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					IN THE MATTER OF                          *          BEFORE THE
                                          *
MAHA KANDIL                               *          MARYLAND BOARD
                                          *
License Number: R179953                   *          OF NURSING
                                          *
*      *       *      *        *    *     *    *     *      *      *     *         *

                              FINAL ORDER OF REVOCATION OF 

                               REGISTERED NURSING LICENSE 


       The Maryland Board of Nursing (lithe Board") pursuant to the Administrative

Procedure Act ("the APA"), Md. State Government Code Ann. ("State Govt.") § 10­

226(c)(1) (2009 Rep!. Vol.) and the Maryland Nurse Practice Act (the "Nurse Practice

Act"), Md. Health Occupations Code Ann. ("Health Occ.") §§ 8-101 et seq. (2009 Rep!.

Vo!.), finds the following:

                                        BACKGROUND

       On February 1,2011, the Board issued an ORDER FOR SUMMARY

SUSPENSION OF REGISTERED NURSING LICENSE AND NOTICE OF CHARGES

("Order of Suspension"), to Maha Kandil ("Respondent"), License Number R179953.

The Order of Suspension was sent by certified and regular mail to the last known

address registered by Respondent with the Board. The Order of Suspension is

attached hereto and fully incorporated into this FINAL ORDER OF REVOCATION OF

REGISTERED NURSING LICENSE. The Allegations of Fact and Conclusions of Law in

the Suspension Order are adopted as the Findings and Conclusions in this document.

       Included with the Suspension Order was a letter from the Board informing

Respondent that there would be a Show Cause Hearing on February 22,2011, before

the Board, for Respondent to have the opportunity to show cause as to why her license

should not remain suspended.
55 FO - M. Kandil, R179953


          Due to inclement weather, the February 22, 2011 Show Cause hearing was

rescheduled. By letter dated March 3, 2011, the Board notified the Respondent that her

Show Cause Hearing was rescheduled for March 21, 2011. Respondent failed to attend

the Show Cause Hearing.

          On March 24, 2011, the Board issued a letter to Respondent informing her that

the Board voted to continue the suspension of her Registered Nursing license.

          The Order of Suspension also placed Respondent on notice that she had thirty

(30) days from the date of notice of the Board's decision after the Show Cause hearing.

Additionally, Respondent was placed on notice that if a written request for an

evidentiary hearing was not sent within the specified time period, an Order would be

issued revoking her license. Respondent failed to submit a written request for an

evidentiary hearing.

          Because Respondent failed to request an evidentiary hearing, the Board now

issues the following Order:

                                              ORDER

                                                               d
          In consideration of the foregoing, it is this 2J6-1f.- ay Ofr   '        2011,

by a majority vote of a quorum of the Board:

          ORDERED that the Registered Nursing license of Maha Kandil, License Number

R179953, is hereby REVOKED; and it is further

          ORDERED that this Order of Revocation is a Final Order of the Board; and it is

further

          ORDERED that this Final Order is a public document pursuant to the Maryland

Public Information Act, State Govt. § 10-611, et seq. (2009 Repl. Vol.) and that for

purposes of public disclosure, the Board may disclose this document at its discretion to,


                                                  2

SS FO - M. Kandil, R179953


including but not limited to, any national reporting bank or other entity to whom the

Board is mandated to report.




                                          Nancy Ad      MBA, RN
                                          President
                                          Maryland Board of Nursing


                             NOTICE OF JUDICIAL APPEAL

Any person aggrieved by a final decision of the Board under Md. Health Occ. Code Ann.

section 8-6A-1 0 may take a direct judicial appeal within thirty (30) days) as provided by

Md. Health Occ. Code Ann. section 8-6A-11, Md. State Gov't. Code Ann. section 10-222

and Title 7, Chapter 200 of the Maryland Rules, including Md. Rule 7-203 ("Time for

Filing Action").




                                            3

IN THE MATTER OF                         *            BEFORE THE
                                         *
MAHA KANDIL                              *            MARYLAND BOARD
                                         *
License Number: R179953                  *            OF NURSING
                                         *
*     *      *      *      *      *      *     *      *      *      *      *      *

                             R
                        ORDEI FOR SUMMARY SUSPENSION 

                        OF REGISTERED NURSING LICENSE 

                            AND NOTICE OF CHARGES 


                                      BACKGROUND 


      On or about April 20, 2010, the Maryland Board of Nurs'ing (lithe Board") received

information that the ITcensee, Maha Kandil, R179953 ("Respondent") was disciplined by

the Pennsylvania State Board of Nursing CPA Board"). On April 20 , 2010, the PA Board

ordered the Respondent's Pennsylvania Nursing license be suspended indefinitely,

retroactive to January 26, 2010, after determining that she is unable to practice nursing

with reasonable skill and safety to patients by reason of mental or physical illness or

condition or physiological or psychological dependence upon alcohol, hallucinogenic or

narcotic drugs or other drugs which tend to impair judgment or coordination .

      While following up on this new information, the Board learned that the

Respondent failed to cooperate with two lawful investigations by the Maryland Board

following complaints regarding her nursing practice in Mary'land in 2007 and 2008 .

      Based on further information received by the Board, the Board has reason , as set

forth below, to find that the public health, safety or welfare imperatively requires

emergency action under Md. Code Ann ., State Gov't. § 10-226 (c) (2) (Repl. Vol. 2009)
Summary Suspension - M. Kandil, R179953


              ALLEGATIONS OF FACT AND REASONS IN SUPPORT OF
                    SUMMARY SUSPENSION AND CHARGES

      The Board has received reliable information that the following facts are true:

1)    On September 6, 20()7, Respondent was issued a Temporary Registered

      Nursing License in the State of Maryland. The Temporary Ucense expired on

      December 5,2007.

2)    On December 18, 2007, Respondent was issued Registered Nursing License

      R179953 in the· State of Maryland. Respondent's license is currently non-

      renewed having expired on May 28, 2008.

3)    On or about April 20,        2010,   the Board   received   information from the

      Pennsylvania Board of Nursing ("PA Board"), that they ordered the Respondent's

      Pennsylvania Nursing license be suspended indefinitely, retroactive to January

      26, 2010, after determining that she is unable to practice nursing with reasonable

      skill and safety to patients by reason of mental or physical illness or condition or

      physiological or psychological dependence upon alcohol, hallucinogenic or

      narcotic drugs or other drugs which tend to impair judgment or coordination.

                               Discipline in Pennsylvania

4)    On April 20, 2010, the PA Board issued a Final Adjudication and Order placing

      the Respondent's Pennsylvania Nursing License, RN-602919, in indefinite

      suspension retroactive to January 26, 2010 based on the following Findings of

      Fact:

      #6      On or about September 29, 2008 through October 9, 2008, Respondent
              was aSSigned by Fastaff Agency to Delaware County Memorial Hospital,
              501 North Lansdowne Ave., Drexel Hill, PA 19026.
      #7      From on or about September 29, 2008 through October 9, 2008, while
              assigned to Delaware County Memorial Hospital, Respondent committed



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Summary Suspension - M. Kandil , R179953



               recordkeeping errors , medication administration errors and was suspected
               of narcotics diversion .
       #8 	    On or about October 7, 2008, Respondent was asked by her employer to
               submit to a urine screen, which she did and was positive for Butalbital ,
               Nordiazepam, Oxapam and Temazepam .
       #9      Respondent failed to produce a prescription for the medications for which
               she tested positive.
       #10     Respondent was subsequently terminated from Delaware County
               Memoria l Hospital and Fastaff Agency.
       #11     Respondent was referred to the Professional Health Monitoring Program
               to determine if she was eligible for the Voluntary Recovery program,
       #12     Respondent refused enrollment in the VRP .
       #13     On or about October 23, 2009, the Commonweailth filed a petition to
               compel a mental and physical examination of Respondent with the
               Probable Cause Screening Committee of the State Board of Nursing .
       #14 	   On or about October 23, 2009, the Board's Probable Cause Screening
               Committee granted the Commonwealth's petition and issued an order
               compelling Respondent to submit to a mental and physical exami nation.
       #19 	   Respondent failed to attend the examination with [the assigned doctor] on
               December 22, 2009 at 5:00pm .
       #21 	   On or about January 4, 2010, the Commonwealth filed a motion to enter
               default and deem facts admitted and served it on Respondent by first
               class mail at her address on file with the Board at 206 Boox St., Forked
               River, NJ 08731.
       #22 	   Respondent did not answer the petition to compel a mental and physical
               examination and did not respond to the motion to enter default and deem
               facts admitted .
       #23 	   On or about January 6, 2010, the Board issued a memorandum order
               giving Respondent notice that if she did not request a hearing by January
               26, 2010, her license would be indefinitely suspended.
       #26     Respondent has not requested a hearing or otherwise responded in any
               way to the Commonwealth or to the Board.
                                                        [Final Adjudication and Order, p 3-6]

                                  Maryland Complaint #1

5) 	   On or about November 9, 2007 , the Board received a complaint regarding the

       Respondent's nursing practice from a hospital located in Baltimore, Maryland

       ("Hospital A").

6) 	   On or about October 22, 2007, Respondent started working for Hospital A as part

       of a travel assignment from an agency based in Florida ("Agency").




                                             3
Summary Suspension - M. Kandii, R179953



7)      On or about October                      several staff                          concerns regarding

        Respondent's actions du               her orientation and                to the unit.

8)      RN1 reported to the unit's            h~"f"1C>   Nurse that              concerns about

        nurse she was                     (the Respondent). RN1                  that a patient on the unit

              already requested that the Respondent not                        assigned to care for

        When the patient in question was asked to elaborate.                       patient noted that when

        the Respondent was trying to start the patient's IV, the Respondent "kept

        scratching her nose                       and her eyes were rolling                in her         "

                  stated that                     had been a heroi n                 for several years

              recognized another drug addict when she saw one."

9)      Another nurse. RN2,                       the Respondent               two bowls of soup off

        patient food carts and while taking then into the                   k room she dropped them."

10)              RN2 and                            that while                    was eating a

             was "pulling her                    up and shirt up                        scratching her

        back and underarms." When co-workers                                     Respondent if she was

        alright, Respondent                 that "she had a visitor             last night and had drank

        some alcohol and that made her itch."

11 )    Towards the end of                      Respondent pulled 8mg of                        I   IV from the

        pyxis 2 and asked RN2 to                         3mg with her.                          waste in



IOialudid is a narcotic (opiate)                  used to treat or prevent moderate to severe pain. It is a
            II CDS.
         (also called AccuDose) is an automated drug-dispensing device that                    CDS and other
medications. Each time it is accessed, it records information including name of medication, dose. time of
                return of medication (if it is not used), patient name and identification of nurse accessing the
                 Each nurse has his/her own           or password to gain access to the medications.
  rno./'1'I""t,    is wasted if the              or unit dose is greater than the            dose or if the
               is not used. Properly               a medication means disposing of       unused portion of the


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Summary Suspension - M. Kandil, R179953



        pyxis, and then when she went to physically waste the 3mg, the Respondent

        turned away from her and said she would have her preceptor, RN 1, waste the

        drug with her. Approximately 15 minutes later RN2 asked RN 1 if Respondent had

        wasted the Dilaudid with her and RN 1 stated that she had not RN2 then asked

        Respondent what had happened to the 3mg of Dilaudid. Respondent answered

        that she had thrown it away.

12) 	   On October 25, 2007, Respondent was sent to Hospital A's Occupational Health

        Services department and ordered to submit to a "for cause" drug and alcohol

        screen.

13) 	   Respondent        tested     positive     for    the    following      substances'          Opiates,
                                                                                            7
        Benzodiazepines 4 , Propoxyphene 5 , Hydromorphone6 and Alprazolam                      .


14)     The drug screen results were forwarded to the Respondent's Agency who 


        terminated her and made her rehire status with the Agency - "Do Not Hire." 


                                       Maryland Complaint #2 


15) 	   On or about January 29, 2008, the Board received a second complaint regarding

        the Respondent's nursing practice from a hospital located in Baltimore, Maryland

        ("Hospital B").

16) 	   The complaint alleged that on January 15, 2008, Respondent visited the

        hospital's Human Resources Department. While meeting with the Manager of

        Human      Resources and         Business       Partner for Patient Care            ("Manager"),

drug, typically with a witness who observes the disposal, and recording the wasting pursuant to facility 

policy. Unused packaged medications can also be returned to the Pyxis machine. 

                                            2
4 Benzodiazepine [benzo-+diazep(am)+ine j: Benzodiazepines work directly on the brain and nerves 

~central nervous ~ystem) to ~roduce a calming effect. 

  Propoxyphene IS a narcotic analgesIc structurally related to methadone. It is a Schedule IV CDS.
6 Hydromorphone is a narcotic analgesic used to treat moderate to severe pain. It is a schedule II CDS.
7 Alprazolam (brand name = Xanax) is a benzodiazepine used to treat anxiety and panic disorder. It is a

Schedule IV CDS


                                                    5
Summary Suspension - M. Kandil, R179953


                                  were                        "very                                times du

        the co                  Respondent                    off while                     " Respondent

        could not stop scratching several parts of her body."

17)     The               reported that following their conversation, Respondent left                       area

        to return to work on the floor.                Manager immed                              her concerns

        about         Respondent's                    duty with the                            Director and the

        Employee               Department

18)     Once reaching her assigned unit, Respondent was                         rn<;;>rcn   to report directly to

        Employee               and submit to "for cause" urine/blood                        and alcohol testing.

        Following               Respondent was                home pending                     screen results.

19)     Respondent tested positive for: Oxymorphone 3, Hydromorphone, Nordiazepam9 ,
                                                               12



20)     On                   2008, Respondent was terminated from Hospital B for violations

        of the               Substance              Policy.

21)     Following           complaint, the              invited the                           enter the

        Rehabilitation Program. The                                 failed to                   to the Board's

        invitation.

22}     The              investigator made multiple attempts to contact                         Respondent to

        complete         investigation. The                         failed to                       investigator




8 Oxymorphone is used to treat moderate to severe          It is a schedule I
9 Nordiazepam, is a            with depressant effect on the central nervous               It is a schedule IV
CDS.
to Oxazepam is used to treat anxiety disorders or alcohol withdrawal symptoms. It is a schedule IV CDS.
II Temazepam is in a group of drugs called                       It affects chemicals in the brain that may
become               and cause        problems               It is a schedule IV
!l Tramadol is a narcotic-like    reliever


                                                      6
Summary Suspension - M. Kandil, R179953


        and the contact information the Respondent had provided to the Board were

        deemed to be out of date.

23) 	   Respondent's recent discipline in Pennsylvania, her frequent traveling to different

        jurisdictions in a possible attempt to avoid discipline, and ongoing problem with

        using multiple controlled dangerous substances while on the job makes her

        practice as a registered nurse dangerous and makes any patient under her care

        a potential victim. Furthermore, while Respondent's nursing license is currently

        non-renewed in the State of Maryland. without Board action, Respondent is not

        prevented from renewing her license. Based on the information in paragraphs 1

        through 22, as well as the information contained in the Background, the Board

        finds that the public health, safety or welfare imperatively requires emergency

        action in this case .

24) 	   Based on the allegations of fact under Background and in paragraphs 1 through

        22, the Board voted to charge Respondent with violations of the Nurse Practice

        Act (the "Act"), Md. Code Ann ., Health Occupations Article, §§ 8-101 et. seq.

        (2009 Repl. Vol.) as listed below. The pertinent provisions of Health Occupations

        Article § 8-316 (a) , and the violations under which the above allegations of fact in

        paragraphs 1 through 22 are brought and for which the Board has charged

        Respondent, are as follows:

        (a) 	   In general. - Subject to the hearing provisions of § 8-317 of this
                 subtitle, the Board may ... reprimand any licensee, place any
                 licensee on probation, or suspend or revoke the license of a
                 licensee if the ... licensee:

                (3) 	   Is disciplined by a licensing, military, or disciplinary authority
                        in this State or in any other state or country or convicted or
                        disciplined by a court in this State or in any other state or



                                                 7
Summary Suspension - M. Kandil, R179953


                     country for an act that would be grounds for disciplinary
                     action under the Board's disciplinary statutes ; to wit:
                     (7) 	  Provides professional services while: (ii) Using any
                            narcotic or controlled dangerous substance, as
                            defined in § 5-101 of the Crimina: Law Arti.cle, or
                                                                    1
                            other drug that is in excess of therapeutic amounts or
                            without valid medical indication;
                     (8) 	  Does an act that is inconsistent with generally
                            accepted professional standards in the practice of
                            registered nursing or licensed practical nursing;
                     (12) 	 Is physically or menta'lly incompetent;
                     (19) 	 Is addicted to, or habitually uses, any narcotic or
                            controlled dangerous substance as defined in § 5-101
                            of the Criminal Law Article;
                     (20) 	 Fails to cooperate with a lawful investigation
                            conducted by the Board;
                     (25) 	 Engages in conduct that violates the profeSSional
                            code of ethics , to wit:
                            COMAR 10.27.19.02(B) A nurse may not, when
                            acting in the capacity or identity of a licensed nurse:
                            (5) 	 Practice nursing if unfit to perform procedures
                                   or make decisions because of physical or
                                   mental impairment, including , but not limited
                                   to, the effects of prescription drug,s;
                            COMAR 10.27.19.02(C) A nurse may not engage in
                            behavior that dishonors the profession whether or not
                            acting in the capacity or identity of a licensed nurse.
                            including. but not limited to:
                            (4) 	  Diverting any medication or providing false or
                                   misleading information to an authorized
                                   prescriber or a pharmacist to obtain or attempt
                                   to obtain any medication;
                            (8) 	  Using . possessing. supplying, administering,
                                   or attempting to use, possess, supply, or
                                   administer prescription drugs or controlled
                                   dangerous substances without valid medical
                                   indication;
                            (9) 	  Reporting for employment under the influence
                                   of alcohol or drugs, without having provided
                                   evidence of valid prescriptions for all drugs in
                                   the sarnple;

             (8) 	   Does an act that is inconsistent with generally accepted
                     professional standards in the practice of registered nursing
                     or licensed practical nursing;




                                            8
Summary Suspension - M. Kandil, R179953


             (19) 	 Is addicted to, or habitually uses, any narcotic or controlled
                    dangerous substance as defined in § 5-101 of the Criminal
                    Law Article;

             (20) 	 Fails to cooperate with a lawful investigation conducted by
                    the 80ard ;

             (25) 	 Engages in conduct that violates the professional code of
                    ethics, to wit:
                    COMAR 10.27.19.02(8) A nurse may not, when acting in the
                    capacity or identity of a licensed nurse:
                    (5) 	 Practice nursing if unfit to perform procedures or
                            make decisions because of physical or mental
                            impairment, including, but not limited to, the effects of
                            prescription drugs;
                    COMAR 10.27.19.02(C) A nurse may not engage in
                    behavior that dishonors the profession whether or not acting
                    in the capacity or identity of a licensed nurse, including, but
                    not limited to:
                    (4) 	 Diverting any medication or providing false or
                           misleading information to an authorized prescriber or
                            a pharmacist to obtain or attempt to obtain any
                            medication;
                    (8) 	 Using, possessing, supplying, administering, or
                           attempting to use, possess, supply, or administer
                            prescription    drugs      or   controlled   dangerous
                           substances without valid medical indication;
                    (9) 	 Reporting for employment under the influence of
                           alcohol or drugs, without having provided evidence of
                           valid prescriptions for all drugs in the sample;


             (28) 	 After failing to renew a license or after a temporary license
                    has lapsed, commits any act that would be grounds for
                    disciplinary action under this section;

      The applicable section of SG § 10-226 (c) (2) provides that:
            (2) A unit may order summarily the suspension of a license if the unit:
                   (i) 	  Finds that the public health, safety, or welfare imperatively
                          requires emergency action; and
                   (ii) 	 Promptly gives the licensee:
                          1. 	   Written notice of the suspension, the finding and the
                                 reasons that support the finding ; and
                          2. 	   An opportunity to be heard.




                                            9
Summary Suspension - M. Kandil, R 179953



                                  CONCLUSIONS OF LAW 


          Based on the foregoing investigative information, the Board finds that the public

health, safety or welfare imperatively requires emergency action in this case, pursuant

to Md . Code Ann., State Gov't. § 10-226 (c) (2) (2009 Repl. Vol.)


                                           ORDER

          It is, by a majority of a quorum of the Maryland Board of Nursing:

          ORDERED that, pursuant to the authority vested in the Board by Md. Code Ann.,

Health Occ ., § 8-316 (a) (2009 Repl. Vol.) and Md. Code Ann., State Gov't., § 10-226

(c)(2) (2009 Repl. VoL), the license of MAHA KANDIL, R179953, an individual licensed

to practice REGISTERED NURSING, is hereby SUMMARILY SUSPENDED; and be it

further

          ORDERED that, there will be a Show Cause Hearing on Tuesday, February 22,

2011, at 10:00 a.m. before the Board at the Board of Nursing, 4140 Patterson Avenue,

Baltimore, Maryland 21215, for Respondent to have the opportunity to show cause as to

why her license should not be suspended; and be it further

          ORDERED that, if Respondent's license is suspended following a Show Cause

Hearing, upon a written request by Respondent, an evidentiary hearing to consider the

merits of this Summary Suspension and charges cited in this Order will be held at the

Board of Nursing, within a reasonable period of time from the date upon which the

Board receives the written request; and be it further

          ORDERED that, if Respondent requests an evidentiary hearing before the Board,

Respondent must make the request in writing within thirty (30) days from the date of the

Show Cause Hearing.        If a request for hearing is not received within thirty (30) days



                                              10
Summary Suspension - M. Kandil, R179953



from the date of the Show Cause Hearing, Respondent waives all rights now and in the

future to any hearing with respect to this Order or the associated charges, or to any

proceedings that would contest the validity of the factual allegations of this Order for

Summary Suspension and to any appeals; and be it further

       ORDERED that, if a request for hearing is not received within thirty (30) days

from the date of the Show Cause Hearing, a Final Order for Revocation of License,

including Findings of Fact and Conclusions of Law, will be issued to Respondent; and

be it further

       ORDERED that, in the event Respondent requests an evidentiary hearing, the

proceeding before the Board will be conducted in accordance with the Administrative

Procedure Act (UAPA"), Md. Code Ann., State Gov't., § 10-201 et seq. (2009 Repl. Vol.),

§ 8-317 of the Act and regulations promulgated by the Board at COMAR 10.27.02. The

APA gives Respondent the right to be represented by counsel authorized to practice law

in Maryland, to request subpoenas for evidence and witnesses, to call witnesses, to

present evidence, to cross examine every witness called by the Board, to obtain a copy

of the hearing procedure upon written request, and to present summation and

argument. Unless otherwise prohibited by law, Respondent may agree to the evidence

and waive her right to appear at the hearing; and be it further

       ORDERED that, for purposes of public disclosure, as permitted by Md . Code

Ann., State Gov't., § 10-617(h) (2009 Repl. Vol.) this document consists of the foregoing

Summary Suspension of Registered Nursing License and Notice of Charges and that

the Board may disclose this document to any national reporting bank or other entity to

whom the Board is mandated to report; and be it further




                                            JJ
Summary Suspension - M. Kandil, R179953



      ORDERED that, this Order is a public document pursuant to Md. Code Ann.,

State Gov't. §§ 10-601, et. seq., (2009 Repl. VoL).




       h16t.4d' II, ZM
       Date                                     Patricia A. Noble R.N .,
                                                Executive Director
                                                Maryla nd ~~~'NUii1rsITrIn1cgl---




                                           12

				
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