Judges: K. N. AYERS
Agency: Agency for Health Care Administration
Latest Update: Apr. 19, 1982
Summary: Complaint dismissed where deficiencies have been corrected.
81-2145STATE OF FLORIDA
DIVISION OF ADMINISTRATIVE HEARINGS
STATE OF FLORIDA, DEPARTMENT ) OF HEALTH AND REHABILITATIVE ) SERVICES, )
)
Petitioner, )
)
vs. ) CASE NO. 81-2145
) 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 on 18 December 1981 at Clearwater, Florida.
APPEARANCES
For Petitioner: Donald R. Odom, Esquire
District V Legal Counsel Department of Health and Rehabilitative Services 2255 East Bay Drive Clearwater, Florida 33516
For Respondent: John T. Blakely, Esquire
Post Office Box 1369 Clearwater, Florida 33517
By Administrative Complaint filed 22 July 1981 the Department of Health and Rehabilitative Services (Petitioner) seeks to impose an administrative fine on Shive Nursing of Florida, d/b/a Sunset Point Nursing Center, Respondent in the amount of $1,000. As grounds therefor it is alleged Respondent failed to correct two Class III deficiencies within the time specified. One of these alleged deficiencies was failure to maintain current physician medication orders for patients and the other was for failure to maintain complete intake and output records on patients. At the hearing each party called one witness, and two exhibits were admitted into evidence.
FINDINGS OF FACT
During an inspection of Respondent's facility on January 29-29, 1981, a review of patient records revealed that some did not have current doctor's orders in their records. Regulations require doctor's orders be signed by the physician every thirty days, even if no change in medication is ordered. The Respondent was advised of this deficiency.
During a follow-up inspection on 5 March 1981 a review of patient records revealed some did not have current doctor's orders in their records. None of these patients were the same as the patients noted as not having current doctor's orders on the 28-29 January inspection.
Nursing homes have no control over the doctors who treat patients at the nursing home. Many of the patients engage their own doctor and retain the sole right to change doctors.
Respondent reviewed patients' records continuously and, for those patients whose medication needed renewal, prior to the 5 March visit mailed to the attending physician seven days before the expiration of the current order a new order for signature with a self-addressed return envelope. Despite these efforts all of the records did not contain current physician's orders. Respondent also presents physicians with prepared orders for their signatures when they visit the patients. Despite these efforts all doctors do not sign orders as required by the regulations and several records were lacking current doctor's orders upon the reinspection on 5 March 1981.
On the 28-29 January visit it was noted that the intake and output records on some patients were incomplete and Respondent was notified of this deficiency.
At the follow-up visit on 5 March 1981 the same deficiency was noted on different patients. On one patient 13 of the 20 days reviewed on the January
28-29 visit showed the patient's output of fluids to be less than 500 cc. The intake records also showed low intake, which led to the conclusion that all of the intake and output were not recorded in the patient's record. No obvious cases of dehydration were noted. However, unless a patient's output is close to 1500 cc per day the patient may not be receiving sufficient fluids.
The decision to record intake and output of fluids is discretionary with the head nurse. Regulations do not require hydration records be maintained. At Respondent's facility there are three shifts, with one head nurse on each shift. One of these head nurses determined that the intake and output records should be maintained for patients on Foley catheter and, on her shift, these entries were recorded in the patients' records. For some patients the other 1head nurses did not agree that intake and output data were indicated and did not have this data recorded. Accordingly, those patients' records did not accurately reflect their intake and output for the 24-hour day, but for only one-third of the day.
CONCLUSIONS OF LAW
The Division of Administrative Hearings has jurisdiction over the parties to, and the subject matter of, these proceedings.
Since nursing homes do not have control over the physicians treating nursing home patients, they cannot compel the doctors to sign physicians' orders for medication and treatment. They can be required to take reasonable steps to get the doctors to sign such orders. This Respondent did. It is noted that all of those patients for whom current doctor's orders were not in their records on 29-29 January had been corrected at the follow-up visit 5 March. Accordingly, Respondent did correct those deficiencies noted. In view of Respondent's lack of control over the doctors, no more than the effort expended by Respondent can be required.
With respect to the failure to report all of the intake and output of liquids on patients' records, the evidence was uncontradicted that such records are not required to be kept and that the decision to keep these records is left up to the head nurse on each shift. This is not a good procedure and Respondent's supervisor of nurses should, in the absence of doctor's orders, establish on which patients intake and output records will be kept. This would provide direction to the nurses and produce meaningful patient records. Here, the patients for whom hydration records were incomplete on the 5 March visit were different from those noted in the 28-29 January inspection. Accordingly, those deficiencies noted on 28-29 January had been corrected.
From the foregoing it is concluded that the Class III deficiencies noted on the January 28-29 inspection had been corrected on the March 5 reinspection, a1though similar violations were noted on the subsequent inspection. It is, therefore,
RECOMMENDED that the Administrative Complaint be dismissed. ENTERED this 15 day of January, 1992, in Tallahassee, Florida.
K. N. AYERS Hearing Officer
Division of Administrative Hearings The Oakland Building
2009 Apalachee Parkway
Tallahassee, Florida 32399-1550
(904) 488-9675
Filed with the Clerk of the Division of Administrative Hearings this 15th day of January, 1982.
COPIES FURNISHED:
Donald R. Odom, Esquire Department of Health and Rehabilitative Services 2255 East Hay Drive Clearwater, Florida 33516
John T. Blakely, Esquire Post Office Box 1368 Clearwater, Florida 33517
David H. Pingree, Secretary Department of Health and Rehabilitative Services 1321 Winewood Boulevard
Tallahassee, Florida 32301
=================================================================
AGENCY FINAL ORDER
=================================================================
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES,
Petitioner,
vs. CASE NO.: 81-2145
SHIVE NURSING CENTERS OF FLORIDA, INC., d/b/a SUNSET POINT NURSING CENTER,
Respondent.
/
FINAL ORDER
The Department of Health and Rehabilitative Services, finding the Recommended Order to be correct and being otherwise well advised in the premises, hereby adopts the findings of fact and conclusions of law of the attached Recommended Order entered in this cause by Hearing Officer K. N. Ayers, dated January 15, 1982, and said Order is hereby declared to be and by this Order becomes the Final Order of the Department, with the following modifications:
This matter involves the nursing facility's alleged failure to correct certain Class III deficiencies, which deficiencies were observed in both a January 28-29, 1981, inspection and a March 5, 1981, reinspection. The Recommended Order, at Paragraph 2 and 3 of the Conclusions of Law, finds that although similar violations were noted in both inspections, such violations related to a different group of patients in each inspection, and, accordingly, that the facility had corrected those deficiencies noted on the earlier inspection.
This conclusion of law is specifically rejected. The deficiencies noted in the earlier inspection related to the facility's failure to comply with Departmental rules governing the operation of a nursing facility. Although the facility, upon reinspection, had corrected the deficiencies with respect to the patients' records inspected initially, substantial deficiencies continued to exist in the records of other patients.
A rule, by definition, is an agency statement of general applicability.
120.52(14), F.S. (1981)(emphasis supplied.) Accordingly, rules related to the operation of a nursing facility are promulgated for the benefit and protection
of all patients residing therein. The nursing facility is obliged to comply with such rules as they apply to the entire facility, not merely with respect to a sample of patients chosen during an inspection survey. The nursing facility's failure to demonstrate substantial compliance, upon reinspection, with the standards upon which the deficiencies were based amounts to a failure to correct the deficiencies.
DONE AND ORDERED this 15th day of April, 1982, in Tallahassee, Florida.
DAVID H. PINGREE
Secretary
COPIES FURNISHED:
Donald R. Odom, Esquire District V Legal Counsel Department of Health and Rehabilitative Services 2255 East Bay Drive Clearwater, Florida 33516
John T. Blakely, Esquire Post Office Box 1368 Clearwater, Florida 33517
K. N. Ayers Hearing Officer
Division of Administrative Hearings The Oakland Building
2009 Apalachee Parkway
Tallahassee, Florida 32301
Docket for Case No: 81-002145
Orders for Case No: 81-002145
