STATE OF FLORIDA

DIVISION OF ADMINISTRATIVE HEARINGS

DEPARTMENT OF HEALTH AND )

REHABILITATIVE SERVICES, )

)

Petitioner, )

)

vs. ) CASE NO. 81-1603

) SHIVE NURSING CENTERS OF FLORIDA, ) INC., d/b/a SUNSET POINT )

NURSING CENTER, )

)

Respondent. )

)

RECOMMENDED ORDER

Pursuant to notice the Division of Administrative Hearings by its duly designated Hearing Officer, K. N. Ayers, held a public hearing in the above styled case at Largo, Florida, on 14 July 1981.

APPEARANCES

For Petitioner: Barbara McPherson, Esquire

Post Office Box 5046 Clearwater, Florida 33518

For Respondent: John T. Blakely, Esquire

Post Office Box 1368 Clearwater, Florida 33517

By Administrative Complaint dated 11 May 1981, Department of Health and Rehabilitative Services (DHRS) , Petitioner, seeks to levy two administrative fines against Shive Nursing Centers of Florida, d/b/a Sunset Point Nursing Center, Respondent, in the amount of $500 each. As grounds therefor, it is alleged that Respondent failed to provide adequate nursing care to patient S during the period September 26, 1980, until October 10, 1980; and, as a result, S developed bedsores and open lesions. In the second ground for fine, it is alleged that Respondent failed to properly notify S's attending physician promptly regarding the changes in S's condition as the bedsores developed.

At the hearing one witness was called by Petitioner, three witnesses were called by Respondent and no exhibits were admitted into evidence. All of the evidence presented by Petitioner came from a review of the medical records maintained by Respondent. Respondent's witnesses testified primarily to conditions they observed.

FINDINGS OF FACT

1. Respondent is a nursing home licensed by Petitioner pursuant to Chapter 400, Florida Statutes.

2. On December 8, 1980, Petitioner's nurse surveyor, Muriel Holzberger, visited Respondent's facility to review the medical records at Respondent's facility following receipt by HRS of a copy of a newspaper article charging Respondent with patient neglect.

   
   

3. Ms. Holzberger reviewed the medical records of patient S and talked with the administrator. After reviewing the records Ms. Holzberger concluded that Respondent had not used the air mattress that accompanied S to the nursing home, that S developed bedsores which were first observed on 1 October, that he was not seen by the doctor until 6 October, that these bedsores worsened until

   10 October, that on 10 October an "egg crate" mattress was placed on bed, proper medication was administered to S, and when he left the nursing home near the end of October, the lesions were healed.

   
   

4. The three witnesses presented by Respondent, all of whom treated and observed S while he was a patient at the nursing center, testified that the air mattress which accompanied S to the nursing center was inflated and on the bed occupied by S from his admission until replaced by the egg crate mattress on 10 October.

   
   

5. At the time of his admission, the patient was recovering from a stroke. He had been cared for by his wife at home following his cardiovascular attack and required total care. He could not communicate or feed himself. Apparently, his wife decided to take a short vacation and placed S in the nursing center to provide the needed care.

   
   

6. On 1 October 198 the nurse on the three to eleven shift noted open areas on the patient's buttocks and lower extremities indicating pressure on these areas from lying in bed. On 2 October more open lesions appeared and the attending physician was called but could not be contacted. On 3 October the physician was contacted and he prescribed medication for the bedsores which had developed. On 6 October the patient was seen by the doctor but the open lesions continued to accumulate until around 10 October, after which the lesions abated.

   
   

7. Upon delivering S to the nursing center, Mrs. S advised that S was subject to bedsores if not carefully attended and included with his effects a long letter describing treatment she had used to treat bedsores and some Betadine solution which been prescribed by the doctor for treating these lesions.

   
   

8. Testimony was unrebutted that during the early part of S's stay at the nursing center (when the bedsores developed) the patient slept on the inflated air mattress, was turned frequently, and appeared despondent due to his wife's absence. He obviously was not as carefully attended to as he could have been, hence the accumulation and subsequent aggravation of the open lesions which healed when the wife returned and more careful attention was given to S.

   
   

9. When open lesions were first observed on 1 October, Respondent's duty nurse applied dressings without doctor's orders. When the doctor could not be contacted on 2 October, his office was advised that the doctor would be called the following day. On 3 October the patient's condition was relayed to the doctor and he prescribed medication but, as noted above, did not visit the patient until October 6. The treatment prescribed on 3 October, viz, Betadine and heat lamp apparently was continued until the lesions were healed some four weeks later.

10. The medical records maintained at the nursing center on S did not show the use of the air mattress which accompanied S to the nursing center. Use of this equipment is in the nature of preventive therapy and should have been recorded in the Nurses Notes. The medical records did record S's condition and the treatment given him both before and after receipt of the doctor's orders.

    No charges were preferred for applying medication to S's lesions before receipt of doctor's orders and this delict will not be considered.

    
    

    CONCLUSIONS OF LAW

    
    

11. The Division of Administrative Hearings has jurisdiction over the parties to and the subject matter of these proceedings.

    
    

12. Section 400.022(1)(g) , Florida Statutes (1979), entitled Patients' rights, which Respondent is charged with violating, provides:

    
    

    The right to receive adequate and appropriate health care consistent with established and recognized practice' standards within the com- munity and with rules as promulgated by the department.

    
    

13. The rules with which Respondent is charged with failure to comply are the following duties and responsibilities enumerated in Rule 10D-29.38, Florida Administrative Code:

    
    

    1. All details of nursing care to patients.

       1. Recording of pertinent information on patient record.

       2. Calling for a physician when necessary and obtaining orders, for medication and treatment.

       (14) Charting all medications, treatments and services. Nursing notes shall include signi- ficant observations made concerning the condition of the patient. This also shall

       include, as a minimum, a monthly nursing progress summary for each skilled and intermediate nursing care patient. Acutely and critically ill patients shall have a shift and continuous entry.

       
       

14. The gravamen of the charges preferred against Respondent is that S was not provided the minimum standard of nursing care by Respondent and, as a result, developed open lesions. These charges were largely predicated upon the conclusion that the air mattress was not used, which conclusion was drawn from the failure of the Nurses Notes to record this fact. The evidence presented was that the air mattress was used, yet S still developed bedsores which did not immediately respond to treatment. These lesions ameliorated after the egg crate mattress was placed on S's bed.

    
    

15. From the evidence presented, it is clear that Respondent did call for a physician when the need for one became apparent but did not aggressively pursue contact when initial contact could not be made. Under the circumstances it would not be egregious error to wait until the following day to contact the physician and obtain orders for treatment of the lesions S was developing.

16. After considering all of the evidence in the light of the standards of care prescribed by the statutes and rules above quoted, it is concluded that Respondent failed to record all pertinent information in the Nurses Notes maintained on patient S, but did provide the minimum standard of nursing care prescribed by those rules. Had the optimum nursing care been provided, it is unlikely S would have developed bedsores. It is, therefore,

RECOMMENDED that Shive Nursing Centers of Florida, Inc. d/b/a Sunset Point Nursing Center, be issued a letter of admonition for failure to maintain complete patient medical records and that all other charges be dismissed.

ENTERED this 27th day of July, 1981, in Tallahassee, Florida.

K. N. AYERS, Hearing Officer Division of Administrative Hearings The Oakland Building

2009 Apalachee Parkway

Tallahassee, Florida 32301

(904) 488-9675

Filed with the Clerk of the Division of Administrative Hearings this 27th day of July, 1981.

COPIES FURNISHED:

Barbara McPherson, Esquire Post Office Box 5046 Clearwater, Florida 33518

John T. Blakely, Esquire Post Office Box 1368 Clearwater, Florida 33517

Docket for Case No: 81-001603

Orders for Case No: 81-001603