Alaska Board Of Nursing Discipline Database
Alaska Board Of Nursing Discipline Database
Alaska Board Of Nursing Discipline Database
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<strong>Board</strong> Meeting Name Case Number License/<br />
certificate<br />
June-07 Pamela J. Hansen 2306-04-011 Certified Nurse<br />
Aide<br />
<strong>Alaska</strong> <strong>Board</strong> of <strong>Nursing</strong><br />
<strong>Discipline</strong> <strong>Database</strong><br />
Falsification of Application - CNA<br />
Violation <strong>Discipline</strong><br />
Falsification of 2000-02 Application regarding<br />
criminal conviction in 1997<br />
June-07 Marlene C. Beard 2356-07-005 Temp Certified Falsification of Application regarding criminal<br />
Nurse Aide conviction for disorderly conduct<br />
June-07 Tnishna I. Burton 2356-07-004 Temp Certified Falsification of Application regarding criminal<br />
Nurse Aide conviction for driving without license<br />
June-07 2302-07-003 Licensed Practical Falsified application, CE requirements not<br />
Nurse<br />
completed<br />
July-07 Myrinel J.<br />
Uwekoolani<br />
2306-07-011 Certified Nurse<br />
Aide<br />
September-07 Mildred I. Dyne 2306-07-012 Certified Nurse<br />
Aide<br />
December-07 Ryanlynch G.<br />
Pacil<br />
2306-07-014 Certified Nurse<br />
Aide<br />
October-08 Patrick Grieser 2356-08-004 Temp Certified<br />
Nurse Aide<br />
October-08 Judy Putt 2356-08-003 Temp Certified<br />
Nurse Aide<br />
October-08 Brittany Gaier 2356-08-005 Certified Nurse<br />
Aide applicant<br />
April-09 TJ Ivey 2356-09-00 Certified Nurse<br />
Aide applicant<br />
April-09 Serena L Streeper 2356-08-007 Certified Nurse<br />
Aide applicant<br />
MOA - Fine of $1,000 with $500 stayed, $500 due by 10-1 -7<br />
(120 days); reprimand placed in certificate file; periodic interview<br />
with the <strong>Board</strong>.<br />
MOA - Fine of $500 payable within 120 days; reprimand placed<br />
in certification file.<br />
MOA - Fine of $500 payable within 120 days; reprimand placed<br />
in certification file.<br />
MOA - Fine of $3,000 with $1,500 suspended, to be paid in 90<br />
days; meet continued competency requirements for 04-06<br />
period; reprimand placed in certification file; mandatory audit of<br />
compliance with CE requirement for next 2 renewal periods;<br />
automatic suspension for violation of MOA.<br />
Falsified criminal history on application MOA - Civil fine of $500 payable within 120 days; reprimand<br />
placed in certification file; automatic suspension for violation of<br />
MOA.<br />
Falsification of Application regarding criminal<br />
conviction<br />
Falsification of Application regarding criminal<br />
conviction<br />
MOA - Civil fine of $500 payable within 120 days; reprimand<br />
placed in certification file.<br />
MOA - Civil fine of $500.00 payable within 120 days; reprimand<br />
placed in licensure file.<br />
Falsification of application regarding misconduct MOA - Civil fine of $500 payable within 120 days; reprimand<br />
involving a controlled substance.<br />
placed in certification file.<br />
Falsification of application regarding DWI MOA - Civil fine of $500 payable within 120 days after issuance<br />
of permanent certificate; reprimand placed in certification file.<br />
Falsification of application by failing to disclose a<br />
criminal conviction for disorderly conduct in another<br />
state<br />
Falsification of application regarding failing to report<br />
misdemeanor of Reckless Driving.<br />
Falsification of Application regarding 2 criminal<br />
convictions for driving without license and issuing a<br />
bad check in MT.<br />
MOA - Civil fine of $500 payable within 120 days after issuance<br />
of permanent certificate; reprimand placed in certification file.<br />
CA- Civil fine of $500.00 within 120 days after CA is accepted by<br />
the <strong>Board</strong>, reprimand place in certificate file.<br />
CA- Civil fine of $500.00 within 120 days after CA is accepted by<br />
the <strong>Board</strong>, reprimand place in certificate file.<br />
1
<strong>Board</strong> Meeting Name Case Number License/<br />
certificate<br />
April-09 Kristal L.<br />
Hammack<br />
2306-08-009 Certified Nurse<br />
Aide<br />
October-09 Angela R. Price 2306-09-005 Certified Nurse<br />
Aide<br />
October-09 Giovanni R. Ortiz 2356-09-006 Certified Nurse<br />
Aide applicant<br />
October-09 MicheaShea N.<br />
Theus<br />
2352-09-002 Certified Nurse<br />
Aide<br />
October-09 Casey Meatier 2306-08-015 Certified Nurse<br />
Aide<br />
January-10 Richard W.<br />
Reuben<br />
2356-09-002 Temporary<br />
Certified Nurse<br />
Aide # NUA T<br />
2519<br />
<strong>Alaska</strong> <strong>Board</strong> of <strong>Nursing</strong><br />
<strong>Discipline</strong> <strong>Database</strong><br />
Falsification of Application - CNA<br />
Violation <strong>Discipline</strong><br />
Falsified application, CE requirements not<br />
completed<br />
Falsified reinstatement application regarding<br />
respondent was convicted of Assault in the 4th<br />
degree in the Haines Magistrate Court on June 10,<br />
1998 under court case number MHA 98-64<br />
Falsified application for permanent certification as a<br />
CAN-10-16-01 conviction of driving without a valid<br />
operator license<br />
Falsified application for a conviction on June 1, 2005<br />
of theft in the 3rd degree in Anchorage District Court<br />
under case number #3AN-05-3518CR<br />
Falsified application, CE requirements not<br />
completed<br />
Falsified application for failure to disclose 4th degree<br />
misdemeanors in the District Court of Kotzebue<br />
dating May7, 2006 and November 13, 2006 and<br />
violation of release for a felony, court case number<br />
2KB-S06-715 November 13, 2006.<br />
CA-Civil fine of $1,500 with $900.00 being suspended, to be<br />
paid in full 90 days of date of CA after being adopted by the<br />
<strong>Board</strong>. Meet continuing competency with continuing education<br />
requirements. Reprimand be placed in file. Mandatory audit of<br />
compliance with continuing education requirements for next 2<br />
renewal periods<br />
CA-Civil fine of $500 to be paid in full 120 days after the date of<br />
CA is accepted by the <strong>Board</strong>. Reprimand placed in file.<br />
CA-Civil fine of $500 to be paid in full 120 days after issuance<br />
of CNA certificate. Public reprimand<br />
CA-Civil fine of $500 to be paid in full 120 days after this CA is<br />
adopted by the <strong>Board</strong>. Public reprimand.<br />
CA-Civil fine of $1,500 with $1250.00 being suspended, for a<br />
total unsuspended fine of $750 to be paid in full within 90 days<br />
of date of CA being adopted by the <strong>Board</strong>. Provide<br />
documentation of 22 hours of continuing education. Reprimand<br />
issued. Mandatory audit of compliance with the continuing<br />
education requirement for the next 2 renewals.<br />
CA-Civil fine $500 payable within 120 days after this CA is<br />
accepted by the <strong>Board</strong><br />
2
<strong>Board</strong> Meeting Name Case Number License/<br />
certificate<br />
<strong>Alaska</strong> <strong>Board</strong> of <strong>Nursing</strong><br />
<strong>Discipline</strong> <strong>Database</strong><br />
Falsification of Application - CNA<br />
Violation <strong>Discipline</strong><br />
January-10 Kathryn K. Crain 2306-09-006 Temporary Falsified application for failure to disclose conviction<br />
Certified Nurse<br />
Aide # NUA T2909<br />
of theft in the State of Ohio on November 21, 1999.<br />
January-10 Valerie J.<br />
Johnson<br />
2356-09-007 Certified Nurse<br />
Aide applicant by<br />
endorsement<br />
April-10 Deina R. Davis 2356-10-007 Certified Nurse<br />
Aide applicant by<br />
examination<br />
April-10 Jocelyn L.<br />
Mendoza<br />
April-10 Summberbreeze<br />
Hutchins<br />
2356-10-003 Certified Nurse<br />
Aide # NUA A<br />
11566<br />
2352-09-003 Certified Nurse<br />
Aide # NUA A<br />
5883<br />
April-10 Lee Sanders 2356-10-002 Expired<br />
Temporary<br />
Certified Nurse<br />
Aide # NUA T<br />
2913<br />
Falsified application for failure to disclose conviction<br />
of illegal possession of a controlled substance on<br />
February 10, 1976<br />
Falsified application for failure to report a conviction<br />
of driving without a license on June 6, 2000<br />
Falsified application for failure to report a previous<br />
CA from July 22, 2009.<br />
Falsified reinstatement application for failure to<br />
report a conviction of theft in the Magistrate Court at<br />
Palmer under Court Case Number 94-1553 on July<br />
27, 1994.<br />
Falsified application for failure to disclose a guilty<br />
conviction of violating UCMJ Article 086-absent<br />
without leave and dishonorable discharged from the<br />
US. Navy on March 9, 1990.<br />
April-10 Elise Demello 2356-10-006 Temporary Falsified application for failure to disclose conviction<br />
Certified Nurse of failure to obey citation to appear in court and no<br />
Aide #NUA T 3017 motor vehicle liability insurance on December 11,<br />
2008<br />
CA-Civil fine $500 payable within 120 days after this CA is<br />
accepted by the <strong>Board</strong> and a public reprimand.<br />
CA-Civil fine $500 payable within 120 days after this CA is<br />
accepted by the <strong>Board</strong> and a public reprimand.<br />
CA-Civil fine $500 payable within 120 days after this CA is<br />
accepted by the <strong>Board</strong> and a public reprimand.<br />
CA-Civil fine $500 payable within 120 days after this CA is<br />
accepted by the <strong>Board</strong> and a public reprimand.<br />
CA-Civil fine $500 payable within 120 days after this CA is<br />
accepted by the <strong>Board</strong> and a public reprimand.<br />
CA-Civil fine $500 payable within 120 days after this CA is<br />
accepted by the <strong>Board</strong> and a public reprimand.<br />
CA-Civil fine $500 payable within 120 days after the issuance of<br />
a permanent certificate and public reprimand.<br />
3
<strong>Board</strong> Meeting Name Case Number License/<br />
certificate<br />
April-10 Giovanni Ortiz 2356-10-005 Certified Nurse<br />
Aide # NUA A<br />
11728<br />
July-10 Denise Teal 2010-000385 Expired<br />
Temporary<br />
Certified Nurse<br />
Aide # NUA T<br />
3053<br />
July-10 Sharilyn Notti 2356-10-011 Expired<br />
Temporary<br />
Certified Nurse<br />
Aide # NUA T2811<br />
July-10 Renee L. Jordan 2306-10-003 Certified Nurse<br />
Aide # NUKA A<br />
8212<br />
July-10 Lauren H. Stalder 2356-10-012 Expired temporary<br />
Certified Nurse<br />
Aide certificate #<br />
NUA T 3046<br />
October-10 Rebecca<br />
Cameron<br />
2010-000868 Expired CNA<br />
certificate applying<br />
for reinstatement<br />
October-10 Kevin D. Cotton 2010-000807 Expired CNA<br />
certificate applying<br />
for reinstatement<br />
<strong>Alaska</strong> <strong>Board</strong> of <strong>Nursing</strong><br />
<strong>Discipline</strong> <strong>Database</strong><br />
Falsification of Application - CNA<br />
Violation <strong>Discipline</strong><br />
Falsified application for failure to report a previous<br />
CA from October 21, 2009.<br />
Falsified application for failure to report a no contest<br />
plea to a misdemeanor violation of Improper Use of<br />
Evidence of Registration/Title on November 14,<br />
2002<br />
CA-Civil fine $500 within 120 days after this CA is accepted by<br />
the <strong>Board</strong> and a public reprimand<br />
CA-Civil fine$500, public reprimand<br />
Falsified application for failure to report in October CA-Civil fine$500, public reprimand<br />
2003 pled no contest to driving without a valid<br />
driver's license, minor consuming alcohol and driving<br />
after minor consuming<br />
Falsified renewal application for failure to report was<br />
on a CA on July 23, 2009 for falsifying her<br />
continuing education requirements for her CAN<br />
renewal during the period of 2008-10<br />
CA-Civil fine$500, public reprimand<br />
Falsified application for failure to report a July 23, CA-Civil fine$500, public reprimand<br />
2008 conviction of driving without a valid operator<br />
license in Fairbanks District Court under case # 4FA-<br />
08-1747<br />
Respondent admits to answering no on the CNA<br />
reinstatement application. November 19, 1986<br />
Respondent was gulity of DWI and DWI while on a<br />
suspended license September 22, 1987<br />
Respondent admits to answering No on the CNA<br />
reinstatement application.June 11, 2001 guilty of<br />
driving without a license on June 11, 2001 for an<br />
arrest that occurred on April 12, 2001. November 1,<br />
1996 was guilty of driving while intoxicated for an<br />
arrest on September 29, 1996 in addtion 3 other<br />
violations from 1990, 1993 and 1995.<br />
CA-Civil fine $500, public reprimand<br />
CA-Civil fine $500, public reprimand<br />
4
<strong>Board</strong> Meeting Name Case Number License/<br />
certificate<br />
October-10 Sarah M. Earhart 2010-000818 Expired CNA<br />
certificate applying<br />
for application for<br />
a CAN by<br />
Examination<br />
October-10 Lorena Johnson 2010-000867 Application for<br />
CNA by<br />
Examination<br />
October-10 Jamie Kriska 2010-000626 Application for<br />
CNA by<br />
Examination<br />
October-10 April E. Phillips 2010-000738 Expired CNA<br />
certificate applying<br />
for reinstatement<br />
October-10 Michelle Fleming 2010-000879 Expired CNA<br />
certificate applying<br />
for reinstatement<br />
April-11 Suzette L. Becker 2011-000106 Application for<br />
CNA by<br />
Examination<br />
April-11 Terry J. Ditty 2011-000102 Application for<br />
CNA by<br />
Examination<br />
April-11 Amber L. Griffin 2011-001033 Application for<br />
CNA permanent<br />
certificate<br />
<strong>Alaska</strong> <strong>Board</strong> of <strong>Nursing</strong><br />
<strong>Discipline</strong> <strong>Database</strong><br />
Falsification of Application - CNA<br />
Violation <strong>Discipline</strong><br />
Respondent admits to answering No on the CNA by<br />
examination application. Respondent pled guilty to<br />
permitting unauthorized person to drive on<br />
September 26, 2001 for an offense that occurred on<br />
September 7, 2006.<br />
CA-Civil fine $500, public reprimand.<br />
Repspondent Falsified application for failure to CA- Civil fine $500, public reprimand<br />
report being found gulity to obey citation to appear in<br />
Court in Craig, AK on December 6, 1995.<br />
Respondent falsifed application by answering no on<br />
the CNA by examination application. Respondent<br />
pled no contest to leaving the scene of an accident<br />
involving vehicular damage on November 1, 1999.<br />
Respondent was not aware the offense prior to age<br />
18 needed to be disclosed.<br />
Respondent admits to answering no on the CNA<br />
application for reinstatement. Respondent failed to<br />
report June 17, 2006 and November 10, 2009 guilty<br />
of DUI and working without a current CNA certificate<br />
fromMarch 11, 2010 to August 16, 2010.<br />
Respondent falsifed application by answering no on<br />
the CNA by reinstement. Respondent was found<br />
guilty of disorderly conduct on June 15, 2007.<br />
Respondent falsified CNA application by failing to<br />
report conviction of a misdemeanor in Florida in<br />
1974.<br />
Respondent falsified CNA application by failing to<br />
report conviction of a misdemeanor in Anchorage in<br />
1992.<br />
Respondent Falsified application for failure to report<br />
three criminal convictions, which are all dated<br />
December, 2001.<br />
CA- Civil fine $500, public reprimand<br />
CA- Civil fine $500, public reprimand<br />
CA- Civil fine $500, public reprimand<br />
CA - Civil fine $500, public reprimand<br />
CA - Civil fine $500, public reprimand<br />
CA - Civil fine $500, public reprimand<br />
5
<strong>Board</strong> Meeting Name Case Number License/<br />
certificate<br />
April-11 Felicia R. Kayotuk 2010-001277 Application for<br />
CNA permanent<br />
certificate<br />
April-11 Martha Lockuk 2011-000342 Application for<br />
reinstatement of<br />
CNA certification<br />
April-11<br />
Carolyn Cooper 2010-001390 CNA certificate #<br />
NUA A 2641<br />
April-11<br />
April-11<br />
April-11<br />
April-11<br />
July-11<br />
Delores Gonzalez 2011-000260 CNA certificate #<br />
NUA A1535<br />
Belynda Gregg 2010-001388 CNA certificate<br />
#NUA A 4948<br />
Sylvia Lamb 2011-000235 CNA certificate #<br />
NUA A 6805<br />
Valaree Nilsen 2010-001432 CNA certificate #<br />
NUA A 7941<br />
Maria Rodriguez-<br />
Gallardo<br />
2011-000258 CNA certificate #<br />
NUA A 10338<br />
<strong>Alaska</strong> <strong>Board</strong> of <strong>Nursing</strong><br />
<strong>Discipline</strong> <strong>Database</strong><br />
Falsification of Application - CNA<br />
Violation <strong>Discipline</strong><br />
Respondent falsified application for failing to report<br />
criminal conviction in the State of <strong>Alaska</strong> for Driving<br />
Without a Valid Operator License from June 2006.<br />
Respondent falsified application for failing to report<br />
misdemeanor DWI conviction in the State of <strong>Alaska</strong><br />
from 1996.<br />
In a random audit, respondent failed to provide<br />
sufficient documentation of completion of the<br />
mandatory Continuing Education Requirements for<br />
CNA's<br />
In a random audit, respondent failed to provide<br />
sufficient documentation of completion of the<br />
mandatory Continuing Education Requirements for<br />
CNAs<br />
In a random audit, respondent failed to provide<br />
sufficient documentation of completion of the<br />
mandatory Continuing Education Requirements for<br />
CNAs<br />
In a random audit, respondent failed to provide<br />
sufficient documentation of completion of the<br />
mandatory Continuing Education Requirements for<br />
CNAs<br />
In a random audit, respondent failed to provide<br />
sufficient documentation of completion of the<br />
mandatory Continuing Education Requirements for<br />
CNAs<br />
In a random audit, respondent failed to provide<br />
sufficient documentation of completion of the<br />
mandatory Continuing Education Requirements for<br />
CNA's<br />
CA - Civil fine $500, public reprimand<br />
CA - Civil fine $500, public reprimand<br />
CA, civil fine of $1500 with $1250 suspended plus $50 per<br />
uncompleted credit hour for a total unsuspended fine of<br />
$462.50, compliance with CEU requirement, mandatory audit for<br />
next 2 renewal periods, public reprimand<br />
CA, civil fine of $1500with $1250 suspended plus $50 per<br />
uncompleted credit hourup to $500 maximum for a total<br />
suspended fine of $750, compliance with CEU requirement,<br />
mandatory audit for next 2 renewal periods, public reprimand,<br />
suspension of nurse aide certificate until completion of CEU<br />
requirement<br />
CA, civil fine of $1500 with $1250 suspended plus $50 per<br />
uncompleted credit hour for a total of $375 total unsuspended,<br />
compliance with CEU requirement, mandatory audit for next 2<br />
renewal periods, public reprimand.<br />
CA, civil fine of $1500 with $1250 suspended plus $50 per<br />
uncompleted credit hour for a total unsuspended fine of $750,<br />
compliance with CEU requirement, mandatory audit for next 2<br />
renewal periods, public reprimand, suspension of nurse aide<br />
certificate until completion of CEU requirement<br />
CA, civil fine of $1500 with $1250 suspended plus $50 per<br />
uncompleted credit hour for a total unsuspended fine of $750,<br />
compliance with CEU requirement, mandatory audit for next 2<br />
renewal periods, public reprimand<br />
CA, civil fine of $1500 with $1250 suspended plus $50 per<br />
uncompleted credit hour for a total unsuspended fine of $750,<br />
compliance with CEU requirement, mandatory audit for next 2<br />
renewal periods, public reprimand<br />
6
<strong>Board</strong> Meeting Name Case Number License/<br />
certificate<br />
July-11<br />
July-11<br />
October-11 Rosecelie D.<br />
Benigno<br />
Kimberly Wiehl 2011-000267 CNA certificate #<br />
6103<br />
Elizabeth A. Lind 2010-001044 Application for<br />
CNA permanent<br />
certificate<br />
2011-000873 CNA certificate #<br />
NUA A 7733<br />
October-11 Shawna R. Lowe 2010-001391 CNA certificate #<br />
NUA A 10143<br />
October-11 Jacqueline Yunak 2011-000265 CNA certificate #<br />
NUA A 10898<br />
October-11 Miranda Davison 2011-000253 CNA certificate #<br />
NUA A 7561<br />
October-11 Carolene E. Hall 2010-001434 CNA certificate #<br />
NUA A 9836<br />
October-11 Myrna J.<br />
Katchatag<br />
2010-001435 CNA certificate #<br />
NUA A 10056<br />
<strong>Alaska</strong> <strong>Board</strong> of <strong>Nursing</strong><br />
<strong>Discipline</strong> <strong>Database</strong><br />
Falsification of Application - CNA<br />
Violation <strong>Discipline</strong><br />
In a random audit, respondent failed to provide<br />
sufficient documentation of completion of the<br />
mandatory Continuing Education Requirements for<br />
CNA's. Respondent has not currently been working<br />
as a CNA but would like to keep her certification.<br />
CA, civil fine of $1500 with $1250 suspended plus $50 per<br />
uncompleted credit hour for a total unsuspended fine of $750,<br />
compliance with CEU requirement, mandatory audit for next 2<br />
renewal periods, public reprimand, suspension of nurse aide<br />
certificate until completion of CEU requirement<br />
Respondent falsified application for failing to CA - Civil fine $500, public reprimand<br />
disclose a criminal conviction of Operating Under the<br />
Influence in 2008 & failure to disclose a brief<br />
outpatient treatment program at Cook Inlet Recovery<br />
Services in 2009.<br />
Respondent failed to disclose an investigation for<br />
her falsified nurse application previously resolved in<br />
a consent agreement<br />
In a random audit, respondent failed to provide<br />
sufficient documentation of completion of the<br />
mandatory Continuing Education Requirements for<br />
CNA's<br />
In a random audit, respondent failed to provide<br />
sufficient documentation of completion of the<br />
mandatory Continuing Education Requirements for<br />
CNA's<br />
In a random audit, respondent failed to provide<br />
sufficient documentation of completion of the<br />
mandatory Continuing Education Requirements for<br />
CNA's<br />
In a random audit, respondent failed to provide<br />
sufficient documentation of completion of the<br />
mandatory Continuing Education Requirements for<br />
CNA's<br />
In a random audit, respondent failed to provide<br />
sufficient documentation of completion of the<br />
mandatory Continuing Education Requirements for<br />
CNA's<br />
CA- Civil fine $500, public reprimand<br />
CA, civil fine of $1500 with $1250 suspended plus $50 per<br />
uncompleted credit hour for a total unsuspended fine of $500,<br />
suspension of license until training is completed, compliance<br />
with CEU requirement, mandatory audit for next 2 renewal<br />
periods, public reprimand<br />
CA, civil fine of $1500 with $1250 suspended plus $50 per<br />
uncompleted credit hour for a total unsuspended fine of $750,<br />
suspension of license until training is completed, compliance<br />
with CEU requirement, mandatory audit for next 2 renewal<br />
periods, public reprimand<br />
CA, civil fine of $1500 with $1250 suspended plus $50 per<br />
uncompleted credit hour for a total unsuspended fine of $600,<br />
compliance with CEU requirement, mandatory audit for next 2<br />
renewal periods, public reprimand<br />
CA, civil fine of $1500 with $1250 suspended plus $50 per<br />
uncompleted credit hour for a total unsuspended fine of<br />
$412.50, compliance with CEU requirement, mandatory audit for<br />
next 2 renewal periods, public reprimand<br />
CA, civil fine of $1500 with $1250 suspended plus $50 per<br />
uncompleted credit hour for a total unsuspended fine of $750,<br />
compliance with CEU requirement, mandatory audit for next 2<br />
renewal periods, public reprimand<br />
7
<strong>Board</strong> Meeting Name Case Number License/<br />
certificate<br />
October-11 Katarina Leavitt 2010-001401 CNA certificate #<br />
NUA A 11349<br />
October-11 Gary Mayforth 2011-000261 CNA certificate #<br />
NUA A 1372<br />
October-11 Elizabeth H.<br />
Paddock<br />
2010-001380 CNA certificate #<br />
NUA A 6025<br />
October-11 Ivan Reutov 2010-001429 CNA certificate #<br />
NUA A 3291<br />
October-11 Ahna Simonds 2010-000255 CNA certificate #<br />
NUA A 513<br />
October-11 Christy Ann<br />
Clark<br />
January-12 Debbie L.<br />
Hickman<br />
2011-000430 Revoked CNA<br />
License # NUA<br />
A 8553<br />
2011-000857 Application of CNA<br />
certification<br />
January-12 Christal Hillman 2010-001400 CNA certificate #<br />
NUA A 11405<br />
<strong>Alaska</strong> <strong>Board</strong> of <strong>Nursing</strong><br />
<strong>Discipline</strong> <strong>Database</strong><br />
Falsification of Application - CNA<br />
Violation <strong>Discipline</strong><br />
In a random audit, respondent failed to provide<br />
sufficient documentation of completion of the<br />
mandatory Continuing Education Requirements for<br />
CNA's<br />
In a random audit, respondent failed to provide<br />
sufficient documentation of completion of the<br />
mandatory Continuing Education Requirements for<br />
CNA's<br />
In a random audit, respondent failed to provide<br />
sufficient documentation of completion of the<br />
mandatory Continuing Education Requirements for<br />
CNA's<br />
In a random audit, respondent failed to provide<br />
sufficient documentation of completion of the<br />
mandatory Continuing Education Requirements for<br />
CNA's<br />
In a random audit, respondent failed to provide<br />
sufficient documentation of completion of the<br />
mandatory Continuing Education Requirements for<br />
CNA's<br />
Respondent had license revoked for continuing<br />
education non-compliance issues on March 9, 2007.<br />
Respondent has admitted to accusation and has<br />
submitted an application for license reinstatement.<br />
Respondent falsified application for failing to<br />
disclose criminal convictions of Concealment of<br />
Mechandise in October, 1981, and Shoplifting in<br />
July,1983, in the State of <strong>Alaska</strong>.<br />
In a random audit, respondent failed to provide<br />
sufficient documentation of completion of the<br />
mandatory Continuing Education Requirements for<br />
CNA's<br />
CA, civil fine of $1500 with $1250 suspended plus $50 per<br />
uncompleted credit hour for a total unsuspended fine of $750,<br />
suspension of license until training is completed, compliance<br />
with CEU requirement, mandatory audit for next 2 renewal<br />
periods, public reprimand<br />
CA, civil fine of $1500 with $1250 suspended plus $50 per<br />
uncompleted credit hour for a total unsuspended fine of $750,<br />
compliance with CEU requirement, mandatory audit for next 2<br />
renewal periods, public reprimand<br />
CA, civil fine of $1500 with $1250 suspended plus $50 per<br />
uncompleted credit hour for a total unsuspended fine of $450,<br />
compliance with CEU requirement, mandatory audit for next 2<br />
renewal periods, public reprimand<br />
CA, civil fine of $1500 with $1250 suspended plus $50 per<br />
uncompleted credit hour for a total unsuspended fine of $550,<br />
compliance with CEU requirement, mandatory audit for next 2<br />
renewal periods, public reprimand<br />
CA, civil fine of $1500 with $1250 suspended plus $50 per<br />
uncompleted credit hour for a total unsuspended fine of $750,<br />
compliance with CEU requirement, mandatory audit for next 2<br />
renewal periods, public reprimand<br />
CA, civil fine of $2,000 with $1,250 suspended, meet continuing<br />
competency requirements, public reprimand, mandatory audit<br />
next two renewal periods<br />
CA, civil fine of $500, a public reprimand<br />
CA, civil fine of $1500 with $1250 suspended plus $50 per<br />
uncompleted credit hour for a total unsuspended fine of $350,<br />
compliance with CEU requirement, mandatory audit for next 2<br />
renewal periods, public reprimand<br />
8
<strong>Board</strong> Meeting Name Case Number License/<br />
certificate<br />
March-12 Mary E. Stone 2011-000237 CNA certificate #<br />
NUA A 9473<br />
April-12 Amy M. Watson 2010-001386 CNA certificate #<br />
NUA A 9257<br />
April-12 Rosemarie C.<br />
Abad<br />
2011-000277 CNA certificate #<br />
NUA A 8847<br />
April-12 Mary Ellen Fritz 2010-001426 CNA certificate #<br />
NUA A 3199<br />
April-12 Jessica A. Wicks 2010-001433 CNA certificate #<br />
NUA A 8129<br />
July-12 Kay Turner 2012-000339 CNA certificate #<br />
NUA A 11080<br />
<strong>Alaska</strong> <strong>Board</strong> of <strong>Nursing</strong><br />
<strong>Discipline</strong> <strong>Database</strong><br />
Falsification of Application - CNA<br />
Violation <strong>Discipline</strong><br />
In a random audit, respondent failed to provide<br />
sufficient documentation of completion of the<br />
mandatory Continuing Education Requirements for<br />
CNA's<br />
In a random audit, respondent failed to provide<br />
sufficient documentation of completion of the<br />
mandatory Continuing Education Requirements for<br />
CNA's<br />
In a random audit, respondent failed to provide<br />
sufficient documentation of completion of the<br />
mandatory Continuing Education Requirements for<br />
CNA's<br />
In a random audit, respondent failed to provide<br />
sufficient documentation of completion of the<br />
mandatory Continuing Education Requirements for<br />
CNA's<br />
In a random audit, respondent failed to provide<br />
sufficient documentation of completion of the<br />
mandatory Continuing Education Requirements for<br />
CNA's<br />
Respondent failed to report on her application a DUI<br />
in the State of <strong>Alaska</strong> on 11/12/10. Respondent also<br />
failed to disclose a substance abuse problem.<br />
CA, civil fine of $1500 with $1250 suspended plus $50 pere<br />
uncompleted credit hour for a total unsuspended fine of $462.50<br />
to be paid in 90 days, compliance with CEU requirement,<br />
mandatory audit for next 2 renewal periods, public reprimand.<br />
CA, civil fine of $1500 with $1250 suspended plus $50 per<br />
uncompleted credit hour for a total unsuspended fine of $350,<br />
compliance with CEU requirement, mandatory audit for next 2<br />
renewal periods, public reprimand<br />
CA, civil fine of $1500 with $1250 suspended plus $50 per<br />
uncompleted credit hour for a total unsuspended fine of $750,<br />
compliance with CEU requirement, mandatory audit for next 2<br />
renewal periods, public reprimand<br />
CA, civil fine of $1500 with $1250 suspended plus $50 per<br />
uncompleted credit hour for a total unsuspended fine of $750,<br />
compliance with CEU requirement, mandatory audit for next 2<br />
renewal periods, public reprimand<br />
CA, civil fine of $1500 with $1250 suspended plus $50 per<br />
uncompleted credit hour for a total unsuspended fine of $750,<br />
compliance with CEU requirement, mandatory audit for next 2<br />
renewal periods, public reprimand<br />
CA , civil fine $500, public reprimand, probation for 5 years,<br />
notify the <strong>Board</strong> if leaving the community for more than 7 days,<br />
notify the <strong>Board</strong> if leaving the state for more than 30 continuous<br />
days or 60 aggregate days, report if respondent is not a resident<br />
of <strong>Alaska</strong> or does not hold an active license, participate in an<br />
ongoing program of rehabilitative & psychotherapy counseling<br />
with quarterly reports submitted to the <strong>Board</strong>. Consume no<br />
controlled drugs, submit to random urinalysis & blood tests,<br />
monitoring by personal health care provider, attend Narcotics<br />
Anonymous or Alcohol Anonymous meetings, restriction of<br />
remote employment & limitation of access to controlled drugs,<br />
employer reports & supervision, permanent total abstinence<br />
from drugs.<br />
9
<strong>Board</strong> Meeting Name Case Number License/<br />
certificate<br />
<strong>Alaska</strong> <strong>Board</strong> of <strong>Nursing</strong><br />
<strong>Discipline</strong> <strong>Database</strong><br />
Falsification of Application - CNA<br />
Violation <strong>Discipline</strong><br />
October-12 Kamea Hale 2012-000917 CNA lapsed Respondent failed to report on her application being<br />
certificate # NUA A found guilty of Operating Under the Influence in the<br />
9585<br />
State of <strong>Alaska</strong> on 12/03/08.<br />
October-12 Maria Rodriguez-<br />
Gallardo<br />
2012-000381 CNA certificate #<br />
NUA A 10338<br />
January-13 Annette Alessi 2012-000441 CNA certificate #<br />
NUA A 2256<br />
January-13 Kristal L.<br />
Hammack<br />
January-13 Dana G.<br />
Ruottinen<br />
2012-001120 CNA certificate #<br />
NUA A 6107<br />
2012-001184 CNA certificate #<br />
NUA A 13348<br />
Respondent failed to report on her application a<br />
previous consent agreement in question number<br />
one.<br />
Respondent answered yes on question #2 and<br />
disclosed a criminal history when renewing her<br />
license on October 14, 2011. However, respondent<br />
failed to disclosed criminal violations on the previous<br />
four applications. Respondent has the following<br />
criminal convictions: Shoplifting, Driving with a<br />
Suspended License twice, and Theft in the Fourth<br />
Degree.<br />
Respondent failed to report on her application two<br />
DUIs reduced to reckless driving misdemeanors in<br />
1992 and 1996 on her original application on<br />
11/20/98. Respondent failed to show 160 of<br />
employment at the time of renewal.<br />
Respondent failed to report on his application a<br />
previous consent agreement with the <strong>Alaska</strong> <strong>Board</strong><br />
of Barbers and Hairdressers in question number<br />
one. Respondent was suspended for noncompliance<br />
with the agreement.<br />
April-13 Shirley L. Agcaoili 2013-000416 CNA lapsed Respondent failed to report on her application a<br />
certificate # NUA A previous consent agreement in question number<br />
670<br />
one. Respondent failed to report a criminal<br />
conviction for disorderly conduct in the State of<br />
<strong>Alaska</strong> on 2/22/1996.<br />
April-13 Stacie L. Joseph 2013-000514 CNA lapsed Respondent failed to report on her application a DUI<br />
certificate # NUA A in the State of <strong>Alaska</strong> on 10/16/2008 and a DWI<br />
7973<br />
11/14/2008.<br />
CA, civil fine of $500, a public reprimand<br />
CA, civil fine of $500, a public reprimand. The previous<br />
suspension of $1,250 for CA 2011-000258 will remain in effect.<br />
CA, civil fine of $2,000 with $1,500 suspended, a public<br />
reprimand.<br />
CA, civil fine of $500, a public reprimand.<br />
CA, civil fine of $500, a public reprimand.<br />
CA, civil fine of $1,000, a public reprimand.<br />
CA, civil fine of $500, a public reprimand.<br />
10
<strong>Board</strong> Meeting Name Case Number License/<br />
certificate<br />
April-13 Martha<br />
Kaiakokonok<br />
2013-000466 Application for<br />
CNA by<br />
examination<br />
April-13 Madeline K. Notti 2013-000371 Application for<br />
CNA by<br />
examination<br />
(Rev. 04/25/13)<br />
<strong>Alaska</strong> <strong>Board</strong> of <strong>Nursing</strong><br />
<strong>Discipline</strong> <strong>Database</strong><br />
Falsification of Application - CNA<br />
Violation <strong>Discipline</strong><br />
Respondent failed to report on her application<br />
convictions of Disorderly Conduct on 10/31/2001,<br />
Harrassment on 8/27/2007, and a DUI on 8/5/2008.<br />
Additionally, respondent was assessed for Alcohol<br />
Dependence on 11/19/2012.<br />
Respondent failed to report on her application two<br />
criminal convictions of Violation of Conditions of<br />
Release and a Domestic Violence Protective Order<br />
dated 7/4/2003.<br />
CA - probation for 5 years, notify the <strong>Board</strong> if leaving the<br />
community for more than 7 days, participate in an ongoing<br />
program of drug rehabilitative & psychotherapy counseling with<br />
quarterly reports submitted to the <strong>Board</strong>, consume no controlled<br />
drugs or alcohol, AA or NA meetings 3 times a week, random<br />
urinalysis & blood tests, monitoring by personal health care<br />
provider, restriction of remote employment & limitation of access<br />
to controlled drugs, employer reports & supervision, permanent<br />
total abstinence from drugs or alcohol.<br />
CA, civil fine of $500, a public reprimand.<br />
11