“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 [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.
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)
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”.
