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AGENCY FOR HEALTH CARE ADMINISTRATION vs PALMS WEST HOSPITAL, L.P., D/B/A PALMS WEST HOSPITAL, 09-004280 (2009)

Court: Division of Administrative Hearings, Florida Number: 09-004280 Visitors: 5
Petitioner: AGENCY FOR HEALTH CARE ADMINISTRATION
Respondent: PALMS WEST HOSPITAL, L.P., D/B/A PALMS WEST HOSPITAL
Judges: ERROL H. POWELL
Agency: Agency for Health Care Administration
Locations: Loxahatchee, Florida
Filed: Aug. 12, 2009
Status: Closed
Settled and/or Dismissed prior to entry of RO/FO on Wednesday, September 2, 2009.

Latest Update: Nov. 09, 2009
AHCA v Palms West Hospital Limited Partnership dba Palms West Hospital


STATE OF FLORIDA

AGENCY FOR HEALTH CARE ADMINISTRATION

zooq Nov -s P 2: 111..t


STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION,


Petitioner,

v.

AHCA CASE NO: 2009007772 DOAH CASE NO: 09-4280

RENDITION NO.: AHCA-09- \2..10 -5-OLC


PALMS WEST HOSPITAL LIMITED PARTNERSHIP d/b/a PALMS WEST HOSPITAL,


Respondent.

---------------·'

FINAL ORDER


Having reviewed the administrative complaint dated July 20, 2009, 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 attached 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.


  2. Respondent shall pay an administrative fine in the amount of

    $750. 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:


    Filed November 9, 2009 12:07 PM Division of Administrative Hearings.


    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 hereb


DONE and ORDERED this /4day 2ref(

inTallahassee, Leon County, Florida.


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:


D. Bland Eng, CEO Palms West Hospital

13001 Southern Boulevard

Loxahatchee, Florida 33470 (U. S. Mail)


Nelson E. Rodney Assistant General Counsel

Agency for Health Care Administration 8350 NW 52nd Terrace, Suite 103

Miami, Florida 33166 (Interoffice Mail)



Richard M. Ellis, Esq. Attorney for Respondent Rutledge, Ecenia & Purnell 119 South Monroe Street Suite 202

Tallahassee, Florida 32301 (U.S. Mail)


Finance & Accounting Agency for Health Care Administration

Revenue Management Unit 2727 Mahan Drive, MS #14

Tallahassee, Florida 32308 (Interoffice Mail)


Jan Mills

Agency for Health Care Administration

2727 Mahan Drive, Bldg #3, MS #3

Tallahassee, Florida 32308 (Interoffice Mail)


Hospital Unit

Agency for Health Care Administration 2727 Mahan Drive

MS #31

Tallahassee, Florida 32308 (Interoffice Mail)


Hon. Errol H. Powell Administrative Law Judge

Division of Administrative Hearings The DeSoto Building

1230 Apalachee Parkway

Tallahassee, Florida 32399-3060 (U.S. Mail)


CERTIFICATE OF SERVICE


I HEREBY CERTIFY that a true and correct copy of this Final Order was

2rlJZ:

served on the above-named per s :nd entities by U.S. Mail, or the method designated, on this the y of ,d& ,


?

Richard Shoop, Agency Clerk

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

Tallahassee, Florida 32308-5403

(850) 922-5873



l.


STATE OF FLORIDA

AGENCY FOR HEALTH CARE ADMINISTRATION



STATE OF FLORIDA AGENCY FOR HEALTH CARE

.ADMINISTRATION,


Petitioner,


vs.


PALMS WEST HOSPITAL LIMITED PARTNERSHIP d/b/a PALMS WEST HOSPITAL,


Respondent.


AHCA No. 2009007772

Return Receipt Requested 7008 0500 0002 0764 6366

7008 0500 0002 0764 6373


/


ADMINISTRATIVE COMPLAINT

COM8S NOW the Agency for Health Care Administration (hereinafter "AHCA"), by and through the undersigned counsel, files this Administrative Complaint against Palms Wes Hospital Limited Partnership d/b/a Palms West Hospital (hereinafter "Palms West Hospital") pursuant to Chapter 395, Part I, and Chapter 120, Florida Statutes (2008) and Chapter 120, Florida Statutes (2008) hereinafter alleges:

NATURE OF THE ACTION


  1. This is an action to impose an administrative fine in the amount $1,000.00 pursuant to Section 395.1041(5)(a) Florida Statutes.


    EXHIBIT

    I J.


    0


    JURISDICTION AND VENUE


  2. This court has ju isdiction pursuant to Section :20.569 and 120.57 Florida Statutes and Chapter 28-106 Flo:-ida Ad inistrative Code.

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

    PAR'l'IES


  4. AHCA is the enforcing authority with regard to Hospital licensure law pursuant to Chapter 395, Part I, Florida Statutes and Rules 59A-3 Florida Administrative Code.

  5. Palms West Hospital is a 175-bed hospital facility located at 13001 Southern Boulevard, Loxahatchee, Florida 33470, and is licensed under Chapter 395, Part I, Florida Statutes and Chapter .59A-3. Florida Administrative Code, license #4164 with an expiration date of June 28, 2011.

    COUNT I


    PALMS WEST HOSPITAL FAILED TO PROVIDE APPROPRIATE STABILIZING

    TREATMENT FOR A PATIENT

    Sections 395.002(9), and 395.002(29), Florida Statutes, and/or

    Rule 59A-3.255, Florida Administrative Code

    (EMERGENCY CARE)

  6. ARCA re-alleges and incorporates paragraphs (1) through

    (5) as if fully set forth herein.

  7. During the complaint investigation conducted on 5/05/09, and based on record review and interview, it was determined that the facility Emergency Department (ED) staff failed to provide appropriate stabilizing treatment for a patient


    who p::::-esented wit::. a::xie:.y a::d tre::no::::-s a::d req ested ac::.:issio:1 to a inpa:.ie t psychiatric facility for treatne::t. This affected 1 of S sampled patients. (#2)

  8. A review of the clinical record o: sa:nple patient 1 2 revealed that the patient came to the ED by county fire-rescue on 4/10/09 at 10:15 AM. The fire rescue note documents the patient complained of shaking for 2 days secondary to possible anxiety/panic attack. The patient was triaged at 10:31 AM in the Emergency Department (ED). The triage nurse's note documents the patient complained of uncontrolled movements of the whole body since Xanax was discontinued in February 2009. The patient also complained of epigastric pain (burning) for many days. The nurse noted erratic clonic type movements of the right upper extremity with a general stiff appearance. The triage note documents the patient's routine medications as Trazadone, Sertraline, Hydroxyzine, Thiamine, Phenytoin and Tranxene.

  9. Nurses' notes at 1321 (1:21 PM) document a Suicide Risk Assessment noting previous attempts at suicide, depression, agitation and suicidal ideation. The notes also docum_ent jerky movements of the right upper extremity and all extremities intermittently and complaints of nausea and diarrhea.

  10. The patient was seen by the ED physician at 2:06 PM. The physician noted that the patient complained of anxiety and panic attacks and frequent exacerbation of shaking. The patient was last seen by the psychiatrist 2 days ago, a new Rx for


    Eydroxyzine was given. The patie t sta es it is not working, and is requesting Xanax. The patie t states s/he was on Xa ax be o e, b t the psychiatrist would not refill it, as it is addicting. The physician documented the patient denies suicidal/r.omicidal ideation. The history and review of systems was esse tially negative except for a family history of 11me nt a l problems11 and mood alteration noted as anxiety. The ED physician noted the patient as having no pain, "patient states no epigastric burning", The physical exam noted voluntary movements/jerks of the arms and body intermittently. "Able to stop movements when talks". No lab work, medications or studies were documented as done while the patient was in the ED. The final diagnosis was anxiety, acute exacerbation of chronic anxiety. The ED physician noted the disposition time as 1410 (2:10 PM).

  11. Nurses' notes at 1445 (2:45 PM) document the ED physician requested a social service consult for psych resources. At 1500 (3:00 PM) the nurses' notes document the patient is awake, agitated and anxious with a flat af feet, intermittent uncontrolled movements of the extremities and writhing of the torso.

  12. At 1515 nurses' notes docum nt the patient was discharged t6 "the care of a friend at the bedside who reports he will take the patient to a mental health facility as instructedTT by the ED physician. Referred to a psychiatric facility by the social worker.


0


:3. N= ses1 ates doc rnent discharge instr c !ons were p ov:ced to tte patie t with verbalizatic of 4 derstanding.

  1. The patient's record contained a Discharge Ir.struction sheet noting the 9atient sr:ould fol}.ow up with his/her psychiatrist a d that by signing the discharge form he/she contracts with the facility that he/she will return if he/she feels suicidal. The form was not s.igned by the patient. 'l'he discharge form also noted a prescription for Zofran as needed for nausea. The physician's Multisystem Evaluation form documents no prescriptions given at discharge and notes that the patient was discharged in "good" condition with a follo_w up. The space for the name of the facility or physician with whom to follow up is blank.

  2. Nurses' notes document the discharge time as 1512 (3:12 PM), departing the ED at 1536 (3:36 PM).

  3. The Social Worker documented in a note at 1638 (4: 38 PM), after the patient was d.ischarged, that the patient needs voluntary psychiatric treatment and had requested to be admitted for inpatient psychiatric care. 'l'he note documents the social Worker instructed the patient's significant other to take the patj_ent to the ED at another hospital that provides inpatient psychtatric care for treatment.

  4. During an interview with the Director of Quality Management on 5/5/09 at 10:15 AM, she stated that the patient came to the facility and requested a prescription for Xanax. The


    5


    \


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    ED physicia assessed the patie t a d fe:t that he/she was a the facility to see d gs. W en tr.e p ysicia refused tc provide a

    p::::escription, he recommended that the patient call her .o. rivat:e

    physician and follcw p w th hin. The patient was to be discharged to the family member to follow up. Once the patient was discharged, she asked the staff where the affiliated psychiatric facility was located. She was given the address.

  5. An interview with the Director of Quality Management and the Chief Nursing Office on 5/5/09 at 11:30 AM revealed that the patient was discharged after speaking with the Social Worker and went by private car to the affiliated psychiatric facility ED for treatment. They were aware of the documentation by the ED nurse and the Social Worker and stated that the ED physician did not document that he was aware of their findings. Neither the nurse nor the Social Worker stopped the discharge process once the patient declared that she wanted to be admitted to an inpatient psychiatric unit for treatment.

  6. A review of the patient's clinical record from the 2nd hospital ED revealed that the patient was seen in the ED on 4/10/09 at 1638 (438 PM). Nurses' notes document the patient presented with gross tremors to bilateral arms, stating he/she is having panic attacks 3-4 times per day and crying. The patient admitted to suicidal ideation, and having a plan to commit suicide.


    0 0


  7. 7te pat e was seen by the ED physician a 4:30 ?M w o revie·.ved the patient's h1..2. .s:ory and revie of systems and completed a physical exam which noted tremors and dystonia. The physician obtained laboratory studi.es ir.cludi!1g Dilar.tin :!.evel, urine toxicology studies, x-ray studies as well as a CT of the

    head for patient's complaint of headache. The patient was medicated with Cogentin at 2106 (9:06 PM).

  8. A nurses' note at 2040 (8:40 PM) documents the patient is felling better and denies suicidal ideation at this time.

  9. The discharge diagnosis was documented as anxiety with tremors, dystonic contractions and substance abuse. Referrals were obtained for psychiatric follow up as well as community crisis center for psych follow up with contact phone numbers.

  10. The patient was discharged home at 2204.

  11. Based on the foregoing, Palms West Hospital violated Sections 395.002(9), and 395.002(29), and/or Rule 59A-3.255, Florida Administrative Code, which carries a $1,000.00 Fine.

    CLAIM FOR :RELIEF

    WHEREFORE, AHCA requests the following relief:

    1. Make factual and legal findings in favor of the Agency on Count I.

    2. Assess a fine against the facility in the amount of

$1,000.00.


C, Grant such other relief as the court deems proper.


0 0


The Respondent is noti ied that it has a right to equest an adninistrative hea ing p rsuant to Sectio 120.569, Flo ida Statutes. Specific options for administrative action are set out in the attached Ex?lanation of Rights (one page) and Elec icn of Rights (one page). All requests for hearing shall be made to the Agency £or Hea1th Care Administration, attention Agency Clerk,

2727 Mahan Drive, Mail Stop #3, Tallahassee, Florida 32308,


Telephone (850) 922-5873.


RESPONDENT IS FURTHER NOTIFIED THAT E'AILURE TO RECEIVE A REQUEST FOR A HEARING WITHIN 21 DAYS OF RECEIPT OF THIS COMPLAINT WILL RESULT IN AN ADMISSION OF THE FACTS ALLEGED IN THE COMPLAINT AND THE ENTRY OF A FINAL ORDER BY THE AGENCY.

IF YOU WANT TO HIRE AN ATTORNEY, YOU HAVE THE RIGHT TO BE REPRESENTED BY AN ATTORNEY IN THIS MATTER.

Respectfully submitted


Es uire Assistant General Counsel Spokane Bldg., Suite #103 8350 NW 52 Terrace

Miami, Florida 33166

(305) 470-6802


Copies furnished to:

Field Office Manager

Agency for Health Care Administration 8355 NW 53 Street, First Floor

Miami, Florida 33166

(Interoffice Mail)


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Hos?ital Frcgram Office

Agency fo::: Eealth Care Adr:-.inis:.ratio:1

2727 Mahan Drive, Mail Stop #31

Tallahassee, F orida 32308

( .:.n...... ero f ...1ce ma1'l)


Revenue and Ma age en: Unit

Agency for Health Care Administration Finance and Accounting

2727 Mahan D:::ive, Mail Stop #14

Tallahassee, Florida 32308 (Interoffice mail)


CERTIFICATE OF SERVICE


I HEREBY CERTIFY that a true copy hereof was sent by U.S. Mail, Return Receipt Requested to D. Bland, CEO, Palms West Hospital, 13001 Southern Boulevard, Loxahatchee, Florida 33470,

and to CT Corporation System, Registered Agent, 1200 South Pine Island Road, Plantation, Florida 33324, on clo , 2009.


0

I


STATE OF FLORIDA f'IL.ED

AGE CY FOR HEALTH CARE ADMI ISTRATIO:',; AGEJt C LERK


RE: Palms \.Vest Hospital Limited Partnership d/b/a Palms ·west Hospital

CASE 011oiB871tr p ti: 30'


ELECTION OF RIGHTS


This Election of Rights form is attached to a proposed action by the Agency for Health Care Administration (AHCA). The title may be Notice of Intent to Impose a Late Fee, Notice of Intent to Impose a Late Fine or Administrative Complaint.


Your Election of Rights must be returned by mail or bv fax within 21 davs of the day you

receive the attached Administrative Complaint.


If your Election of Rights with your selected option is not received by ARCA within twenty­ one (21) days from the date you received this notice of proposed action by ARCA, you will have given up your right to contest the Agency's proposed action and a final order will be issued.


(Please use this fonn unless you, your attorney or your representative prefer to reply according to Chapter120, Florida Statutes (2006) and Rule 28, Florida Administrative Code.)


PLEASE RETURN YOUR ELECTION OF RIGHTS TO THIS ADDRESS:


Agency for Health Care Administration

Attention: Agency Clerk

2727 Mahan Drive, Mail Stop #3

Tallahassee, Florida 32308,

Phone: 850 922-5873 Fax: 850 92IN0158.


PLEASE SELECT ONLY 1 OF THESE 3 OPTIONS


OPTION ONE (I) I admit to the allegations of facts and law contained in the

Administrative Complaint and I waive my right to object and to have a hearing, I understand that by giving up my right to a hearing, a final order will be issued that adopts the proposed agency action and imposes the penalty, fine or action.


OPTION TWO (2) I admit to the allegations of facts contained in the Administrative

Complaint, but I wish to be heard at an informal proceeding (pursuant to Section 120.57(2), Florida Statutes) where I may submit testimony and written evidence to the Agency to show that the proposed administrative action is too severe or that the fine should be reduced.


OPTION THREE (3) I d_ispute the allegations of fact contained in the Administrative Complaint, and I request a formal hearing (pursuant to Subsection 120.57(1), Florida Statutes) before an Administrative Law Judge appointed by the Division of Administrative Hearings.


PLEASE NOTE: Choosing OPTION THREE (3), by itself, is NQI sufficient to obtain a formal bearing. You also must file a written petition in order to obtain a formal hearing before the Division of Administrative Hearings under Section 120.57(1), Florida Statutes. It must be received by the Agency Clerk at the address above within 21 days of your receipt of this proposed


0 0

administrative action. The request for formal hearing must conform to the requirements of Rule 28 106.2015, Florida Administrative Code, which requires that it contain:


t. Your name, address, and telephone number, and the name, address, and telephone number of your representative or lawyer, if any.

  1. The file number of the proposed acti.on.

  2. A statement of when you received notice of the Agency's proposed action.

  3. A statement of all disputed issues of material fact. If there are none, you must state that there

are none.


Mediation under Section 120.573, Florida Statutes, may be available in this matter if the Agency agrees.


. License type: Hospital (ALF? nursing home? medical equipment? Other type?) Licensee Name: Palms West Hofirpital License number: _

Contact person: Richard M. Ellis


Name

Attorney for Petitioner

Title

Address: SEE ATTACHED PETITION

Street and number City


Zip Code


Telephone No. Fax No. Email(optional)


I hereby certify that I am duly authorized to submit this Notice of Election of Rights to the Agency for Health Care Administration on behalf of the licensee referred to above.


e

Signed:


Print Name:

Richard M. Ellis

Title:

Attor·n y


Late fee/fine/AC


STATE OF FLORIDA

AGENCY FOR HEALTH CARE ADMINISTRATION


STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION,


Petitioner,

vs. AHCA CASE NO.: 2009007772

PALMS WEST HOSPITAL, L.P., d/b/a

PALMS WEST HOSPITAL,


Respondent.

-----------------'

DOAH CASE NO.: 09-4280

SETTLEMENT AGREEMENT


Petitioner, State of Florida, Agency for Health Care


Administration (hereinafter undersigned representatives,

the and

"Agency" ), through its Respondent, Palms West

Hospital, L.P., d/b/a Palms West Hospital (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 a hospital licensed pursuant to


Chapters 408, Part II, and 395, Part I, Florida Statutes (2007), Section 20.42, Florida Statutes (2007), and Chapter 59A-3, Florida Administrative Code; and

WHEREAS, the Agency has jurisdiction by virtue of being the regulatory and licensing authority over Respondent, pursuant to

Chapter 395, Part I, Florida Statutes; and


Page 1 of 6


EXHIBIT

I


WHEREAS, the Agency served Respondent with an administrative complaint on or about July 20, 2009, notifying the Respondent of its intent to impose an administrative fine in the amount of $1,000.00; and

WHEREAS, Respondent requested a formal hearing administrative proceedings by selecting Option three (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, 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 of relief 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 of law) 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 $750.00 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 the allegations raised in the administrative complaint, and the Agency continues to assert the validity of these allegations. However, 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.

  7. No agreement made herein shall preclude the Agency from using the deficiencies from the surveys identified in the administrative complaint to demonstrate a pattern of deficient performance. The Agency is not precluded from using the subject events for any 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.

  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 59G-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 respective principals to it.

  16. This Agreement contains and incorporates the entire understandings and agreements of the parties.

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

  18. This Agreement may not be amended except in writing.


    Any attempted assignment of this Agreement shall be void.


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


The following representatives hereby acknowledge that they


are duly authorized to enter into


Deputy Secretary

Divisi n of Health Quality Ass1:r nee

Agency for Health Care Administration

2727 Mahan Drive

Tallahassee, Flor;da 32308

Dated: :J{:(::B


J

General ounsel

Agency for Health Care Administration

2727 Mahan Drive

Tallahassee, Florida 32308 Dated:


Assistant General Counsel Agency for Health Care Administration

h/02

8350 N.W. 52 Terrace - #103

Miami, Florida 33166

Dated: 'I

this Agreement.


Rich - Attorney for Respondent Rutledge, Ecenia & Purnell

119 South Monroe Street Suite 202

Tallahassee, Florida 32301 Dated:


D. Bland Eng, CEO Palms West Hospital 13001 Southern Blvd.

Loxahatchee, Florida 33470 Dated:


Page 6 of 6


Docket for Case No: 09-004280

Orders for Case No: 09-004280
Issue Date Document Summary
Nov. 05, 2009 Agency Final Order
Source:  Florida - Division of Administrative Hearings

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