vs. ) CASE NO. 80-223
Respondent. )
Pursuant to notice an administrative hearing was held before Delphene C. Strickland, Hearing Officer of the Division of Administrative Hearings, on June 16, 1980, commencing at 10:35 a.m. in Room 106, Collins Building in Tallahassee, Florida.
For Petitioner: Robert P. Daniti, Esquire
For Respondent: Howard P. Ross, Esquire
St. Petersburg, Florida 33743 ISSUE
Whether the operation of Respondent is proper in Hernando County, Florida; whether the operation of Respondent is proper in Citrus County, Florida.
FINDINGS OF FACT I.
Respondent Gulf Coast Home Health Services, Inc. is a corporation providing home health care services in several Florida counties. It has an office in Hernando County and also serves clients in Citrus County. It presently has no license to serve Citrus County and has no Subunit in Hernando County. Petitioner Department of Health and Rehabilitative Services notified Respondent on January 17, 1980 that it intended to enter a final order requiring Respondent to terminate its operations in the two counties, aid Respondent requested an administrative hearing.
Respondent's home office is located in St. Petersburg, Pinellas County, Florida. It was licensed to serve an area including Pinellas, Pasco, Hillsborough and Hernando Counties until licensure in 1980-81, when Hernando County was omitted. It was then stipulated that Respondent could continue operations in Hernando County until the final order in this case. Respondent was licensed to serve said counties without obtaining a certificate of need inasmuch as Petitioner had determined that Section 400.504, Florida Statutes, was inapplicable to those counties in which there was service to the area previous to the effective date of the statute. Respondent first served Hernando County from its Pinellas County office, but after opening an office in Pasco County in April of 1979, it notified Petitioner that it was serving Hernando County from its Pasco County office.
Petitioner wrote a letter to Respondent on April 28, 1978 stating that in view of the increased expansion of Gulf Coast Home Health Services, Inc. into Hernando County, a sufficient client population base in Hernando County, and because of the time and distance factors from Pinellas County to Hernando County, a "Subunit" must be established in Hernando County (Petitioner's Exhibit 2, page 17). Respondent replied to the April correspondence by letter dated October 20, 1978 that servicing of Hernando County bad been moved from Pinellas County to Pasco County and stated that Respondent, too, saw a need to establish an office in Hernando County (Petitioner's Exhibit 2, page 14). Thereafter, an office was opened in Brooksville, Hernando County, Florida, by Respondent, but no application for a Subunit was filed. By correspondence dated June 14, 1979 Petitioner notified Respondent that a certificate of need had been deemed not necessary but an application for a Subunit was necessary and should be filed by July 6, 1979, and that a survey would then be scheduled. No application was filed, and a Notice to Show Cause why the Respondent's license should not be modified was issued on August 23, 1979. Respondent took no action.
The office that was established in Brooksville, Florida in April of 1979 is under the overall general supervision of an Associate Director of Nursing. The Associate is the supervisor of the staff in the office both as to patient care and the clerical processing of all office records. The Associate's duties include supervision of a variety of skilled professional nurses, physical therapists, speech therapists, occupational therapists, social workers, home health aides and homemakers as well as the supervision of clerical personnel. The field supervisor in St. Petersburg coordinates the care of patients from the hospital to the home and relays information regarding patient care from the patient's physician to the nursing supervisor in the Brooksville office, who in turn relays the information to the appropriate staff who visit the patient. Patient medical records and plans for treatment are kept in the Brooksville office except for the annual survey, when they are moved to the home office in St. Petersburg.
Some billing and typing of progress notes for the Brooksville office is provided by the Respondent's office in New Port Richey before such records are sent to the home office in St. Petersburg, Florida.
The distance from Brooksville in Hernando County to St. Petersburg in Pinellas County is approximately 63 miles. Pasco County, where Respondent has another office, is between Pinellas County arid Hernando County. The distance between the office site in New Port Richey and that of Brooksville is about 37 miles. The area is rapidly growing, and the traffic is often congested on the few highways.
II.
On August 26, 1976 the Program Coordinator for Home Health Services of the Department of Health and Rehabilitative Services stated in a letter to the president of Gulf Coast Home Health Services, Inc. that Respondent had agreed to assume care on an interim basis of the former patients of Alaris Home Health Care Agency, which had ceased operations in Citrus County, Florida. The letter further stated that if the staff of that agency were employed by Respondent they should be supervised from the central office of Gulf Coast Home Health Service, Inc. (Petitioner's Exhibit 3, pages 15-16). Respondent accepted the patients of Alaris in August of 1976 as well as other patients from Citrus County. It continued to serve patients from Citrus County but did not apply for a license to serve Citrus County and did not include that county on its applications for licensure for the other counties it served until 1980.
In late 1978 or early 1979 the Director of the office of Licensure and Certification, Department of Health and Rehabilitative Services, received a complaint from Central Florida Home Health Agency, Inc. that Respondent was operating in Citrus County. The Director notified Respondent's Director that Gulf Coast Home Health Service, Inc. was not licensed to serve Citrus County and requested some action. On January 15, 1979 Respondent sent a memorandum to the Brooksville office in Hernando County instructing the staff to cease serving Citrus County and forwarded a copy of said memorandum to Petitioner. However, before the memorandum was effected Respondent's Director verbally rescinded his directive, without notifying Petitioner, and continued to serve patients in Citrus County (Petitioner's Exhibit 3; Transcript, pages 139-144)
Central Florida Home Health Agency, Inc. has been issued a license to service Citrus County, and at present both that agency and Respondent are serving patients in Citrus County, Florida. Central Florida Home Health Agency, Inc. has requested the Department of Health and Rehabilitative Services to enjoin Respondent from its activities in Citrus County.
Both parties submitted proposed findings of fact, memoranda of law and proposed recommended orders. These instruments were considered in the writing of this order. To the extent the proposed findings of fact have not been adopted in or are inconsistent with factual findings in this order, they have been specifically rejected as being irrelevant or not having been supported by the evidence.
CONCLUSIONS OF LAW
The Division of Administrative Hearings has jurisdiction of this matter and the parties thereto pursuant to Section 120.57, Florida Statutes.
Gulf Coast Home Health Services, Inc. is a "home health agency" and provides "home health services" as defined in Chapter 400, Nursing Homes and Related Health Care Facilities, Part III - Home Health Agencies, Florida Statutes. It Is unlawful to operate such an agency without first obtaining from the Department of Health and Rehabilitative Services a license authorizing such operation. Section 400.467, Florida Statutes; Rule 10D-68.03, License Required, Florida Administrative Code.
A Subunit is defined in Rule 10D-68/01(19) as "a semiautonomous agency which serves persons in a county different from the parent agency and/or is incapable of sharing administration, supervision and services on a daily basis with the parent agency." The Hernando County office of Gulf Coast Home Health
Services, Inc. in Brooksville, Florida is in a county different from the parent agency in St. Petersburg, Pinellas County, Florida. The Brooksville office is semi-autonomous as it applies to the daily operations of its health services.
General supervision, policy making and reimbursement is rendered by the parent in St. Petersburg. Clerical, reimbursement and administration services are shared by the Hernando County office, the Pasco County office and the parent agency in Pinellas County.
The distance from the parent agency in St. Petersburg and the comprehensive operation of its services under the Associate Director of Nursing in Brooksville, as well as its location in a separate, non-adjacent county to the parent agency, bring the Brooksville, Hernando County office within the definition of a Subunit and subject to separate licensure as a "Subunit" under Rule 10D-68.04(2), Florida Administrative Code.
Sections 400.464 and 400.467, Florida Statutes, and Rule 10D-68.03, Florida Administrative Code, require a license to operate as a hone health agency. Respondent Gulf Coast Home Health Services, Inc. has no license to operate in Citrus County and can be required by Petitioner Department of Health and Rehabilitative Services to terminate its operation in that county.
Based on the foregoing Findings of Fact and Conclusions of Law the Hearing Officer recommends that Respondent be required to cease its operations in Hernando County until and unless it is licensed as a Subunit. It is also recommended that Respondent terminate its operation in Citrus County until and unless it is licensed to serve said county.
DONE and ORDERED this 5th day of September, 1980, in Tallahassee, Leon County, Florida.
DELPHENE C. STRICKLAND
Division of Administrative Hearings Room 101, Collins Building Tallahassee, Florida 32301
Robert P. Daniti, Esquire Department of HRS
Howard P. Ross, Esquire 980 Tyrone Boulevard Post Office Box 41100
St. Petersburg, Florida 33743
