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STATE OF FLORIDA

AGENCY FOR HEALTH CARE ADMINISTRATION

STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION,

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   Petitioner,

   
   

   v.

   
   

   CASE NO(S): 08-3917

   2008004021

   RENDITION NO.: AHCA-09- Z? -5-OLC

   
   

   ALTERRA HEALTHCARE CORPORATION d/b/a ALTERRA STERLING HOUSE OF WEST MELBOURNE II,

   
   

   Respondent.

   / FINAL ORDER

   Having reviewed the administrative complaint dated July 16, 2008, attached hereto and incorporated herein (Ex. 1), and all other matters of record, the Agency for Health Care Administration ("Agency") has entered into a Settlement Agreement (Ex. 2) with the other party to these proceedings, and being otherwise well-advised in the premises, finds and concludes as follows:

   ORDERED:

   
   

   1. The. att ached Settlement Agreement is approved and adopted as part of this Final Order, and the parties are directed to comply with the terms of the Settlement Agreement.

      
      

      Filed June 30, 2009 1:59 PM Division of Administrative Hearings.

      
      

   2. Respondent shall pay an administrative fine in the amount of One Thousand Dollars ($1000.00). The administrative fine is due and payable within thirty (30) days of the date of rendition of this Order.

   3. Checks should be made payable to the "Agency for Health Care Administration." The check, along with a reference to these case numbers, should be sent directly to:

      Agency for Health Care Administration Office of Finance and Accounting Revenue Management Unit

      2727 Mahan Drive, MS# 14

      Tallahassee, Florida 32308

      
      

   4. Unpaid amounts pursuant to this Order will be subject to statutory interest and may be collected by all methods legally available.

   5. Respondent's petition for formal administrative proceedings is hereby dismissed.

   6. Each party shall bear its own costs and attorney's fees.

      
      

   7. The above-styled case is hereby closed.

DONE and ORDERED this du, day of- =---' 2009, in Tallahassee, Leon County, Florida.

Holly Ben on, Secretary

Agency fo Health Care Administration

A PARTY WHO IS ADVERSELY AFFECTED BY THIS FINAL ORDER IS ENTITLED TO JUDICIAL REVIEW WHICH SHALL BE INSTITUTED BY FILING ONE COPY OF A NOTICE OF APPEAL WITH THE AGENCY CLERK OF AHCA, AND A SECOND COPY, ALONG WITH FILING FEE AS PRESCRIBED BY LAW, WITH THE DISTRICT COURT OF APPEAL IN THE APPELLATE DISTRICT WHERE THE AGENCY MAINTAINS ITS HEADQUARTERS OR WHERE A PARTY RESIDES. REVIEW OF PROCEEDINGS SHALL BE CONDUCTED IN ACCORDANCE WITH THE FLORIDA APPELLATE RULES. THE NOTICE OF APPEAL MUST BE FILED WITHIN 30 DAYS OF RENDITION OF THE ORDER TO BE REVIEWED.

Copies furnished to:

CERTIFICATE OF SERVICE

I HEREBY CERTIFY that a true and correct copy of this Final Order was served on the above-named person(s) and entities by U.S. Mail, or the

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method designated, on this the Z f C J , 2009.

Richard Shoop, Agency Clerk

Agency for Health Care Administration 2727 Mahan Drive, Building #3

Tallahassee, Florida 32308-5403

(850) 922-5873

STATE OF FLORIDA

AGENCY FOR HEALTH CARE ADMINISTRATION

STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION,

Petitioner,

vs. Case No. 2008004021

ALTERRA HEALTHCARE CORPORATION

d/b/a ALTERRA STERLING HOUSE OF WEST MELBOURNE II,

Respondent.

/

ADMINISTRATIVE COMPLAINT

COMES NOW the Petitioner, State of Florida, Agency for Health Care Administration (hereinafter "the Agency"), by and through its undersigned counsel, and files this Administrative Complaint against the Respondent, ALTERRA HEALTHCARE CORPORATION d/b/a ALTERRA STERLING HOUSE OF WEST MELBOURNE II (hereinafter "the Respondent"), pursuant to Sections 120.569 and 120.57, Florida Statutes (2007), and states:

NATURE OF THE ACTION

This is an action to impose an administrative fine against an assisted living facility in the sum of ONE THOUSAND DOLLARS ($1,000.00) based upon one (1) Class II deficiency pursuant to Section 429.19(2)(b), Florida Statutes (2007).

JURISDICTION AND VENUE

1. The Court has jurisdiction over the subject matter pursuant to Sections 120.569 and 120.57, Florida Statutes (2007).

2. The Agency has jurisdiction over the Respondent pursuant to Sections 20.42 and 120.60, and Chapters 408, Part II, and 429, Part I, Florida Statutes (2007).

   EXHIBIT

   I 1

   
   

3. Venue lies pursuant to Rule 28-106.207, Florida Administrative Code.

   
   

   PARTIES

   
   

4. The Agency is the licensing and regulatory authority that oversees assisted living facilities in Florida and enforces the applicable federal and state regulations, statutes and rules governing such facilities. Chapters 408, Part II, and 429, Part I, Florida Statutes (2007); Chapter 58A-5, Florida Administrative Code (2007). The Agency may deny, revoke, or suspend any license issued to an assisted living facility, or impose an administrative fine in the manner provided in Chapter 120, Florida Statutes (2007). Sections 408.815 and 429.14, Florida Statutes (2007).

5. The Respondent was issued a license by the Agency (License Number 9244) to

   
   

   operate a 55-bed assisted living facility located at 7200 Greensboro Drive, Melbourne, Florida 32904, and was at all times material required to comply with the applicable federal and state regulations, statutes and rules governing assisted living facilities.

   COUNT!

   The Respondent Failed To Provide Care And Services Appropriate To The Needs Of Residents Accepted For Admission To The Facility In Violation Of Rule SSA-5.0182, Florida Administrative Code

   
   

6. The Agency re-alleges and incorporates by reference paragraphs one (1) through five (5).

7. Pursuant to Florida law, an assisted living facility shall provide care and services appropriate to the needs of residents accepted for admission to the facility. Rule 58A-5.0182, Florida Administrative Code.

8. On or about February 13, 2008 the Agency conducted a Biennial Survey of the Respondent and its facility.

9. Based on record review and interview, the facility did not ensure that one (1) of

   
   

   
   

   five (5) sampled residents was provided the appropriate care and services to prevent the development of a pressure ulcer, Resident number one (1).

10. A resident record review on February 13, 2008 at approximately 10:00 a.m. for resident number one (1) revealed a health assessment report form 1823 dated October 16, 2006 that documented diagnoses of Alzheimer Disease, Depression and Dementia.

11. Facility notes documented the following:

    
    

    a.) February 14, 2007-11:00 a.m.-Resident number one (1) went out to MD (neurologist) appointment accompanied by his/her family member. Family member stated Resident number one (1) complained of his/her left foot being sore. When shoe was removed, an open area was noted by the family member. The doctor on examination deemed the open area a Stage III wound. Resident number one (1) was placed on Keflex 250 mg twice daily for seven

    . (7) days. New order for home health to administer wound care.

    
    

    b.) February 14, 2007-12:30 p.m.-Call placed to Facility's Registered Nurse (name mentioned). Discussed condition of wound and decided to issue the family a forty-five

    (45) day notice due to the Stage III status of the wound.

    
    

    c.) February 23, 2007-Home health here to visit with Resident number one (1)

    
    

    for wound care

12. A continued record review revealed a Skilled Nursing Evaluation completed by a home health registered nurse dated February 15, 2007 that documented: Wound-great toe-open

    1. cm x 0.8 cm x 0.3-stage III-weeping, scant, watery- Progress: Not healing.

       
       

13. A continued record review revealed physician orders dated February 14, 2007 for home health and Bacitracin 500u/GM ointment apply to wound daily.

14. A review of the financial record revealed a forty-five (45) day discharge notice to

    
    

    
    

    Resident number one (1) dated February 20, 2007 that documented the reason of discharge to be "because the resident required care other than that which Sterling House of M_elbourne II is licensed to provide".

15. A continued record review revealed there was no documentation that indicated the facility was aware of the pressure sore prior to the family member's observations. There was no documentation found to indicate the measures, if any, that were instituted to protect Resident number one's (1) skin to prevent further breakdown once the pressure sore was discovered nor was there documentation as to what type of care that the facility and home health agency provided and the progress of the pressure sore other than the February 15, 2007 note.

16. An interview with the facility's corporate nurse on February 13, 2008 at

    
    

    'approximately 11:15 a.m., who searched the record for information regarding the treatment of the pressure sore, stated that she would request the documentation from the home health agency.

17. At approximately 11:55 a.m. on February 13, 2008 the nurse provided documentation received from the health care provider that documented the following:

    a.) February 14, 2007 Consultation: "Resident suffers from Alzheimer's Dementia and is living in an assisted living facility with his/her spouse. He/she receives regular

    hygiene care there, however, it was noticed just today that he/she has a wound on the top of

    
    

    his/her left foot right near his/her great toe. He/she saw a neurologist today for his/her Alzheimer's and he/she was referred by the doctor to us for wound care. He/she doesn't have this wound resolved within forty-five (45) days or he/she may lose his/her ability to be in the Assisted Living facility and they are quite concerned ".

    b.) Wound: "The wound appears on the left foot of the dorsum of the great toe, metatarsal head area and measure 1.2 cm x 0.8 cm x 0.2 cm and has a moderate amount of

    
    

    slough in the wound bed that is fairly easily wiped away. This reveals red firm granulation tissue. There is no exposed bone, tendon, eschar or odor and a small amount of serosanguineous drainage is present. The peri-wound integrity is intact and slightly erythematous. The wound was cleansed, photographed and dressed with Aquacel plain with Clindagel and 2 x 2 gauze and occlusive wrapping".

    c.) Impression: Chronic ulcer, secondary more than likely to pressure friction and peripheral vascular disease.

18. Progress Notes for health care provider documented on February 22, 2007: a.) The patient returns to the Wound Care program today.

    b.) Wounds: Wound recheck reveals left dorsum of foot wound measures 0.7 cm x 0.3 cm x 0.1 cm and has a moderate amount of slough, red firm granulation tissue and a small amount of yellow drainage. The peri-wound integrity is intact and slightly non­ erythematous. The wound was cleansed, photographed and dressed with Clindagel and Mepilex Border Lite.

19. The Discharge Summary health care provider March 2, 2007 - Discharge Diagnosis: Wound left foot healed. He/she suffers from Alzheimer's Dementia and is in assisted

    living facility where he/she does receive regular excellent care; however, it was noticed that

    
    

    he/she had a wound on his/her foot. They (family) were fearful that he/she would develop a larger ulcer and lose his/her assisted living facility status. He/she was treated with a course of Clindagel and Mepilex Border lite and offloading of his/her foot and did very well and has healed today. He/she is discharged back to the assisted living facility care with orders for good daily hygiene and moisturizing as well as offloading foot to prevent future occurrence. He/she will follow-up with the attending nurse there.

    
    

20. At approximately 12:45 p.m., the home health notes were received in the assisted living facility via fax and documented:

a.) February 15, 2007-Skilled Nursing-teach safety; infection methods to reduce skin pressure. Provide wound care-toe, great 1, dorsal metatarsal: Frequency: daily; who: Skilled Nurse; Cleanse: Normal saline; Pack 1: Prisma; Soak: Normal saline; Primary dressing: Gauze; Secondary Dressing: Kling; secure with: Tape. Wound-great toe-open 1.2 cm x 0.8 cm x OJ cm-stage III-

February 19, 2007-0.7 cm x 0.5 cm x 0.2 cm -progress-Healing-stage IL

February 20, 2007-1.0 cm x 0.7 cm x 0.2 cm-stage II. February 21, 2007-February 22, 2007-No notes provided.

February 23, 2007-No documentation regarding the pressure sore. February 24, 2007-0.7 cm x 0.2 cm x 0.1 cm -stage II.

February 25, 2007-open-no measurements or stage. February 26, 2007-0.6 cm x 0.2 cm x 0.1 cm -stage II-open. February 27, 2007-March 2, 2007-no notes provided.

March 3, 2007-Closed ulcer-0.1 cm x 0.1 cm x 0.0 cm -color pink-healed.

21 An interview with the administrator on the said date at approximately 2·30 p rn who stated that she did not have an answer regarding how Resident number one (1) sustained the pressure sore since the facility staff did not document skin integrity changes during daily routine resident care. The corporate nurse stated at the time that staff did provide assistance with the resident Activities of Daily Living and she did not know why staff did not observe/notice what was documented to be a Stage III pressure sore. The administrator said that the neurologist stated the pressure sore was Stage III but according to the description given by the wound care

doctor on February 14, 2007, it was not a Stage III. The administrator stated that the home health documented it as a Stage III but it was not.

1. A continued interview with the corporate nurse who stated that the only interventions in place to prevent skin breakdown was for the staff to observe Resident number one's (1) skin and encourage Resident number one (1) to wear socks. She added there was nothing in writing regarding preventative measure for the skin care as ordered by the health care provider on March 2, 2007. Observations of Resident number one (1) revealed that Resident number one (1) was in Resident number one's (1) room during the tour of the facility at approximately 9:30 a.m. sitting on the couch and the only time Resident number one (1) moved was when Resident number one (1) went to lunch at approximately 12:00 p.m. and returned at approximately 1:00 p.m. After returning from lunch, Resident number one (1) remained sitting on the sofa with Resident number one's (1) feet on the floor until the surveyors exited the building.

2. The Respondent's deficient practice constituted a Class II violation in that it related to the operation and maintenance of a facility or to the personal care of residents which the Agency determines directly threaten the physical or emotional health, safety, or security of

   the facility residents, other than a Class I violation. Section 429.19(2)(b), Florida Statutes (2007)

   
   

3. The Agency shall impose an administrative fine for a cited Class II violation in an amount not less than one thousand dollars ($1,000.00) and not exceeding five thousand dollars ($5,000.00) for each violation as set forth in Section 429.19(2)(b), Florida Statutes (2007). A fine shall be levied notwithstanding the correction of the violation.

4. The Respondent was given a mandatory correction date of February 14, 2008.

WHEREFORE, the Petitioner, State of Florida, Agency for Health Care Administration, intends to impose an administrative fine against the Respondent in the amount of ONE THOUSAND DOLLARS ($1,000.00) pursuant to Section 429.19(2)(b), Florida Statutes (2007).

CLAIM FOR RELIEF

WHEREFORE, the Petitioner, State of Florida, Agency for Health Care Administration, respectfully requests the Court to grant the following relief:

1. Enter findings of fact and conclusions of law in favor of the Agency.

   
   

2. Impose an administrative fine against the Respondent in the amount of ONE THOUSAND DOLLARS ($1,000.00).

3. Order any other relief that the Court deems just and appropriate.

Respectfully submitted on this L4/t£ dayofJ,,4'e , 2008.

ary aleyj obs, Senior Attorney Florida Bar No. 0355712

Agency for Health Care Administration Office of the General Counsel

2295 Victoria Avenue, Room 346C Fort Myers, Florida 33901 Telephone: (239) 338-3203

NOTICE

RESPONDENT IS NOTIFIED THAT IT/HE/SHE HAS A RIGHT TO REQUEST AN ADMINISTRATIVE HEARING PURSUANT TO SECTIONS 120.569 AND 120.57, FLORIDA STATUTES. THE RESPONDENT IS FURTHER NOTIFIED THAT IT/HE/SHE HAS THE RIGHT TO RETAIN AND BE REPRESENTED BY AN ATTORNEY IN THIS MATTER. SPECIFIC OPTIONS FOR ADMINISTRATIVE ACTION ARE SET OUT IN THE ATTACHED ELECTION OF RIGHTS.

ALL REQUESTS FOR HEARING SHALL BE MADE AND DELIVERED TO THE ATTENTION OF: THE AGENCY CLERK, AGENCY FOR HEALTH CARE ADMINISTRATION, 2727 Jl,fAHAN DRIVE, BLDG #3, MS #3, TALLAHASSEE, FLORIDA 32308; TELEPHONE (850) 922-5873.

THE RESPONDENT IS FURTHER NOTIFIED THAT IF A REQUEST FOR HEARING IS NOT RECEIVED BY THE AGENCY FOR HEALTH CARE ADMINISTRATION WITIDN TWENTY-ONE (21) DAYS OF THE RECEIPT OF THIS ADMINISTRATIVE COMPLAINT, A FINAL ORDER WILL BE ENTERED BY THE AGENCY.

CERTIFICATE OF SERVICE

I HEREBY CERTIFY that a true and correct copy of the Administrative Complaint and Election of Rights form has been served to: Brenda Jones, Administrator, Alterra Healthcare Corporation d/b/a Alterra Sterling House of West Melbourne II, 7200 Greensboro Drive, Melbourne, Florida 32904, by U.S. Certified Mail, Return Receipt No. 7006 2760 0003 1537 3006, and to CT Corporation System, Registered Agent for Alterra Healthcare Corporation d/b/a

Alterra Sterling House of West Melbourne II, 1200 South Pine Island Road, Plantation, Florida 33324, by U.S. Certified Mail, Return Receipt No. 7006 2760 0003 1537 3013 on this 4M,

dayofp«,q,c , 2008.

aryaley Jacobs, Senior Attorney Florida Bar No. 0355712

Agency for Health Care Administration Office of the General Counsel

2295 Victoria Avenue, Room 346C Fort Myers, Florida 33901 Telephone: (239) 338-3203

Copies furnished to:

STATE OF FLORIDA

AGENCY FOR HEALTH CARE ADMINISTRATION

STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION,

Petitioner,

vs. Case No(s): 08-3917

2008004021

ALTERRA HEALTHCARE CORPORATION

d/b/a ALTERRA STERLING HOUSE OF WEST MELBOURNE II,

Respondent.

./

SETTLEMENT AGREEMENT

Petitioner, State of Florida, Agency for Health Care Administration (hereinafter the "Agency"), through its undersigned representatives, and Respondent, Alterra Healthcare Corporation d/b/a Alterra Sterling House of West Melbourne II (hereinafter "Respondent"), pursuant to Section 120.57(4), Florida Statutes, each individually, a "party," collectively as "parties," hereby enter into this Settlement Agreement ("Agreement") and agree as follows:

WHEREAS, Respondent is an assisted living facility licensed pursuant to Chapters 408, Part II, and 429, Part I, Florida Statutes (2007); Section 20.42, Florida Statutes (2007) and 58A- 5, Florida Administrative Code; and

WHEREAS, the Agency has jurisdiction by virtue of being the regulatory and licensing authority over Respondent, pursuant to Chapter 429, Part I, Florida Statutes (2007); and

WHEREAS, the Agency served Respondent with an administrative complaint on or about July 18, 2008, notifying the Respondent of its intent to impose administrative fines in the amount of One Thousand Dollars ($1000.00); and

EXHIBIT

I 2-

WHEREAS, Respondent requested a formal administrative proceeding by filing a petition with the Agency Clerk selecting Option 3 on the Election of Rights form; and

WHEREAS, the parties have negotiated and agreed that the best interest of all the parties will be served by a settlement of this proceeding; and

NOW THEREFORE, in consideration of the mutual promises and recitals herein, the parties intending to be legally bound, agree as follows:

1. All recitals herein are true and correct and are expressly incorporated herein.

   
   

2. Both parties agree that the "whereas" clauses incorporated herein are binding findings of the parties.

3. Upon full execution of this Agreement, and subject to the Agency's entry of a Final Order incorporating the terms of this Agreement without any modification thereto, Respondent agrees to waive any and all appeals and proceedings to which it may be entitled including, but not limited to, an informal proceeding under Subsection 120.57(2), Florida Statutes, a formal proceeding under Subsection 120.57(1), Florida Statutes, appeals under Section 120.68, Florida Statutes; and declaratory and all writs ofrelief in any court or quasi­ court of competent jurisdiction; and agrees to waive compliance with the form of the Final Order (findings of fact and conclusions oflaw) to which it may be entitled, provided, however, that no agreement herein shall be deemed a waiver by either party of its right to judicial enforcement of this Agreement.

4. Upon full execution of this Agreement, Respondent agrees to pay One Thousand

   
   

   Dollars ($1000.00) in administrative fines to the Agency within thirty (30) days of the entry of the Final Order.

   
   

5. Venue for any action brought to enforce the terms of this Agreement or the Final Order entered pursuant hereto shall lie in Circuit Court in Leon County, Florida.

6. By executing this Agreement, Respondent neither admits nor denies, and the Agency asserts the validity of the allegations raised in the administrative complaint referenced herein. No agreement made herein shall preclude the Agency from imposing a penalty against Respondent for any deficiency/violation of statute or rule identified in a future survey of Respondent, which constitutes a "repeat" or "uncorrected" deficiency from surveys identified in the administrative complaint. The parties agree that in such a "repeat" or "uncorrected" case, the Respondent retains the right to challenge the validity of any such deficiency and the deficiencies identified in any administrative complaint that forms the basis for the allegation of a "repeat" or "uncorrected" deficiency claim before an appropriate tribunal.

7. For purposes of settlement in this case, the Agency agrees that the deficiencies from the surveys identified in the administrative complaint will not be used in any decision regarding licensure of Respondent for limited nursing services and extended congregate care. The Agency is not precluded from using the subject events for any other purpose within the jurisdiction of the Agency. Further, Respondent acknowledges and agrees that this Agreement shall not preclude or estop any other federal, state, or local agency or office from pursuing any cause of action or taking any action, even if based on or arising from, in whole or in part, the facts raised in the administrative complaint. This agreement does not prohibit the Agency from taking action regarding Respondent's Medicaid provider status, conditions, requirements or contract.

8. Upon full execution of this Agreement, the Agency shall enter a Final Order adopting and incorporating the terms of this Agreement and closing the above-styled case.

   
   

9. Each party shall bear its own costs and attorney's fees.

   
   

10. This Agreement shall become effective on the date upon which it is fully executed by all the parties.

11. Respondent for itself and for its related or resulting organizations, its successors or transferees, attorneys, heirs, and executors or administrators, does hereby discharge the State of Florida, Agency for Health Care Administration, and its agents, representatives, and attorneys of and from all claims, demands, actions, causes of action, suits, damages, losses, and expenses, of any and every nature whatsoever, arising out of or in any way related to this matter and the Agency's actions, including, but not limited to, any claims that were or may be asserted in any federal or state court or administrative forum, including any claims arising out of this agreement, by or on behalf of Respondent or related facilities.

12. This Agreement is binding upon all parties herein and those identified in paragraph eleven (11) of this Agreement.

13. In the event that Respondent was a Medicaid provider at the subject time of the occurrences alleged in the complaint herein, this settlement does not prevent the Agency from seeking Medicaid overpayments related to the subject issues or from imposing any sanctions pursuant to Rule 590-9.070, Florida Administrative Code.

14. Respondent agrees that if any funds to be paid under this agreement to the Agency are not paid within thirty-one (31) days of entry of the Final Order in this matter, the Agency may deduct the amounts assessed against Respondent in the Final Order, or any portion thereof, owed by Respondent to the Agency from any present or future funds owed to Respondent by the Agency, and that the Agency shall hold a lien against present and future funds owed to Respondent by the Agency for said amounts until paid.

    
    

    
    

15. The undersigned have read and understand this Agreement and have the authority to bind their dtive principals to it.

• 16. . ·This Agreement contains and incorporates the entire understandings and

agreements of.t e parties.

1. This Agreement supersedes any prior oral or written agreements between the

   
   

   parties.

   
   

2. This AgTeement may not be amended except in writing. Any attempted assignment of this Agreement shall be void.

3. All parties agree that a facsimile signature suffices for an original signature.

The folio-wing representatives hereby acknowledge that they are duly authorized to enter into this Agreement.

.Elizabe Gm

Deputy

.Agenc r Health Care Administration 2727 Mahan Drive, Bldg #I Tallahassee, Florida 32308

DATED: tf,BP/

jjstfuM;SenG,-Gene.ral Counsel Florida Bar No. 79741

Agency for Health Care Administration

2727 Mahan Orive. Mail Stop #3

Tallahassee, Florida 32308

I I

DATED: 6/2s-/o9

Senior Vice President of Legal Operations 6737 W. Washington Street, Suite 2300

Milwaukee. Wisconsin 53214

David C. Ashburn

Attorney for the Respondent Florida Bar No. 708046 Greenberg Trauri-g, P.A. IO1 East College Avenue Tallahassee, Florida 32302

="'6aleJy :sbes ol«

Assistant General Counsel Florida Bar No. 355712

Agency for Health Care Administration 2295 Victoria Avenue, Room 346C Fort Myers, Florida 33901

DATED: ,l4tfl//Jf

6

Docket for Case No: 08-003917

Orders for Case No: 08-003917