before the wyoming state board of nursing in the disciplinary matter ...

BEFORE THE WYOMING STATE BOARD OF NURSING
IN THE DISCIPLINARY MATTER OF )
KAREN WENDT, )
ADVANCED PRACTICE REGISTERED NURSE )
LICENSE NO. NO. RN APRN 8746.044. )
Docket No. 10-015 - TW/KC
SETTLEMENT AGREEMENT, STIPULATION AND ORDER
FOR CONDITIONAL LICENSE
COMES NOW the Disciplinary Committee ("PETITIONER") on behalf of the Wyoming
State Board of Nursing ("Board"), in consultation with the Office of the Attorney General, and
KAREN WENDT, APRN ("RESPONDENT"), pursuant to WYo. STAT. § 16-3-107(n) of the
Wyoming Administrative Procedure Act ("WAPA") and WYO. STAT. § 33-21-122(c)(ix) 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"), do hereby enter into this Settlement Agreement,
Stipulation and Order ("Agreemenf') for approval by the Board.
FINDINGS OF FACT
1. RESPONDENT is licensed as an advanced practice nurse under License No. APRN
8746.044 in the State of Wyoming, with recognition as a Certified Nurse Midwife
("CNM"), with prescriptive authority, which will expire on December 31, 2010,
according to the records of the Board. As such, RESPONDENT is also subject to
Chapter 4 of the Board's Rules applicable to "Advanced Practitioners of Nursing."
Allegations RE: WSBN Case No. 10-015
2. On July 28, 2010, an administrative complaint, assigned Case No. 10-015, was submitted
by Jan K. Siebersma, M.D. alleging that on July 26, 2010, RESPONDENT engaged in
unsafe patient care with regard to antibiotic practice and allowing the patient to rest at
home without a nurse, nurse practitioner or physician present for 9 hours on July 26,
2010.
3. On June 30, 2010, RESPONDENT was sent a Notice of Complaint ("NOC") letter
regarding the administrative complaint in Case No.1 0-015 by certified mail.
4. On August 1, 2010, RESPONDENT sent a response to the Case No. 10-015 complaint,
generally providing explanations and admitting that she left the patient to obtain rest
herself without specifying actual period but denying that her actions feIl below the
standard of care by midwifery standards.
5. In addition to the facts alleged above, PETITIONER's investigation disclosed the
foIlowing:
IN THE DISCIPLINARY MATTER OF KAREN WENDT, APRN 8746.044 -- Docket No. 10-015 - TW!KC
SETTLEMENT AGREEMENT, STIPULATION AND ORDER FOR CONDITIONAL LICENSE
Page 1 of8

a. An additional complaint was made by J. Brubaker, M.D., of the Lander Regional
Hospital in Lander, Wyoming, related to another pregnant patient desiring a home
delivery (identified for privacy reasons as "JR") alleging that RESPONDFENT
failed to timely refer a patient with ruptured membranes, who was attempting
home birth, to the hospital.
b. RESPONDENT also provided a response generally denying that she engaged in
any conduct that was below standards for midwives in home deliveries and that
the patient was properly informed regarding risks of infection, but chose to
continue with home delivery.
Grounds aud Recommendations for Discipliuary Action RE: WSBN Case No. 10-015
6. PETITIONER contends that RESPONDENT's conduct as described in Paragraphs 2 and
5 hereinabove constitutes separate and independent grounds for discipline pursuant to
WYO. STAT. § 33-21-146(a)(i) [act inconsistent with uniform and reasonable standards of
nursing practice as defined by Board's Rules]; WYO. STAT. § 33-2l-146(a)(iv)(B)
[performance of unsafe nursing practice or failure to conform to the essential standards of
acceptable and prevailing nursing practice]; and WYO. STAT. § 33-21-146(a)(ix)
[violation ofNPA/Board's Rules].
7. PETITIONER contends that RESPONDENT's conduct as described in Paragraphs 2 and
5 hereinabove, constitutes separate and independent grounds for discipline pursuant to
Chapter 3, Section 4(a) [Disciplinary Procedures for Registered Professional Nurses] of
the Board's Rules, including, performance of unsafe client care [Ch. 3, Sec. 4(a)(i)(B)];
and failure to conform to the standards of prevailing nursing practice [Ch. 3, Sec.
4(a)(ii)] .
8. PETITIONER contends that RESPONDENT's conduct as described in Paragraphs 2 and
5 hereinabove, constitutes separate and independent grounds for discipline pursuant to
Chapter 4, Section 1 1 (a) [Disciplinary Procedures for Advanced Practitioners of Nursing]
of the Board's Rules, and specifically, performance of unsafe client care [Ch. 4, Sec.
II(a)(i)(B)] and failure to conform to the standards of prevailing nursing practice [Ch. 4,
Sec. I I (a)(i)(ii)].
9. Violation of the above-indicated statutory and rule provisions is subject to discipline of
RESPONDENT's advanced practice nurse license with recognition as a certified nurse
midwife. PETITIONER recommends that in lieu of a formal disciplinary hearing for
discipline of RESPONDENT's registered nursing license, RESPONDENT complete the
following terms and conditions specified below within the prescribed time frames:
a. Direct Supervision by Physician or Certified Nurse Midwife. Upon the
effective date of this Agreement, or such earlier time as may be mutually agreed
by and between RESPONDENT and PETITIONER, RESPONDENT be directly
supervised by a physician or certified nurse midwife ("CNM"), which may be in
another state or via locum tenens, approved by the Board or its designee, for a
minimum of ten (10) deliveries, and provide PETITIONER with a copy of the
medical records related to such deliveries, which shall include documentation by
such physician or CNM. Unless extended by permission of the BOARD or its
designee, such deliveries shall be completed, and medical records delivered to the
BOARD, no later than October 31, 2012.
IN THE DISClPLINARY MATTER OF KAREN WENDT. APRN 8746,044 -- Docket No. 10-015 -TW/KC
SETTLEMENT AGREEMENT, STIPULATION AND ORDER FOR CONDITIONAL LICENSE
Page 20f8

. Peer Review. Within six (6) months following the effective date of this
Agreement, RESPONDENT shall establish a peer review committee as
recommended by the American College of Nurse-Midwives ("ACNM"), and
provide PETITIONER with documentation of the same, including
acknowledgment by members of the committee.
c. Refresher Educatioual Course. Within six (6) months of the effective date of
this Agreement, or as may be otherwise mutually agreed by and between
RESPONDENT and PETITIONER, RESPONDENT shall enroll in and complete
a refresher course in Labor and Delivery, or alternatively, further continuing
education offered by the ACNM focusing on management of home deliveries,
subject to the prior approval of the Board or its designee.
d. Additioual Training. RESPONDENT has undergone and reported to the Board
of nursing training in coursework similar to "Ethics of Nursing Practice,"
"Professional Accountability & Legal Liability for Nurses," "and "Sharpening
Critical Thinking Skills" provided by National Council of State Boards of
Nursing, Inc. ("NCSBN").
e. RESPONDENT shall provide documentation of completion of the education,
experience and training in subparagraph a, b, c and d within the prescribed times.
In the event RESPONDENT does not provide documentation of completion of the
coursework as provided above, RESPONDENT's Advanced Practice Nurse
License No. APRN 8746.044 shall be suspended until completed or pending
further order of the Board and that a formal letter of reprimand shall be entered
against RESPONDENT's License No. APRN 8746.044.
e. Authorizations. RESPONDENT shall duly execute any information releases,
including for medical records, or other consents that further the objectives of this
Agreement.
I, KAREN WENDT, ACKNOWLEDGE AND UNDERSTAND
THAT A SIGNIFICANT VIOLATION OF THE ABOVE
WILL RESULT IN THE IMMEDIATE SUSPENSION OF MY
LICENSE
10. The foregoing 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 1-10 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 WAPA, WYO. STAT. §§ 16-3-101 et. seq., and the
applicable Board's Rules.
IN THE DISCIPLINARY MATTER OF KAREN WENDT, APRN 8746.044 -- Docket No. 10-015 - TW/KC
SETTLEMENT AGREEMENT, STIPULATION AND ORDER FOR CONDITIONAL LICENSE
Page 3 of8

3. The Board concludes that RESPONDENT's conduct as described in Paragraphs 2 and 5
of the Findings of Fact hereinabove, if established by clear and convincing evidence at a
contest case hearing, constitutes grounds for discipline pursuant to WYo. STAT.
§ 33-21-146(a)(i) [act inconsistent with uniform and reasonable standards of nursing
practice as defined by Board's Rules]; WYO. STAT. § 33-21-146(a)(iv)(B) [performance
of unsafe nursing practice or failure to conform to the essential standards of acceptable
and prevailing nursing practice]; and WYO. STAT. § 33-21-146(a)(ix) [violation of
NPAIBoard's Rules].
4. The Board concludes that RESPONDENT's conduct as described in Paragraphs 2 and 5
of the Findings of Fact hereinabove, if established by clear and convincing evidence at a
contest case hearing, constitutes grounds for discipline pursuant to Chapter 3, Section
4(a) [Disciplinary Procedures for Registered Professional Nurses] of the Board's Rules,
including, performance of unsafe client care [Chapter 3, Section 4(a)(i)(B)] and failure to
conform to the standards of prevailing nursing practice [Ch. 3, Sec. 4(a)(ii)].
5. The Board concludes that RESPONDENT's conduct as described in Paragraphs 2 and 5
of the Findings of Fact, hereinabove, if established, constitutes separate and independent
grounds for discipline related to Chapter 4, Section Il(a) [Disciplinary Procedures for
Advanced Practitioners of Nursing] of the Board's Rules, and specifically, performance
of unsafe client care [Ch. 4, Sec. ll(a)(i)(B and failure to conform to the standards of
prevailing nursing practice [Ch. 4, Sec. 11(a)(i)(ii)].
6. The applicable statutory and rule provisions determined to have been violated in the
previous paragraph are fully cited as follows:
WYO. STAT. § 33-21-146. Disciplining licensees; grounds.
(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) Has engaged in any act inconsistent with uniform and
reasonable standards of nursing practice as defined by board rules
and regu lations;
* * *
(ix) Has been found by the board to have violated any of the
provisions of this act or of board rules and regulations ....
Chapter 4, Section 11 [Disciplinary Procedures for Advanced Practitioners of
Nursing] of the Board's Rules:
(a)
Grounds for Discipline:
(i)
(ii)
Engaging in any act inconsistent with uniform and reasonable
standards of nursing practice, including but not limited to: * * *
[~] (B) Performance of unsafe client care [and]
Failure to conform to the standards of prevailing nursing practice,
in which case actual injury need not be established.
[CONTINUED ON FOLLOWING PAGE]
IN THE DISCIPLINARY MATTER OF KAREN WENDT, AP RN 8746.044 -- Docket No. 1.0-015 - TW IKe
SETTLEMENT AGREEMENT, STIPULATION AND ORDER FOR CONDITIONAL LICENSE
Page 40f8

7. The Board hereby concludes that violation of the above-indicated statutory and rule
provisions are subject to discipline of RESPONDENT's registered nursing license,
including her license for advanced practitioners of nursing ("APRN"). However, for the
reasons expressed in Paragraph 9 of the Findings of Fact hereinabove, PETITIONER
recommends that in lieu of a formal disciplinary hearing for discipline of
RESPONDENT's registered nursing license, RESPONDENT complete the following
terms and conditions specified below within the prescribed time frames.
8. Pursuant to WYO. STAT. § 16-3-107(n), applicable provisions of the NPA, and Chapter 8,
Section 4(d) [Disciplinary Committee and Review of Original Complaint] ofthe Board's
Rules, the Board 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:
[among other things,] [~] (C) Impose discipline by revocation, suspension, reprimand,
restriction, condition, non-renewal, or a combination thereof."
ORDER
IT IS THEREFORE HEREBY SETTLED, STIPULATED AND ORDERED AS
FOLLOWS:
1. Conditional License. The Board accepts this Agreement, which constitutes disciplinary
action of RESPONDENT's Registered Professional Nursing License, including her
license for advanced practitioners of nursing ("APRN") License No. APRN 8746.044,
for the conduct set forth in the Findings of Fact and Conclusions of Law in this
Agreement, and RESPONDENT shall be deemed to possess a Conditional License,
pursuant to the Board's authority in WYo. STAT. §33-2l-149, and the records of the
Board shall reflect such status until such time as reinstatement without restriction has
been approved by the Board.
2. Terms of Agreement. PETITIONER recommends that in lieu of a formal disciplinary
hearing for discipline of RESPONDENT's registered nursing license, RESPONDENT
complete the following terms and conditions specified below within the prescribed time
frames:
a. Direct Supervision by Physician or Certified Nnrse Midwife. Upon the
effective date of this Agreement, or such earlier time as may be mutually agreed
by and between RESPONDENT and PETITIONER, RESPONDENT be directly
supervised by a physician or certified nurse midwife ("CNM"), which may be in
another state or via locum tenens, approved by the Board or its designee, for a
minimum of ten (10) deliveries, and provide PETITIONER with a copy of the
medical records related to such deliveries, which shall include documentation by
such physician or CNM. Unless extended by permission of the BOARD or its
designee, such deliveries shall be completed, and medical records delivered to the
BOARD, no later than October 31, 2012.
[CONTINUED ON FOLLOWING PAGE]
IN THE DISCIPLINARY MATTER OF KAREN WENDT. APRN 8746.044·- Docket No. 10-015 -TW/KC
SETTLEMENT AGREEMENT, STIPULATION AND ORDER FOR CONDITIONAL LICENSE
Page 5 of8

. Peer Review. Within six (6) months following the effective date of this
Agreement, RESPONDENT shall establish a peer review committee as
recommended by the American College of Nurse-Midwives ("ACNM"), and
provide PETITIONER with documentation of the same, including
acknowledgment by members of the committee.
c. Refresher Educational Course. Within six (6) months of the effective date of
this Agreement, or as may be otherwise mutually agreed by and between
RESPONDENT and PETITIONER, RESPONDENT shall enroll in and complete
a refresher course in Labor and Delivery, or alternatively, further continuing
education offered by the ACNM focusing on management of home deliveries,
subject to the prior approval ofthe Board or its designee.
d. Additional Training. RESPONDENT has undergone and reported to the
BOARD training in coursework similar to "Ethics of Nursing Practice,"
"Professional Accountability & Legal Liability for Nurses," "and "Sharpening
Critical Thinking Skills" provided by National Council of State Boards of
Nursing, Inc. ("NCSBN") to be completed within six (6) months of the effective
date ofthis Agreement.
e. RESPONDENT shall provide documentation of completion of the coursework,
experience and training in subparagraph a, b, c and d within the prescribed times.
In the event RESPONDENT does not provide evidence and documentation of
completion of the coursework, experience and training as provided above,
RESPONDENT's Advanced Practice Nurse License No. APRN 8746.044 shall
be suspended until completed or pending further order of the Board and that a
formal letter of reprimand shall be entered against RESPONDENT's License No.
APRN 8746.044.
f. Authorizations. RESPONDENT shall duly execute any information releases,
including for medical records, or other consents that further the objectives of this
Agreement.
3. Notifications to Present/Future Employers. In the event RESPONDENT does not
provide evidence and documentation of completion of the coursework, experience and
training set forth above, and the CNM's APN License No APRN 8746.044 is suspended
and a formal letter of reprimand is entered against said practitioner and her license, she
shall notify any health care employer of the status of her suspended license. In the event
RESPONDENT relocates or obtains new or different employment, RESPONDENT shall
promptly notify PETITIONER oflhe same.
[CONTINUED ON FOLLOWING PAGE]
IN THE DfSCIP LINARY MATTER OF KARKN WEND7~ AP RN 8746. 044 -- Docket No.1 0-015 - TW IKe
SETTLEMENT AGREEMENT, STIPULATION AND ORDER FOR CONDITIONAL LICENSE
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4. Reporting by Board of Discipline. This Agreement also 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. 10-015, constitutes a public record within the meaning of the
Wyoming Public Records Act [WYo. STAT. §§ 16-4-201 et seq.] ("WRPA"), and
therefore, upon proper request shall be available for inspection and dissemination in
accordance therewith, except as otherwise provided by applicable state and/or federal
law, and Reprimand of and above conditions imposed on RESPONDENT's Advanced
Practice Nurse License No. APRN 8746.044, for discipline, shall be reported to such
public or private entities as required by law, including but not limited the Healthcare
Integrity and Protection Data Bank ("HIPDB") and the Office of Inspector General
("OIG"), as well as reporting to the NCSBN, which may be accessed under the
"NURSYS" web portal by authorized persons or entities.
5. Publication of Discipline. This Agreement shall be subject to publication on the Board's
website and a summary of the disciplinary action described therein shall be published in.
published in an issue of the Board's quarterly publication, the Wyoming Nurse Reporter,
following the Board's approval of the Agreement.
6. 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
bylaw.
7. Venue. Venue for enforcement or interpretation of this Agreement shall be in Laramie
County, Wyoming.
8. Waiver of Contested Case Hearing. RESPONDENT's execution of this Agreement
includes her full waiver of any contested case hearing to which she is entitled pursuant to
the NPA and the W APA.
9. Entire Agreement. 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. Should any portion of
this Agreement be judicially determined to be void, illegal or unenforceable, the
remainder of the Agreement shall continue in full force and effect, and either party may
renegotiate the terms affected by the severance.
10. Effective Date. 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 KAREN WENDT. APRN 8746.044 -- Docket No. 10-015 - TW/KC
SETTLEMENT AGREEMENT, STIPULATION AND ORDER FOR CONDITIONAL LICENSE
Page 70f8

AGREED TO AND ACCEPTED BY RESPONDENT
J, Karen Wendt, RESPONDENT herein, swear and affirm that I have read the foregoing
Agree~agree to its ter s and conditions as provided above.