Ui w) < s . . Pile ; EP) STATE OF FLORIDA See AGENCY FOR HEALTH CARE ADMINISTRATION COUUN IG PH 2: 49 AGENCY FOR HEALTH CARE DIVISION ADMINISTRATION, ADS ‘stn RA VE , HEARINGS Petitioner, vs. AHCA No. 08-00-01-H (Fawcett Memorial Hospital, Inc., d/b/a Columbia Fawcett Memorial), COLUMBIA FAWCETT MEMORIAL 00-2 yf S Respondent. ADMINISTRATIVE COMPLAINT YOU ARE HEREBY NOTIFIED that after twenty one (21) days from the receipt of this complaint, the Agency for Health Care Administration (hereinafter referred to as the "AGENCY") intends to impose an administrative fine in the amount of seven thousand five hundred dollars ($7,500.00 } upon COLUMBIA FAWCETT MEMORIAL (hereinafter referred to as "RESPONDENT"). As grounds for this administrative fine the AGENCY alleges as follows: ‘Respondent is licensed to a at 21298 Olean Boulevard, Port Charlotte, Florida 33950, as a hospital in compliance with Chapter 395, Part |, Florida Statutes, and Chapter 59A-3 and 59A-10, Florida Administrative Code AFA. CG). 3. The Respondent has violated the provisions ‘of Chapter 395, seen ere et lla Bowe Howe yon wo a) Part I, F.S., and the provisions of Chapter 59A-3, F.A.C., as follows: (a) This STANDARD is not met as evidenced by the fact _ patient grievances were not investigated and analyzed by the facility Risk Management Program. This was cited at the March 10, 1998 survey and the July 28, 1998 follow-up survey. This deficiency is in violation of Rule 59A-10.0055, Florida Administrative Code. (b) This STANDARD is not met as evidenced by the fact two of seven employees had not received their annual Risk Management training. This deficiency is in violation of Rule 59A-10.0055, Florida Administrative Code. (c) | This STANDARD is not met as evidenced by the fact the facility did not develop Risk Management policies and procedures to address allegations of sexual misconduct by facility staff. This deficiency is in violation of Section 395.0197(9), Florida Statutes. FINE AMOUNT: $7,500.00. 4. The Respondent has violated the minimum standards, rules and regulations promulgated by the AGENCY under Chapter 395, Part I, Florida Statutes. ¢ 5: . The above referenced violations constitute grounds to levy this administrative fine pursuant ‘to Section 395. 0197 and 395. 104115), Florida Statutes, in that the above-referenced conduct of Respondent constitutes a violation of the minimum standards rules and regulations for the operation of 6. -Respon ent is notified ‘that it has a right ‘to request a hearing pursuant to Section 120.569, Florida Statutes, to be represented by counsel “(at its expense), to take testimony, to call and cross-examine witnesses, to ip ere ape eee ope have subpoenas and/or subpoenas duces tecum issued, and to present written evidence or argument if it requests a hearing. Chapter 59-1, Part Il, Florida Administrative Code, constitutes the Agency's procedural rules for administrative proceedings resulting from this complaint. In order to obtain a formal proceeding under Section 120.57(1), Florida Statutes, you request for an administrative hearing must conform to the requirements in Rule 28- 106.201, Florida Administrative Code, and must state which issues of material fact you dispute. Failure to dispute material issues of fact in request for a hearing may be treated by the AGENCY as an election by you of an informal proceeding under Section 120.57(2), Florida Statutes. All requests for hearings shall be made to: Thomas Caufman, Senior Attorney Agency for Health Care Administration 6800 N. Dale Mabry Highway, Suite 220 Tampa, Florida 33614 813-871-7402 Payment of fines shall be made to: Jim Mitchell, Finance and Accounting Agency for Health Care Administration 2727 Mahan Drive Ft. Knox #2, 2" Floor oS Tallahassee, Florida 32308 ae RESPONDENT IS FURTHER NOTIFIED THAT FAILURE TO. REQUEST “AY EARING WITHIN TWENTY ONE (21) “DAYS FROM THE . “RECEIPT ¢ OF THIS COMPLAINT WILL RESULT IN AN ADMISSION ‘OF THE FACTS ALLEGED IN THE = COMPLAINT A AND THE ENTRY OF A FINAL ORDER BY THE AGENCY | HEREBY CERTIFY that a true copy hereof was sent by U.S. Certified Mail, Return Receipt Requested to Registered Agent, Fawcett Memorial Hospital, Inc., 21298 Olean Boulevard, Port Charlotte, Florida 33949-4028, this 4 day of , 2000. Office Manager Agency for Healthare Administration State Regional Service Center 2295 Victoria Avenue, Room 346 Fort Myers, Florida 33901 Copies furnished to: Thomas Caufman, Senior Attorney Agency for Health Care Administration 6800 N. Dale Mabry Highway, Suite 220 Tampa, Florida 33614 813-871-7402 Risk Management Unit Agency for Health Care Administration ~... 2727 Mahan Drive .s¢ Tallahassee, Florida 32308 peer stp gee

Docket for Case No: 00-002463