Clayton v. Ohio Bd. of Nursing, 2014 Ohio 2077

Clayton, a nurse, supervised ICU care for Patient 1, an elderly patient with multiple comorbidities, on Aug. 27–28, 2009.
Dr. Bowers issued orders including Lasix q8h, Cardizem bolus then drip, consultations, and a saline lock; orders were entered by the hospital pharmacist.
Clayton relied on computer-entered information and failed to locate or implement the physician's orders for Patient 1.
Clayton administered 1,097 mL of normal saline during her shift, including a 250 mL bolus, with no clear physician order supporting the total amount.
Patient 1’s condition deteriorated; he died later that day; the Board charged Clayton under R.C. 4723.28(B)(16) and (19) for substandard care and failure to practice safely.
The Board held hearings; the hearing examiner found violations and recommended indefinite suspension with conditions; the Board adopted an adjudication order with modifications.

Issue	Plaintiff's Argument	Defendant's Argument	Held
Subpoena denial and prejudice	Clayton contends denial prevented relevant defense evidence.	Board asserts no prejudice since other testimony was allowed and records could be obtained otherwise.	No reversible prejudice; subpoena denial affirmed.
Saline administration without proper order	Record does not prove uninterrupted saline administration without a physician order.	847 mL saline beyond the Chaudhry order violated standards regardless of timing specifics.	Clayton administered 847 mL without a physician order, violating standards.
Failure to locate/implement physician orders	Reliance on pharmacist-entered data justified treatment when orders were missing.	Standards require locating and implementing physician orders; pharmacist entry does not excuse violations.	Violation found; failure to locate/implement orders sustains disciplinary action.
Timeliness of seeking physician intervention	Waiting until 4:00 a.m. to contact a hospitalist was reasonable under chaotic conditions.	Standards require timely notification when patient deteriorates or when treatments fail.	Unreasonable delay; failure to timely seek physician intervention supported discipline.
Burden of proof and credibility of evidence	Hearing examiner misapplied burden and credibility standards.	Board properly carried burden; credibility determinations are for the factfinder.	Appellate review upheld; any misphrasing did not undermine Board's burden or outcome.

Our Place, Inc. v. Ohio Dept. of Job & Family Servs., None (2005-Ohio-2714) (reliability, probativity, and substantiality standard in administrative review)
Pons v. Ohio State Med. Bd., 66 Ohio St.3d 619 (1993) (appellate review confines to abuse of discretion when assessing agency findings)
In re University of Cincinnati v. Conrad, 63 Ohio St.2d 108 (1980) (credibility and deference to agency fact-finding on evidentiary conflicts)
AmCare, Inc. v. Ohio Dept. of Job & Family Servs., 161 Ohio App.3d 350 (2005-Ohio-2714) (standard for reviewing agency credibility and evidentiary weight)
Lies v. Ohio Veterinary Med. Bd., 2 Ohio App.3d 204 (1981) (credibility and weight of evidence in administrative appeals)
Ohio State Bd. of Pharmacy v. Frantz, 51 Ohio St.3d 143 (1990) (subpoena authority and necessity in administrative hearings)