, despite his knowledge of Jeremy’s history of psychosis and instability.  Duran instead transported Jeremy to the house he shared with Sherris.  Mere hours later, Jeremy acted out his [medication induced] homicidal and suicidal visions, just as he told [Zach] Duran he would […]"


Hence, what we DO know  with absolute certainty is that  "At all times set forth herein, [Lisa] Sims was not licensed by the Arizona Board of Nursing to prescribe and administer the drugs mentioned above and [Zach] Duran was not licensed by Arizona Board of Behavioral Health Examiners as a Substance Abuse Counselor ) See Arizona State Board of Nursing Consent Agreement number 07-06058, dated September 5, 2007 enclosed and State of Arizona Board of Behavioral Health Examiners statement containing information current as of January 27, 2009 also enclosed) [...]

"A prescription [for Concerta, a Schedule II controlled substance] may only be issued by a physician, dentist, podiatrist, veterinarian, mid-level practitioner, or other registered practitioner who is: 1) Authorized to prescribe controlled substances by the jurisdiction in which the practitioner is licensed to practice" [emphasis added] (U.S. Department of Justice, Drug Enforcement Administration, Office of Diversion Control)

The facts and law lead to one undeniable conclusion:  VVGC [Verde Valley Guidance Clinic] alone bears the blame for Sherris’ death […] Moreover, VVGC’s institutional failures, Sims’ negligent prescription of Concerta, and [Zach] Duran’s negligent failure to warn were the proverbial bookends to any supposed negligence by Jeremy.  As such, VVGC’s, Sims’, and Duran’s conduct supersedes any negligence by Jeremy.”

So, how do you get away with this? Two dead kids later, this writer hears in the grapevine that “The business is good at Verde Valley Guidance Clinic”.

Jeremy Pompeneo, about Verde Valley Guidance Clinic prescribed medications ...

" I saw Doctor Collins on Tuseday and he gave me a slight med[ication] adjustment, nothing serious.  He also told me he got the subpoena and he has no problem with getting on the stand because he said he agrees that the medication [prescribed by Verde Valley Guidance Clinic] played a large part on what happened [...] and [he] recognizes the truth.”