SANFIEL v. DEPARTMENT OF HEALTH

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Docket Number

No. 98-1717.

Advocates

Jose N. Proenza Sanfiel, St. Cloud, pro se. Kathryn L. Kasprzak, Senior Attorney for the Agency for Health Care Administration, Tallahassee.

Judges

THOMPSON, J.

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Smart Summary

Factual and Procedural Background

Jose N. Proenza Sanfiel, a licensed psychiatric nurse, possessed a computer containing confidential patient records previously owned by Charter Behavioral Health System, a psychiatric hospital. He obtained the computer, allegedly from a thrift shop, though the thrift shop denied any record of sale and Charter denied donating the computer. Proenza Sanfiel reviewed the patient data, believed Charter was defrauding the government, and sought to initiate a criminal investigation. When law enforcement declined jurisdiction, he disclosed the confidential patient information to the news media, requesting that patient names be blurred. Despite this request, the broadcast revealed patient names and diagnoses, causing distress to at least one patient and possibly others. The State Agency for Health Care Administration (AHCA) ordered an emergency suspension of Proenza Sanfiel's nursing license and demanded the return of the hard drive, which he refused, even proposing to return it for $20,000. Charter obtained an injunction preventing further disclosure of the confidential information. The State Board of Nursing subsequently issued a final order suspending Proenza Sanfiel's license and placing him on probation for five years for disclosing confidential patient information. Proenza Sanfiel appealed this disciplinary order.

Legal Issues Presented

Whether the State Board of Nursing was authorized to suspend Proenza Sanfiel's nursing license due to his conduct involving patients who were not under his care.

Arguments of the Parties

Appellant's Arguments

Proenza Sanfiel contended that he should not be disciplined because he acted in a private capacity rather than as a nurse in relation to the patients whose records he disclosed.

Appellee's Arguments

This information was not available in the provided opinion.

Table of Precedents Cited

Precedent	Rule or Principle Cited For	Application by the Court
Boedy v. Dept. of Professional Regulation, Board of Medical Examiners, 433 So.2d 544 (Fla. 1st DCA 1983)	Board's jurisdiction to discipline a licensed professional despite inactive practice status.	Used to support the Board's jurisdiction over Proenza Sanfiel despite him not actively practicing nursing at the time of misconduct.
Taylor v. Dept. of Professional Regulation, Board of Medical Examiners, 534 So.2d 782 (Fla. 1st DCA 1988)	Limits on Board's jurisdiction to discipline for misconduct occurring before licensure.	Distinguished to clarify that Proenza Sanfiel was licensed at the time, so the Board had jurisdiction.
Okeechobee Health Care v. Collins, 726 So.2d 775 (Fla. 1st DCA 1998)	Deference to agency interpretation of statutes and rules it administers.	Supported affirming the Board's interpretation of confidentiality rules as reasonable.
Republic Media, Inc. v. Dept. of Transp., 714 So.2d 1203 (Fla. 5th DCA 1998)	Standard for judicial review of agency interpretations within a reasonable range.	Reinforced the court's deference to the Board's interpretation of confidentiality violations.
Metropolitan Dade County v. State Dept. of Environmental Protection, 714 So.2d 512 (Fla. 3d DCA 1998)	Judicial deference to administrative agency interpretations.	Further supported affirming the Board's disciplinary action based on its interpretation of the rules.
Natelson v. Dept. of Insurance, 454 So.2d 31 (Fla. 1st DCA 1984)	Judicial deference standard for agency interpretations.	Cited to confirm the appropriateness of deferring to the Board's interpretation of confidentiality rules.

Court's Reasoning and Analysis

The court recognized that the Board's authority to discipline Proenza Sanfiel stems from Florida Statutes Chapters 455 and 464, which govern professional regulation and nursing specifically. Although Proenza Sanfiel was not actively practicing nursing at the time of the disclosure, his license was active and in good standing, thus the Board had jurisdiction. The key legal question was whether the Board could discipline him for disclosing confidential patient information relating to patients not under his care. The court acknowledged that Proenza Sanfiel knowingly violated confidentiality rules by releasing patient information to the media, despite his awareness that such disclosures could subject a nurse to discipline. The Board's interpretation of Rule 59S-8.005(1)(e), which prohibits violating patient confidentiality, was deemed reasonable and within the scope of the agency’s authority. The court applied established principles of judicial deference to administrative agency interpretations, citing multiple precedents that support affirming agency decisions when interpretations are reasonable. The court concluded that Proenza Sanfiel's actions constituted unprofessional conduct, regardless of whether he acted in a private capacity, and therefore upheld the Board's disciplinary order.

Holding and Implications

The court affirmed the State Board of Nursing's final order suspending Proenza Sanfiel's psychiatric nursing license and placing him on probation for five years.

The direct effect of this decision is the enforcement of disciplinary measures against Proenza Sanfiel for disclosing confidential patient information. The court did not establish new legal precedent but reinforced the principle that licensed professionals may be disciplined for breaches of confidentiality regardless of whether they were acting in a professional or private capacity at the time of the misconduct.

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JOSE N. PROENZA SANFIEL, R.N., Appellant, v. DEPARTMENT OF HEALTH, Appellee.

THOMPSON, J.

Jose N. Proenza Sanfiel appeals a final order issued by the State Board of Nursing following disciplinary proceedings. The order suspends Proenza Sanfiel's psychiatric nursing license and places him on probation for five years for disclosing confidential patient information. We affirm.

Proenza Sanfiel raises several issues which have no merit. We address one issue: whether the State Board of Nursing was authorized to suspend Proenza Sanfiel's license because of his conduct involving patients not under his care.

Proenza Sanfiel obtained a computer which was previously owned by Charter Behavioral Health System("Charter"), a psychiatric hospital in Orlando. Charter's patient records were contained in the computer. Proenza Sanfiel testified that he reviewed this information and recalled that Charter was being investigated for defrauding the government. He contacted local law enforcement and the state attorney's office to initiate a criminal investigation. The agencies declined, telling him that the matter was outside their jurisdictions. Proenza Sanfiel then called the news media and allowed them to see the information concerning the patients. He asked that the patients' names be blurred to protect their identity. He believed that the information on the computer should have been erased before the computer was donated as surplus. He told reporters that the hard drive contained the names of psychiatric patients, their admission dates, types of addiction, treatments and psychiatric disorders. The story was broadcast along with the patients' names and diagnoses shown on the computer screen. One of the journalists located and interviewed a patient identified from Sanfiel's computer. The patient was tremendously distraught over the fact that his confidential medical information was being exposed to the public. An unknown number of other patients were also contacted by the news media.

Proenza Sanfiel testified that he obtained the computer from a thrift shop for $20. The executive director of the shop testified there were no records of any purchase of a computer at any time by Proenza Sanfiel. Charter maintains it did not donate the computer to the thrift shop.

The State Agency for Health Care Administration ("AHCA") immediately began investigating and ordered an emergency suspension of Proenza Sanfiel's nursing license. When the representative for AHCA asked for the hard drive with the patients' confidential information, Proenza Sanfiel refused to surrender it. When representatives from Charter asked that the computer be returned, Proenza Sanfiel again refused, but suggested he would be willing to return the computer and the information for $20,000. Charter obtained an injunction prohibiting Proenza Sanfiel from disclosing confidential patient information.

Proenza Sanfiel does not dispute that he made the disclosure or that as a psychiatric nurse he knew that the information on the computer was confidential. He admitted that he was aware that a nurse could be disciplined for disclosing confidential psychiatric information to unauthorized persons. However, he argues that he could not be punished because he was acting in a private capacity and not as a nurse to the patients whose records were contained on the computer.

The Board's authority to discipline Proenza Sanfiel is derived from Chapters 455 and 464, Florida Statutes. Chapter 455 contains general provisions for the regulation of all professions, while Chapter 464 specifically addresses nursing. Proenza Sanfiel may not have been practicing nursing in January 1997, but he was licensed and his license was active and evidently in good standing. Therefore, the Board had jurisdiction to discipline him. Compare Boedy v. Dept. of Professional Regulation, Board of Medical Examiners, 433 So.2d 544 (Fla. 1st DCA 1983) (Board of Medical Examiners had jurisdiction to discipline physician whose license was inactive) with Taylor v. Dept. of Professional Regulation, Board of Medical Examiners, 534 So.2d 782 (Fla. 1st DCA 1988) (Board of Medical Examiners lacked jurisdiction to discipline physician for professional misconduct which occurred before he became licensed). That Proenza Sanfiel was not working as a nurse and had no professional relationship with the patients whose records were on his computer has no bearing on the Board's jurisdiction to discipline him. Rather, those circumstances are relevant to whether he may be disciplined for his actions.

Under section 464.108(1)(l), Florida Statutes (1997), Proenza Sanfiel could be disciplined for "[k]nowingly violating any provision of this chapter, a rule of the board or the department, or a lawful order of the board or department previously entered in a disciplinary proceeding or failing to comply with a lawfully issued subpoena of the department." The Board the determined that Proenza Sanfiel violated Florida Administrative Code Rule 59S-8.005(1)(e) "by violating the confidentiality of information or knowledge concerning a patient." An agency's interpretation of a statute or rule it has authority to administer should receive deference from a reviewing court and should not be overturned unless it is clearly erroneous. Okeechobee Health Care v. Collins, 726 So.2d 775 (Fla. 1st DCA 1998); Republic Media, Inc. v. Dept. of Transp., 714 So.2d 1203 (Fla. 5th DCA 1998); Metropolitan Dade County v. State Dept. of Environmental Protection, 714 So.2d 512 (Fla. 3d DCA 1998). So long as the agency's interpretation "is within the range of possible and reasonable," it should be affirmed. Republic Media at 1205 (citing Natelson v. Dept. of Insurance, 454 So.2d 31 (Fla. 1st DCA 1984)).

Rule 59S-8.005 states in part that unprofessional conduct includes violating the confidentiality of information or knowledge concerning a patient. The Board reasonably interpreted this provision to apply to the circumstances present in this case. Proenza Sanfiel testified that he knew the information he possessed was confidential patient information, and that he understood the danger in disclosing psychiatric records to unauthorized persons. He knew that a nurse could be disciplined for disclosing such information, yet he intentionally released the information to the news media. It is reasonable to characterize Proenza Sanfiel's actions as unprofessional conduct even though Proenza Sanfiel was acting in a "private" capacity. Therefore, we do not disturb the Board's determination.

Rule 59S-8.005 has been renumbered and is now Rule 64B9-8.005.

AFFIRMED.

ANTOON, C.J., and COBB, J., concur.