vs.
Respondent.
) Case No. 04-3859
Administrative Law Judge (ALJ) Daniel Manry conducted the administrative hearing of this case on January 27, 2005, in Tampa, Florida, on behalf of the Division of Administrative Hearings (DOAH).
For Petitioner: Gerald L. Pickett, Esquire
525 Mirror Lake Drive, North St. Petersburg, Florida 33701
For Respondent: R. Davis Thomas, Jr.
215 South Monroe Street, Suite 400 Post Office Drawer 11300 Tallahassee, Florida 32302-1300
The issues are whether Respondent is guilty of a class I violation, within the meaning of Subsection 400.23(8)(a), Florida Statutes (2003), for the alleged failure to provide either supervision of residents or assistance devices that were adequate to prevent accidents; whether Petitioner should have changed the status of Respondent's license from Standard to Conditional; whether Petitioner should impose a $10,000 administrative fine and a $6,000 survey fee; and whether Petitioner should place Respondent on an accelerated six-month
survey cycle.
On October 6, 2004, Petitioner issued an Administrative Complaint against Respondent. Respondent timely requested an administrative hearing. Petitioner referred the matter to DOAH to conduct the hearing.
Prior to the hearing, the parties resolved some of the disputed issues of fact pursuant to a joint stipulation of facts. At the hearing, the parties submitted for admission into evidence three joint exhibits, including pre-hearing deposition transcripts of two of Respondent's employees. Petitioner presented the testimony of one witness and submitted one composite exhibit. Respondent presented the testimony of three witnesses and submitted one exhibit.
The identity of the witnesses and exhibits and any attendant rulings are reported in the one-volume Transcript of hearing filed on February 4, 2005. The parties timely filed their respective Proposed Recommended Orders on
February 14, 2005.
Petitioner is the state agency responsible for licensing and regulating nursing homes in Florida pursuant to Chapter 400, Florida Statutes (2003). Respondent is licensed to operate a nursing home located at 2916 Habana Way, Tampa, Florida (the facility).
The facility is a four-story building. The event at issue occurred on the second floor of the facility.
The second floor of the facility consists of a single, straight, east-west hallway with adjoining resident rooms, storage closets, a nursing station, a day room, and an elevator. An exit door is located at each end of the hallway.
Each exit door leads into a stairwell. A small landing on the stairwell-side of each exit door provides a short, flat surface between the exit door and the first step of the stairwell. An undetermined number of steps lead to a landing in the stairway midway between the second and first floors.
Each exit door is equipped with an alarm designed to activate when the door is opened and to de-activate when the
door closes. When the door is opened and the alarm activates, staff who hear the alarm should redirect any resident that is near the exit door.
On July 7, 2004, Respondent admitted a resident identified in the record as Resident 1 and assigned Resident 1 to the second floor of the facility. Resident 1 was cognitively impaired and had an unsteady gait. Facility staff provided a wheelchair that Resident 1 was able to self-propel.
Facility staff assessed Resident 1 to be at risk for falls and developed a care plan. Pursuant to the care plan, staff provided a wheelchair alarm to notify staff in the event Resident 1 attempted to exit the wheelchair without assistance.
Resident 1 was a potential risk to wheel herself through the exit doors on the second floor of the facility. However, Resident 1 was not a likely risk to exit the facility through the exit doors because Resident 1 had not previously demonstrated any exit-seeking or elopement behavior. It is undisputed that a likely risk of exit existed only if Resident 1 had previously engaged in exit-seeking behavior. Resident 1 had limited her behavior to wandering from room to room.
On July 9, 2004, between 5 and 7 p.m., Resident 1 received her evening meal and a shower from a certified nursing assistant (CNA). The resident's daughter then visited for a brief period of time and left. Between 7:30 and 7:45 p.m., a
nurse on duty saw Resident 1 in her wheelchair in the hallway, but Resident 1 was not exit-seeking or otherwise engaged in any unsafe behavior.
Sometime between 7:45 and 8:00 p.m. on July 9, 2004, Resident 1 wheeled her chair to the exit door at the east end of the hallway, opened it, and entered the stairwell. Resident 1 fell down an undisclosed number of stairs and landed on the stairway landing between the second and first floor.
At approximately 8 p.m. on July 9, 2004, a CNA entered the second floor from the elevator to pass out snacks to residents. The CNA heard the sound of a wheelchair alarm, traced the alarm to the landing in the stairwell, and found Resident 1 with the wheelchair on top of the resident.
Resident 1 sustained a laceration of her forehead and suffered head, neck, and back pain. Facility staff transferred Resident 1 to a hospital where she received stitches to close the laceration. Resident 1 did not return to the facility.
Respondent notified Petitioner of the incident involving Resident 1, and Petitioner sent a surveyor to investigate the incident on July 16, 2004. Upon completion of the investigation, Petitioner charged Respondent with a violation of 42 CFR Section 483.25(h)(2). The federal standard requires nursing homes to provide "adequate supervision and assistance devices to prevent accidents."
The federal standard is made applicable to nursing homes in Florida, including Respondent, pursuant to Florida Administrative Code Rule 59A-4.1288. The parties identified the alleged deficiency in the record as Tag F324 because the survey report identifies the alleged deficiency as Tag F324.
Tag F324 alleges that Respondent violated two conjunctive requirements. First, Respondent allegedly failed to provide adequate supervision to prevent accidents. Second, Respondent allegedly failed to provide adequate assistance devices to prevent accidents.
It is undisputed that applicable law does not impose absolute or strict liability on Respondent for the accident involving Resident 1. Petitioner has cited no law similar to the "but for" test in tort law to support a finding that Resident 1 could not have suffered injury "but for" the inadequate supervision of residents or inadequate assistance devices. For reasons stated in the Conclusions of Law, Petitioner must show by the applicable standard of proof that the event involving Resident 1 was reasonably foreseeable; that a specific intervention existed involving resident supervision or assistance devices; and that Respondent should have identified the intervention and could have provided the intervention to prevent the accident.
The preponderance of evidence does not support a finding that the accident was reasonably foreseeable. It is undisputed that a foreseeable risk of Resident 1 exiting through one of the exit doors existed only if she had previously engaged in exit-seeking. Resident 1 had not previously exhibited any unsafe behaviors, including active exit-seeking. Her behavior had been limited to wandering from room to room. It was not reasonably foreseeable that Resident 1 would attempt to enter an exit door on her own.
The evidence does not show whether the alarm on the exit door activated; or, if it did activate, whether staff members did not hear the alarm; or, if any member of the staff heard the alarm, the staff member ignored it or otherwise failed to respond to the alarm. Between 7:30 and 8:00 p.m., CNAs on the second floor routinely put residents to bed. When providing that care, CNAs close the door of each resident's room to assure privacy, thereby making it difficult to hear a door alarm. Between 7:45 and 8:00 p.m., the staff member in the nursing station was away from the station obtaining supplies from another location. A door alarm would be audible to a staff member in the nursing station or in the hallway between rooms. When facility staff conducted a random test of the door alarms during the investigation on July 16, 2004, the door alarms functioned properly, and staff members adequately responded to
the alarms. The floor plan of the second floor precluded a staff member in the nursing station from viewing the east exit door without standing in the front of the nursing station at the hallway.
The ratio of facility staff to residents on July 9, 2004, satisfied the minimum requirements for nursing homes. It is undisputed that the applicable standard required staff members who were on duty to check on Resident 1 once every two hours. The staff members on duty observed Resident 1 more frequently than every two hours between 6 p.m. and 8 p.m. on July 9, 2004.
The preponderance of evidence is inadequate to support a finding that Tag F324 required facility staff to provide Resident 1 with supervision that was more frequent than staff provided on July 9, 2004. Resident 1 had not previously exhibited any exit-seeking behavior, and the incident on July 9, 2004, was not reasonably foreseeable. As Petitioner has stated in previous final orders, the quality of care regulations applicable to nursing homes do not require staff members to constantly monitor residents. See Beverly Enterprises-Florida, Inc. d/b/a Beverly Health and Rehabilitation Center – Rio Pinar v. Agency for Health Care Administration, DOAH Case No.97-2017, Final Order entered June 29, 1998. Petitioner did not provide
any factual or legal basis to distinguish this proceeding from the policy that Petitioner has stated in previous final orders.
It is undisputed that a hall monitor was a specific staffing intervention that existed and that Respondent could have identified and provided prior to the accident on July 9, 2004. However, a preponderance of the evidence does not support a finding that Respondent should have identified and provided a hall monitor prior to the accident. The evidence does not show that any of the residents on the second floor, including Resident 1, had previously exhibited any exit-seeking behavior, and the evidence did not support a finding that a hall monitor was required to prevent a reasonably foreseeable event.
Petitioner did not show that Petitioner construed Tag F324 to require a hall monitor before the survey on July 16, 2004. Petitioner did not show that it charged Respondent in previous surveys with a deficiency for failure to provide a hall monitor in violation of Tag F324.
Petitioner did not show prior inadequate supervision that may have supported a finding of inadequate supervision in this proceeding based on prior similar acts. Rather, the evidence showed that routine supervision in the existing physical floor plan of the second floor without a hall monitor had been effective for more than three years in preventing incidents or injuries in the stairwell. If such supervision
were inadequate under Tag F324, notwithstanding the absence of incident or injury, it is reasonable to infer that Petitioner would have stated its agency interpretation of Tag F324 in previous surveys by charging Respondent with such a deficiency. Petitioner did not prove any previous deficiencies or prior similar acts in violation of Tag F324.
It is undisputed that a keypad locking system for the exit doors on the second floor was a specific assistance device that Respondent could have provided to prevent the accident on July 9, 2004. However, a preponderance of evidence does not show that Respondent should have identified and provided a keypad system to prevent the accident involving Resident 1.
The exit doors on the second floor were unlocked because the applicable fire code prohibited Respondent from locking the exit doors. It is undisputed that door alarms on unlocked exit doors do not prevent accidents, such as the one involving Resident 1, unless facility staff are immediately at hand to redirect an exit-seeking resident rather than inside resident rooms preparing residents for bed. If unlocked exit doors equipped with alarms were inadequate assistance devices under Tag F324, it is reasonable to infer that Petitioner would have stated its interpretation of Tag F324 in previous surveys by charging Respondent with such a deficiency. Petitioner did not prove any such previous deficiencies. The door alarms
operated properly when facility staff tested the alarms during the survey.
The fire code permitted use of a keypad system that unlocks each exit door on the second floor when a member of the staff enters an appropriate code on the keypad. However, Petitioner did not show that Petitioner interpreted Tag F324 to require a keypad system to prevent accidents prior to the survey conducted on July 16, 2004. If Petitioner had interpreted Tag F324 to require a keypad system prior to the survey, it is reasonable to infer that Petitioner would have cited Respondent in previous surveys for failure to provide adequate assistance devices to prevent accidents. Petitioner did not prove any such previous deficiencies.
The preponderance of evidence does not support a finding that Petitioner should have changed Respondent's license rating from standard to conditional from July 16 until
August 18, 2004. Prior to the surveyor's departure from the facility on July 16, 2004, Respondent assigned a hall monitor to the hallway to prevent any attempt by a resident to exit the second floor. Respondent provided hall monitors until Respondent subsequently installed a keypad system on the exit doors. Petitioner's surveyor testified that hall monitors were sufficient to comply with the requirements of Tag F324.
Tag F324 did not require Respondent to provide a hall monitor between July 9 and 16, 2004. It is undisputed that a foreseeable risk of a resident exiting through one of the exit doors existed only if a resident had previously engaged in active exit-seeking. From July 9 until July 16, 2004,
Resident 1 was no longer in the facility, and Petitioner did not prove any other resident in the facility that was actively exit- seeking or otherwise engaged in unsafe behavior between July 9 and 16, 2004. If Petitioner interpreted Tag F324 to require a hall monitor prior to July 16, 2004, it is reasonable to infer that Petitioner would have stated that policy in previous surveys by charging Respondent with a deficiency for failure to provide monitors.
The preponderance of evidence does not support a finding that Respondent failed to adequately respond after the incident involving Resident 1. It is undisputed that Respondent's medical care of Resident 1 after the incident was adequate, as was the report to Petitioner.
Between July 9 and July 16, 2004, the facility's Director of Nursing twice counseled staff on the 3 to 11 p.m. shift about the incident involving Resident 1 and the need for heightened awareness of the door alarms. On July 10, 2004, the facility administrator tested the staff's response to the alarms, and the response was adequate. During the survey on
July 16, 2004, Petitioner's surveyor observed a timely response by staff to an unannounced activation of the door alarm.
Respondent installed a keypad system in a timely manner. On July 12, 2004, Respondent scheduled a vendor to visit the facility to provide an estimate of cost for a keypad system. Respondent installed a keypad system after the survey and prior to the administrative hearing. Petitioner did not prove that Respondent was unreasonably slow to install the keypad system.
If it were determined that Respondent violated one or more of the requirements in Tag F324, Petitioner did not prove Respondent is guilty of a class I deficiency. In order for a deficiency to be a class I deficiency, Petitioner must show that the deficiency "caused, or is likely to cause, serious injury, harm, impairment or death to a resident receiving care" within the meaning of Subsection 400.23(8)(a), Florida Statutes (2003). In relevant part, the statute requires Petitioner to prove that the alleged deficiency either caused serious harm or is likely to cause such harm.
It is undisputed that the alleged deficiency did not cause serious harm to Resident 1. Petitioner's only witness testified that Resident 1 did not sustain serious harm and characterized the injuries to Resident 1 as "minimal."
Moreover, Petitioner's witness did not rely on the injuries to Resident 1 to support the class I rating.
Petitioner's witness opined during the hearing that the alleged deficiency was a class 1 deficiency because it was likely that another resident would enter the stairwell and suffer serious harm or death. The opinion of Petitioner's witness of the likelihood of serious harm or death is not supported by a preponderance of evidence.
A likely risk of a resident exiting through one of the exit doors existed only if a resident had previously engaged in active exit-seeking. The evidence does not show any resident in the facility, other than Resident 1 on July 9, 2004, had demonstrated any exit-seeking behavior to support a finding that it was likely a resident would exit the facility through one of the exit doors. Resident 1, the only resident for which there was any evidence to support the opinion of Petitioner's witness, did not return to the facility after the incident.
Respondent installed a hall monitor on July 16, 2004, and it is undisputed that this action was adequate to eliminate the likelihood of a resident exiting the facility. For reasons stated in the previous paragraph and paragraph 28, it was not likely that a resident would exit through the stairwell between July 10 and 16, 2004.
If it were determined that a "potential" risk, rather than a likely risk, existed for a resident to exit the facility through the exit doors, a potential risk is inadequate to classify the deficiency as a class I deficiency. A deficiency with a "potential" to compromise a resident's well being is properly classified as a class III deficiency within the meaning of Subsection 400.23(8)(c), Florida Statutes (2003). Any such deficiency was not an uncorrected class III deficiency because the assignment of a hall monitor corrected any potential risk by the time of the survey.
CONCLUSIONS OF LAW
DOAH has jurisdiction over the parties and subject matter of this cause pursuant to Section 120.569 and Subsection 120.57(1), Florida Statutes (2003). The parties received adequate notice of the administrative hearing.
The ALJ reserved ruling on three ore tenus motions that Respondent entered on the record during the hearing. First, Respondent's motion for summary final order is denied. The ALJ does not have final order authority in this proceeding.
§ 120.57(1)(h), Fla. Stat. (2004). Second and third, the ALJ denies Respondent's two motions to dismiss separate charges in the Administrative Complaint. When the evidence is viewed in a light most favorable to Petitioner, Petitioner established a prima facie case for each charge against Respondent. Valdes v.
Association I.N.E.D., H.M.O., Inc., 667 So. 2d 856, 857 (Fla. 3d DCA 1996); Barclays American Mortgage Corporation v. Bank of
Central Florida, 629 So. 2d 978, 979 (Fla. 5th DCA 1993).
Petitioner has the burden of proof in this proceeding.
However, the standard of proof varies. Petitioner must show by a preponderance of the evidence that Respondent committed the deficiencies alleged as a basis for changing Respondent's license rating from Standard to Conditional. Florida Department of Transportation v. J.W.C. Company, Inc., 396 So. 2d 778 (Fla. 1st DCA 1981); Balino v. Department of Health and Rehabilitative
Services, 348 So. 2d 349 (Fla. 1st DCA 1977). Petitioner must show by clear and convincing evidence that Respondent committed the deficiencies alleged as a basis for the proposed administrative fine. Department of Banking and Finance,
Division of Securities and Investor Protection v. Osborne Stern and Company, 670 So. 2d 932, 935 (Fla. 1996).
Petitioner must show by the applicable standard of proof that Respondent failed to provide either adequate supervision or adequate assistance devices to prevent accidents within the meaning of 42 CFR Section 483.25(h)(2). The occurrence of an accident, of itself, does not establish that supervision was inadequate or that door alarms were inadequate. The law applicable to nursing homes does not impose strict liability on Respondent. Petitioner has adopted this legal
principle in a final order in Washington Manor Nursing and Rehabilitation Center v. Agency for Health Care Administration, DOAH Case Number 00-4735, adopted by Final Order dated September 13, 2001.
Petitioner must demonstrate the existence of a specific intervention that Respondent should have identified and could have provided to prevent a reasonably foreseeable event. Vista Manor v. Agency for Health Care Administration, DOAH Case No. 98-5471, adopted by Final Order dated July 15, 1999. Petitioner has not shown a legal or factual basis for distinguishing this case from the foregoing standard adopted in Petitioner's previous final orders. Administrative stare decisis requires Petitioner to treat like cases alike in its final agency orders. Gessler v. Department of Business and
Professional Regulation, 627 So. 2d 501, 503 (Fla. 4th DCA 1993).
The application of administrative stare decisis to final agency orders was not overruled in Caserta v. Department
of Business and Professional Regulation, 686 So. 2d 651 (Fla. 5th DCA 1996). The decision in Caserta merely imposes temporal limits on the statutory requirement for agencies, including Petitioner, to maintain a subject matter index of final agency orders. As the court explained:
We conclude that, by striking the January 1, 1975 starting date, the legislature must have intended to eliminate the requirement that subject-matter indexes must be maintained from that date. As the legislature struck the required beginning date for the alphabetical index without establishing a new beginning date, we conclude the legislature intended the new date to be the effective date of the amended statute. It is likely that the legislature recognized the impossible burden many agencies would face in providing subject- matter indexes that, in some instances, may not even exist, particularly in light of subsection 120.68(8)'s mandate that an agency's failure to comply with section
120.53 is presumed to be prejudicial error. (citation omitted) In sum, we conclude that agencies must maintain and provide a subject-matter index from March 1, 1992
. . . . (emphasis supplied) Caserta, 686 So. 2d at 653.
Apart from the application of administrative stare decisis to final agency orders, Petitioner's final agency orders must describe agency policy sufficiently for judicial review. See McDonald v. Department of Banking and Finance, 346 So. 2d 569, 582 (Fla. 1st DCA 1977)(requiring agency final orders to describe agency policy sufficiently for judicial review). Petitioner's final order in this proceeding must explicate non- rule policy reasons for the agency's proposed action and explain any deviation from officially stated agency policy or prior agency practice. Moreover, this Recommended Order must do the same. Schiffman v. Department of Professional Regulation, Board
of Pharmacy, 581 So. 2d 1375, 1377 (Fla. 1st DCA 1991); Gulf Coast Home Health Services of Florida, Inc. v. State of Florida,
Department of Health and Rehabilitative Services, 513 So. 2d 704, 706 (Fla. 1st DCA 1987); McDonald, 346 So. 2d at 582-583.
Petitioner, like any other state agency, expresses the terms of its non-rule policy each time Petitioner takes enforcement action against a licensee. By analogy, numerous judicial decisions hold agency enforcement action to be a statement of policy of generally applicability, within the meaning of Subsection 120.52(15), Florida Statutes (2003), and an invalid rule. See Reiff v. Northeast Florida State Hospital, 710 So. 2d 1030, 1032 (Fla. 1st DCA 1998) (enforcement of clinical privileges in hospital by-laws is an invalid rule); Federation of Mobile Home Owners of Florida, Inc. v. Florida
Manufactured Housing Association, Inc., 683 So. 2d 586, 591-592 (Fla. 1st DCA 1996)(enforcement action that repeals an existing promulgated rule is itself a rule); Department of Revenue of State of Florida v. Vanjaria Enterprises, Inc., 675 So. 2d 252,
255 (Fla. 5th DCA 1996) (enforcement of tax assessment procedure in training manual is an invalid rule); Christo v. Florida Department of Banking and Finance, 649 So. 2d 318, 319 (Fla. 1st DCA 1995) (enforcement of "CAMEL" ratings as a means to recover costs of examination and supervision of an institution is an invalid rule under former Section 120.535), rev. dismissed mem.,
660 So. 2d 712 (Fla. 1995); Florida Public Service Commission v. Central Corporation, 551 So. 2d 568, 570 (Fla. 1st DCA 1989) (administrative order is invalid rule); McCarthy v. Department of Insurance and Treasurer, 479 So. 2d 135, 137 (Fla. 2d DCA 1985) (letter establishing qualifications for eligibility and revoking certification is invalid rule), reh'g denied; Department of Administration, Division of Personnel v. Harvey,
356 So. 2d 323, 324 (Fla. 1st DCA 1977)(statement denying application is an invalid rule), reh'g denied.
Petitioner did not explicate the apparent inconsistency between agency policy that Petitioner stated at the conclusion of the survey conducted on July 16, 2004, and agency policy that Petitioner stated in its prior practice. On July 16, 2004, Petitioner interpreted Tag F324 to require Respondent to provide better supervision or assistance devices, including a hall monitor and keypad system. In surveys that Petitioner conducted of the facility prior to July 16, 2004, Petitioner's practice was not to charge Respondent with a violation of Tag F324 for failure to provide hall monitors or a keypad system.
If Petitioner's policy before the survey were to interpret Tag F324 as requiring Respondent to provide better supervision and assistance devices, including a hall monitor or a keypad system, it is reasonable to infer that Petitioner would
have stated such a policy through enforcement action that charged Respondent in previous surveys with violating those requirements in Tag F324. Petitioner did not prove that Petitioner's enforcement action stated such a policy prior to the survey on July 16, 2004.
Petitioner could not amend its non-rule policy on July 16, 2004, to impose new requirements for supervision and assistance devices, including a hall monitor and keypad system, and retroactively apply the new requirements of the amended policy. To do so, would violate procedural safeguards in the Administrative Procedure Act (APA) as well as fundamental principles of due process. See Albrecht v. Department of Environmental Regulation, 353 So. 2d 883, 887 (Fla. 1st DCA 1977) (agency orders may not be employed to prescribe substantive standards), cert. denied, 359 So. 2d 1210 (Fla. 1978). See also Environmental Trust v. State, Department of Environmental Protection, 714 So. 2d 493, 499-500 (Fla. 1st DCA 1998)(describing the general proposition that agency policy of general applicability that imposes new requirements cannot be applied retroactively).
The APA has for more than 25 years infused administrative proceedings such as this one with concern for agency policy as well as concern for facts and law. As the First District Court of Appeal explained in 1977:
Thus the APA infuses Section 120.57(1) proceedings with concern for agency policy as well as for facts and law. The hearing officer . . . is also charged to record, recommend and critique agency policy as it is revealed in the record. [T]he
hearing officer's duty to respond to evidence in that way cannot fail to promote responsible agency policymaking.
McDonald, 346 So. 2d at 582-583.
Section 400.23(8)(a), Florida Statutes (2003), authorizes a class I rating for a deficiency if the deficient practice creates a likelihood of death or serious physical harm. For reasons stated in the Findings of Fact, Petitioner did not prove the requisite likelihood of injury to other residents or that the accident involving Resident 1 was reasonably foreseeable.
A deficiency with only a "potential" to compromise a resident's well being is properly classified as a class III deficiency within the meaning of Subsection 400.23(8)(c), Florida Statutes (2003). The assignment of a hall monitor corrected any class III deficiency by the time Petitioner conducted a survey of the facility.
In relevant part, the absence of a class I deficiency deprives Petitioner of statutory authority to impose the proposed fine, accelerated survey cycle, and survey fee.
§§ 400.19(3) and 400.23(8)(a), Fla. Stat. (2003). In the absence of class I or II deficiency or an uncorrected class III
deficiency, Petitioner lacks statutory authority to change the status of Respondent's license from Standard to Conditional.
§ 400.23(7)(a), Fla. Stat. (2003).
RECOMMENDED that Petitioner enter a final order finding Respondent not guilty of the violations charged in the Administrative Complaint; dismissing the proposed fine, fee, and accelerated survey cycle; and replacing the Conditional rating from July 16 through August 28, 2004, with a Standard rating.
DONE AND ENTERED this 28th day of February, 2005, in Tallahassee, Leon County, Florida.
Filed with the Clerk of the Division of Administrative Hearings this 28th day of February, 2005.
Gerald L. Pickett, Esquire
525 Mirror Lake Drive, North St. Petersburg, Florida 33701
215 South Monroe Street, Suite 400 Post Office Drawer 11300 Tallahassee, Florida 32302-1300
R. Davis Thomas, Jr. Broad and Cassel
215 South Monroe Street, Suite 400 Post Office Drawer 11300 Tallahassee, Florida 32302-1300
Valda Clark Christian, General Counsel Agency for Health Care Administration Fort Knox Building, Suite 3431
15 days from the date of this Recommended Order. Any exceptions to this Recommended Order should be filed with the agency that will issue the Final Order in this case.
