Opinion ID: 1973256
Heading Depth: 1
Heading Rank: 4

Heading: nebraska licensure and revocation

Text: Navrkal applied for a medical license in Nebraska in 1996. In letters to the then Nebraska Department of Health Professional and Occupational Licensure Division, Navrkal informed it that he had successfully completed a treatment program for alcoholism and had been sober for 2 years. He also wrote that he took full responsibility for his past lapses and was agreeable to any reasonable stipulations on his license. His application was also supported by several letters of recommendation. On April 4, 1996, the Nebraska Board of Examiners in Medicine and Surgery (board) granted a license to Navrkal subject to a 5-year probationary period. Among the terms and conditions attached to his license, Navrkal was required to abstain from the consumption of alcohol and submit a practice plan for approval by the board. The board subsequently approved a practice plan that permitted Navrkal to practice at the Douglas County Hospital in Omaha, Nebraska. Despite having been approved to practice medicine only at the Douglas County Hospital, Navrkal also began practicing occasionally at the Schuyler Memorial Hospital in Schuyler, Nebraska. Navrkal claimed that he erroneously thought he had been approved to practice in Schuyler. Navrkal moonlighted at the hospital in Schuyler without authorization for approximately 1 year. While working at the Douglas County Hospital in early 1997, Navrkal met T.M., a female patient in the hospital's psychiatric ward. The details of Navrkal's relationship with T.M. were set forth in the State of Nebraska's petition to revoke Navrkal's license. Navrkal did not contest any of the following allegations from that petition: 22. Patient TM is a 27 year old female with a ninth grade education who was admitted to the Douglas County Hospital on January 11, 1997, for major depression with suicidal ideation and panic disorder. She was also treated at the Douglas County Hospital for drug and alcohol dependency prior to her discharge to the Hastings Regional Center on February 7, 1997 for another month of chemical dependency treatment. 23. [Navrkal's] responsibilities for treating Patient TM at the Douglas County Hospital included screening and assessing her medical condition, collaborating with the Advanced Registered Nurse Practitioner who also treated Patient TM's medical condition, and medical follow-up as needed or indicated for Patient TM. 24. [Navrkal] was notified of Patient TM's admission to Douglas County Hospital on the afternoon of January 11, 1997. [Navrkal] directed that Patient TM's initial medical history and physical be performed by the Advanced Registered Nurse Practitioner for whom [Navrkal] was the designated collaborating physician. 25. [Navrkal] made and/or annotated treatment orders for Patient TM on at least five occasions while she was a patient in the Douglas County Hospital. The five occasions included [Navrkal's] documentation of the following matters on Physician's Order/Progress Notes of Patient TM's medical records: Patient TM's history of abnormal PAP smears, scheduling for pelvic and PAP smear in the hospital's clinic for which [Navrkal] was the Medical Director, prescribing medications on separate occasions, examining Patient TM after her complaint of lower left quadrant pain, discussing results of PAP smear, and treating Patient TM's complaint of sinus congestion. 26. [Navrkal] regularly visited and communicated with Patient TM while she was a patient at Douglas County Hospital. 27. Several of the nursing and professional staff at Douglas County Hospital warned [Navrkal] against having personal involvement with patients in the psychiatric unit, specifically including Patient TM after observing [Navrkal's] interactions with Patient TM. [Navrkal] ignored the warnings. 28. Patient TM was transferred directly from the Douglas County Hospital to the Hastings Regional Center on February 8, 1997. 29. Patient TM was a patient in the Hastings Regional Center from February 8, 1997, through March 7, 1997, when she was discharged. 30. During the time Patient TM was a patient in the Hastings Regional Center, [Navrkal] regularly phoned Patient TM. 31. During the time Patient TM was a patient in the Hastings Regional Center, [Navrkal] sent her flowers. 32. During the time Patient TM was a patient in the Hastings Regional Center, [Navrkal] engaged in written correspondence of a romantic nature with Patient TM. .... 35. Patient TM responded by sending numerous letters to [Navrkal]. The letters became more sexually explicit as time moved toward her anticipated discharge from the Hastings Regional Center, including references to a rendezvous with [Navrkal] upon Patient TM's discharge. 36. On March 7, 1997, Patient TM was discharged from the Hastings Regional Center. 37. On March 7, 1997, [Navrkal] picked Patient TM up at a prearranged meeting location. 38. After picking up Patient TM, [Navrkal] drove straight to a motel in Schuyler, Nebraska. 39. [Navrkal] registered and paid for a motel room for two people in his name. [Navrkal] and Patient TM stayed at the motel the entire weekend of March 7 through 10, 1997. .... 41. [Navrkal] and Patient TM had sexual relations in the motel at various times during the weekend. 42. [Navrkal] also worked as a physician and was on call at the Schuyler Memorial Hospital the same weekend. 43. When Patient TM was discharged from the Hastings Regional Center, her discharge treatment recommendations included the recommendation that she contact a specific psychiatrist who had treated Patient TM at the Douglas County Hospital. 44. After Patient TM's discharge from the Douglas County Hospital [sic], Patient TM told [Navrkal] of Patient TM's desire to pursue out-patient treatment with the psychiatrist at the Douglas County Hospital. [Navrkal] told Patient TM that she couldn't see this particular psychiatrist for aftercare because of [Navrkal's] sexual relationship with Patient TM and [Navrkal's] employment at the Douglas County Hospital. [Navrkal] advised Patient TM to go elsewhere for out-patient treatment. 45. The psychiatrist at Douglas County Hospital subsequently had to advise Patient TM, when she contacted him for treatment, that he could not treat her because of Patient TM's personal involvement with [Navrkal], who was an employee of the same hospital. The psychiatrist referred her to another hospital for out-patient treatment. 46. On April 15, 1997, [Navrkal] was placed upon a leave of absence, pending further investigation, by the Douglas County Hospital when supervisory staff became aware of [Navrkal's] correspondence with Patient TM. 47. The day [Navrkal] was placed on a leave of absence, he called Patient TM. While the son of a cardiologist was listening in on the phone conversation, with the consent of Patient TM, [Navrkal] made comments such as the following to Patient TM: You can't tell anyone that we had relations-promise me! Can you promise me? You have to tell them that we had no relations, you have to tell them that you were unstable and that I kept asking you to quit sending them, you have to tell them that or I will lose my license and that can't happen. We need to get our stories straight. 48. Douglas County Hospital, at all times relevant herein, had a written hospital policy that stated, in part, as follows: Personnel will not be personally involved with any patient during the patient's hospitalization ... at Douglas County Hospital and for a period of 6 months following discharge, unless the relationship existed prior to hospitalization/residency or is part of the patient's written care plan. [Navrkal] would have been made aware of the policy during his orientation as a hospital employee in 1996. 49. On or about April 24, 1997, [Navrkal] resigned his position with Douglas County Hospital. 50. At approximately the same time [Navrkal] resigned his position, he went to the trailer where Patient TM was residing and entered the trailer without being invited. While Patient TM was hiding in a closet, [Navrkal] went through drawers and other areas of the trailer. Two witnesses, in addition to Patient TM, caught [Navrkal] in the act of searching Patient TM's trailer. 51. [Navrkal] was observed consuming beer, by persons other than Patient TM, from March through April, 1997. 52. Patient TM, upon discharge from chemical dependency treatment at the Hastings Regional Center, was also taken by [Navrkal] to bars in the town of Schuyler, Nebraska during the same weekend of March 7-10, 1997. Patient TM observed [Navrkal] drinking beer. 53. [Navrkal] has been interviewed by an investigator for the Department of Health and Human Services Regulation and Licensure concerning the above events. 54. [Navrkal] has admitted to the investigator that he sent the previously alleged written correspondence to Patient TM while she was a patient in the Hastings Regional Center, that he sent her [a] stuffed animal, that he called her, that he picked her up, and that they stayed in the same motel room in Schuyler on the weekend of March 7-10, 1997. However, [Navrkal] denied having any sexual relations with Patient TM and explained that he and Patient TM had just been good friends. 55. [Navrkal] lied to the Department's investigator when he denied having sexual relations with Patient TM. As mentioned, the State filed a petition for disciplinary action against Navrkal on June 27, 1997. The petition sought to revoke Navrkal's medical license because of his relationship with T.M., his consumption of alcohol in violation of the terms of his probationary license, and his practicing medicine in Schuyler without approval. On October 17, 1997, the chief medical officer approved an agreement between Navrkal and the State that resulted in the revocation of his license. Under the terms of the revocation, Navrkal could not seek reinstatement of his license for 2 years. The terms of the revocation also stated that any future reinstatement of [Navrkal's] license is completely discretionary and that he has received no promises or assurances that his license will be reinstated. Navrkal was 34 years old in 1997.