STATE OF FLORIDA a AGENCY FOR HEALTH CARE ADMINISTRATION ae STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION, AHCA No: 2001040111 Petitioner, Return Receipt Requested 7000 1670 0011 4845 7823 vs. 7000 1670 0011 4845 7830 ST JOHNS REHABILITATION HOSPITAL AND NURSING CENTER, INC., d/b/a SAINT JOHNS REHAB HOSPITAL & NURSING CENTER, Respondent ADMINISTRATIVE COMPLAINT COMES NOW the Agency for Health Care Administration (hereinafter “AHCA”), by and through undersigned counsel, and files this Administrative Complaint against St Johns Rehabilitation Hospital and Nursing Center, Inc., d/b/a Saint Johns Rehab Hospital & Nursing Center, (hereinafter “Saint Johns”) pursuant to 28-106.111, Florida Administrative Code (2000) (F.A.C.), and Chapter 120, Florida Statutes (hereinafter “Fla. Stat.”), and alleges: NATURE OF THE ACTION 1. This igs an action to impose an administrative fine against Saint Johns in the amount of two thousand eight hundred dollars ($2,800.00), pursuant to Section 400.23 Fla. Stat (2000). JURISDICTION AND VENUE 2. This Court has jurisdiction pursuant to Sections 120.569 and 120.57, Fla. Stat. (2000), and Chapter 28-106, F.A.C. 3. Venue lies in Broward County, pursuant to 120.57, Fla. Stat., and Chapter 28-106.207, F.A.C. PARTIES 4. AHCA is the enforcing authority with regard to nursing home licensure, pursuant to Chapter 400, Part II, Fla. Stat. (2000) and Rule 59A-4 F.A.C. 5. Saint Johns is a nursing home located at 3075 Nw 35 Avenue, Lauderdale Lakes, Florida 33311, and is licensed under Chapter 400, Part IT, Fla. Stat. (2000), and Chapters 59A-4, F.A.C.; license number 1520096. COUNT I SAINT JOHNS FAILED TO PROVIDE PERSONAL PRIVACY FOR A RESIDENT. 400.022(1)(m), Florida Statutes and 42 C.F.R. 483.10 (e) (RIGHT TO PERSONAL PRIVACY) REPEATED CLASS III DEFICIENCY 6. AHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 7. Because Saint Johns Participates in Title XVIII or XIX, it must follow the certification rules and regulations found in 42 C.F.R. 483, as incorporated by 59A-4.1288 F.A.C. 8. Based on observation and interview during the survey conducted on 2/13-15/01, AHCA’s surveyor found that Saint Johns failed to provide personal privacy for resident #11, who was 1 of 24 sampled residents. Findings include the following: (a) At approximately 10:30 AM, on 02/15/01, AHCA’s surveyor observed that a social services staff member was speaking with a family member of Resident #11, at the front of the second floor nurses’ station. The conversation was quite loud and could be overheard by staff at the nurses’ station as well as any other residents or visitors who passed the station. They were discussing the medical condition of Resident #11 and his/her ability to leave the facility, as well as a personal problem of the family member that might prevent the resident from returning home. This is a repeat Class III deficiency from the survey conducted on 12/27-29/99. 9. Pursuant to the survey conducted on 12/27- 12/29/99 and based on observations, AHCA’s surveyor determined that (6) residents were not provided with personal privacy. Findings from the 12/27- 12/29/99 survey include the following: 10. During observations on the 4th floor at 10:05 AM on 12/29/99, four female residents in the women's shower area were observed to be naked. The door entering the room was opened by CNA staff going in and out or on four occasions, exposing the naked residents to view from outside of the shower area. In addition, an environmental services aide was observed pushing her cleaning cart through the entrance to this shower area at 10:15 AM without knocking on the door, again causing the unclothed females inside to be fully exposed to anyone walking in the outside corridor. This shower area is directly across from the 4th floor nurses’ station and there is no inside curtain behind the door opening onto the hallway. As a result, residents without clothes on inside the room are at risk to being visible to any person in this vicinity. At the time of the surveyor's observations, the area was frequented by visitors, staff, other residents and three males working on a facility remodeling project. Therefore, the facility did not provide a means of protecting the resident's personal privacy and therefore failed to provide personal privacy to the exposed residents each time the door entering the shower area was opened and closed. 11. During an observation at 10 AM on the 4th floor on 12/29/99, resident #11 was fully visible from the hallway outside her room. This female resident's upper torso and breasts were fully exposed due to the top of her gown being off of her shoulders and down to her waist. The facility failed to provide personal privacy to resident #11. 12. During a tour of the 3rd floor at 10:50 AM on 12/27/99 with the Unit Manager, an unsampled female resident was visible in her room from the hallway. This female resident, who had an upper trunk and lap belts fastened, was sitting by her bed ina wheelchair in her diaper, fully exposed from the waist down. Also, the resident's slacks were observed to be on the floor near the bed area. The facility failed to provide personal privacy to this resident. 13. Based on the foregoing, Saint Johns violated Section 400.022(1) (m), Florida Statutes (2000), and 42 CFR 483.40(e), herein classified as a repeated Class ILI deficiency, which carries, in this case, an assessed fine of $700.00, pursuant to Section 400.23(8), Fla. Stat. (2000). COUNT II SAINT JOHNS FAILED TO PROVIDE MEDICALLY-RELATED SOCIAL SERVICES TO ATTAIN OR MAINTAIN THE HIGHEST PRACTICABLE PHYSICAL, MENTAL, AND PSYCHOSOCIAL WELL-BEING OF EACH RESIDENT. 42 C.F.R. 483.15 (g) (QUALITY OF LIFE,SOCIAL SERVICES) REPEATED CLASS III DEFICIENCY 14. AHCA re-alleges and incorporates paragraphs (1) through (5) and paragraph (7) as if fully set forth herein. 15. During the survey conducted on 2/13-15/01 and based on review of the records for Residents #8, #17 and #20, AHCA’s surveyor found that Saint Johns failed to provide medically- related social services to attain or maintain the highest wn practicable physical, mental, and psychosocial well-being of each resident. Findings include the following: 16. The surveyor reviewed the records for resident #8, who has a diagnosis of Dementia, and the surveyor noted that this resident had an advance directive, dated 1992, prior to the resident's admission to the facility. This advance directive included a living will from resident #8, with instructions that the resident did not wish to have any artificial means to prolong his/her life, including feeding tubes. The record also contained documentation that the son was to be surrogate, when and if the resident was no longer capable of making his/her own decisions. The record did not contain a notice of terminal jliness signed by two physicians or a notice that the resident was no longer capable of making his/her own decisions. Further review revealed that, with counseling by the Director of Social Services, the surrogate approved the insertion of a peg tube for medical reasons. Social Services failed to obtain the necessary documentation that would allow this procedure, which was in opposition to the living will. The facility failed to provide medically-related social services to attain or maintain the highest practicable physical, mental, and psychosocial well- being of resident #8. 17. The surveyor reviewed the clinical record's nursing notes for Resident #17, and noted that this resident can be verbally abusive and demanding of staff. The surveyor interviewed the resident and the resident admitted to verbal abuse when he is frustrated and feels that he needs assistance and does not get it. The surveyor reviewed the social service notes and found that the notes only indicate this as a problem at quarterly care plan review. The record failed to contain any interventions or counseling in regard to the resident's verbal abuse and demands. The facility failed to provide medically- related social services to attain or maintain the highest practicable physical, mental, and psychosocial well-being of resident #17. 18. The surveyor reviewed the record for Resident #20, who has a diagnosis of Multiple Sclerosis, CVA, Acute M.I. and Urosepsis and requires total care for all his/her ADLs, and the surveyor noted that this resident often refuses to shower or get out of bed. Additionally, the resident has lost a substantial amount of weight in the last six months. The surveyor noted that in September the resident weighed 180 lbs. and in February weighed 157.3 lbs. Dietary noted that, "further weight loss is discouraged." The surveyor interviewed the nursing staff who stated that the weight loss was the decision of the resident and his/her significant other. The surveyor reviewed the social services progress notes and found that the notes only contained quarterly care plan review notes. The record did not contain any documentation that social services had intervened or counseled the resident or their significant other in the importance of showering and getting out of bed for increased circulation or for maintaining his/her weight. Additionally, the surveyor interviewed nursing staff, who indicated that the reason for a lack of psychosocial interventions is due a lack of communication between the disciplines. The facility failed to provide medically-related social services to attain or maintain the highest practicable physical, mental, and psychosocial well- being of resident #20. This is a repeated deficiency from the survey of 12/27-29/1999. 19. During the survey conducted on 12/27-29/1999 and based on the initial tour of the facility at approximately 11:00am on 12/27/99, several times on 12/28/99 and 12/29/99, and interviews, the surveyor found that the facility failed to provide medically-related social services to attain or maintain the highest practicable physical, mental, and psychosocial well- being of each resident. The surveyor found that resident #16 had been a resident at an Assisted Living Facility (ALF) until his/her admission to the nursing home, and the resident stated that he/she was very unhappy and depressed at being in a nursing home and wanted to return to the ALF. The resident did not know why he/she could not return to the ALF. This resident is alert and oriented, knowledgeable of his/her condition and aware of his/her needs. The surveyor interviewed the LPN for that wing who stated that "she's not returning to the ALF; she is going to be here long term." The nurse indicated that the resident has unreal expectations. The surveyor reviewed the social service notes, dated 12/21/99, that also confirmed "discharge plans are for the resident to remain at St. John's as a long term care resident." The record does not contain any information that indicates that social services has counseled this resident in regard to remaining in the nursing home on a long term basis or assisted the resident in making the necessary adjustment to the nursing home, from the ALF. Additionally, the record contained documentation that the resident had been assessed by Physical Therapy and the ALF staff at a trial at the ALF, to determine if the resident could return. The record did not contain any documentation indicating that the results of that assessment had been discussed with the resident and that the reason for his/her continued residency at St. John's was as a result of that assessment. The facility failed to provide medically-related social services to attain or maintain the highest practicable physical, mental, and psychosocial well-being of resident #16. 20. During an interview with this resident, on 12/29/99, the surveyor found that the resident was unaware that, unlike at the ALF, he/she could attend activities and church services in his/her wheelchair. He/She indicated that activity staff invited her but she refused because she could not walk. 21. Due to this belief, the resident self-isolated herself. However, the resident never relayed that information to the activity personnel. Had there been more interventions, counseling and communication between the resident and the social services staff, this resident possibly would have been an active participant in activities in the facility. Due to surveyor intervention, the resident was observed in the afternoon of 12/29/99 coming from church, smiling, and stated, "This is the first time I've been to church since I'm here. All I did before is sit in my room, in my wheelchair." The resident thanked the surveyors for helping her realize that she wasn't the only resident in the church in a wheelchair. She indicated, with a smile, that she was going to the entertainment social that afternoon. 22. The surveyor reviewed resident #3's record on 12/28/99 and noted there had been a change of room for this long-time resident. The surveyor interviewed the resident and found that the resident and his/her new roommate did not get along. Further review of the social service progress notes showed that the record did not contain documentation that social service staff were involved in counseling or mediation in regard to the roommates not getting along. During an interview with the Social 10 Services Director, the Director indicated that, "the patient advocate had knowledge of the problem, as resident #3 had been 1 in to discuss the problem on nine occasions." However, the advocate and social services staff did not have any communication in regard to this or any other situations where social services could have intervened and counseled the resident. The facility failed to provide medically-related social services to attain or maintain the highest practicable physical, mental, and psychosocial well-being of resident #3. 23. The surveyor reviewed the record for resident #2 and found that this resident had been discharged to home on 07/07/99 and then returned with a diagnosis of seizure disorder on 07/12/99. The admission face sheet noted "Elder Abuse". Further review of the record determined that the resident had resided with a daughter and a grandchild prior to the original admission and had returned home with a son. The record did not contain any information or documentation that social services had investigated the elder abuse allegation, the cause for the investigation, or the result of the investigation prior to the resident returning to the family home. The facility failed to provide medically-related social services to attain or maintain the highest practicable physical, mental, and psychosocial well- being of resident #2. 11 24. Resident #4 is a frail elderly, alert and oriented resident with periods of confusion. The resident requires total care for all his/her ADLs. A review of the residents record revealed that in 1995 the resident selected two friends as his/her surrogate; one as the surrogate and the other as the alternate. This selection was signed by the surrogate, as an acceptance, and witnessed by a notary. The surveyor further reviewed the record and found that social services had been contacting a nephew, in another state, to make medical decisions for the resident. The surveyor interviewed the Social Services Director who stated, "I think the surrogate has deceased." However, the record did not contain documentation that the resident has been adjudicated incompetent or that the resident had chosen the nephew as his/her surrogate, nor did the record contain information indicating that the surrogate had deceased. The facility failed to provide medically-related social services to attain or maintain the highest practicable physical, mental, and psychosocial well-being of resident #4. 25. During a telephone interview with Resident #9's family on 12/28/99 at 7:40 P.M., the surveyor found that they were unaware that the resident had been transferred from one room to another on 12/27/99. The family member stated that he/she had visited in the morning of 12/27/99 and would be visiting again on 12/29/99. The surveyor asked the family member if he/she was 12 aware of the transfer. The family member responded that he/she had no knowledge of the move or the reason for the same. 26. The surveyor interviewed the social worker on 12/29/99 at 11:30 A.M. and learned that the facility's policy and procedure includes notification of the family of a Long-Term Care resident's room transfer. The social worker could not give a reason as to why Resident #9's family had not been notified of the transfer. The facility failed to provide medically-related social services to attain or maintain the highest practicable physical, mental, and psychosocial well-being of resident #9. 27. Based on the foregoing, Saint Johns violated 42 C.F.R. 483.15(g), incorporated by 59A-4.1288, F.A.C., herein classified as a repeated Class III deficiency, which carries, in this case, an assessed fine of $700.00. COUNT III SAINT JOHNS FAILED TO MAINTAIN ALL RESIDENT ASSESSMENTS COMPLETED WITHIN THE PREVIOUS 15 MONTHS IN RESIDENTS’ ACTIVE RECORDS. 483.20(d), C.F.R., and 59A-4.109(1) (c), F.A.C. (RESIDENT ASSESSMENT) REPEATED CLASS III DEFICIENCY 28, AHCA re-alleges and incorporates paragraphs (1) through (5) and paragraph (7) as if fully set forth herein. 29. During the survey conducted on 2/13-15/01 and based on record review, the surveyor found that Saint Johns failed to maintain all resident assessments completed within the previous 13 15 months in residents’ active records, for residents #3 and #12. On 2/13/01 at 2:35 pm, in the second floor, the surveyor informed the facility’s MDS RN Coordinator that there were no Minimum Data Set (MDS) Assessments and Resident Assessment Protocol Summaries (RAPS) on the active record of Resident #12. The staff member informed the surveyor that these documents were probably in the "thinned chart." Further record review revealed that resident #12 was originally admitted on 4/20/98, discharged out to the hospital on 11/21/00 and readmitted on 11/28/00. 30. The following day, at 3:15 PM, the Director of Nurses (DON) provided the surveyor with the resident's last full MDS dated 4/17/00, and a quarterly assessment dated 10/9/00, pulled from the thinned chart in medical records. The surveyor found that there was no MDS assessment done since the resident's readmission, other than a 5 day PPS. 31. Based on record review for Resident #3 on 2/15/01 at 10:00 AM on the second floor, the surveyor informed the facility’s unit manager and unit secretary that there were no other MDS assessments for resident #3 in the active record, other than one completed on 12/15/00, after the resident had returned from the hospital. At 10:45 AM, two closed records, approximately 3 inches thick, for Resident #3 were brought up to the second floor and handed to the surveyor for him/her to retrieve the missing documents. Further record review revealed resident #3 was originally admitted on 4/14/99, was discharged on 11/29/00 to the hospital and then readmitted to the facility on 12/07/00. This is a repeated deficiency from the survey of 12/27-29/1999. 32. During the survey of 12/27-29/1999 and based on record review and interview with the staff, the surveyor determined that the facility did not maintain all resident assessments completed within the previous 15 months in the resident's active record, for 3 of 24 sampled residents (residents #10, #11, and #20). 33. Resident #20 was admitted to the facility 8/11/99, with the initial Resident Assessment Instrument (RAI) completed 8/24/99. This RAI, including the MDS and RAPs, was maintained on the 3rd floor nursing unit in a large binder designated for the purpose of storing completed RAIs. Review of the clinical record and the RAI binder revealed only the 8/24/99 MDS and RAPs for resident #20 on the 3rd floor, nursing unit at the time of the survey on 12/28/99. Interview with the MDS coordinator revealed another RAI had been completed for resident #20 due to a significant change in the resident's status. At the surveyor’s request, the MDS coordinator went to her office on the 2nd floor and brought the RAI completed on 11/20/99 to the 3rd floor nursing unit and placed it in the large RAI binder. 34. Resident #11 was admitted to the facility on 3/10/99, with the initial RAI completed 3/23/99. Review of resident #11's clinical record and the RAI binder revealed that the last quarterly review assessment in the RAI binder for this resident was dated 9/15/99. At the surveyor’s request on 12/29/99 at 10:30AM, the unit secretary for the 4th floor nursing unit was also unable to locate the most recent guarterly assessment and subsequently notified the MDS coordinator to locate the missing document. At 11:30AM, the surveyor spoke with the Unit Manager and the Assistant Director of Nursing and again requested this document. At that time the surveyor was told that, "it was done but not filed". At 11:40 AM, the quarterly assessment for resident #11 was brought to the 4th floor nursing unit, by the MDS coordinator, from her 2nd floor office. This quarterly review assessment dated 12/16/99 was blank in the section requiring signature; section R2a. The MDS coordinator said, "The staff can't find the signed MDS". 35. A review of the clinical record for resident #10 revealed that the staff was unaware of the location of the resident's assessments. All the MDS's, RAPS & Triggers are maintained in a large binder, in numerical order, at the nurses’ station. On 12/29/99, at 8:05am, the surveyor checked the binder under the resident's room number. The MDS available was for a resident other than resident #10. At 8:40am, the MDS nurse for the fourth floor provided the surveyor with a computer generated MDS, without the RAPS or Triggers. This assessment was dated 12/13/99 as a significant change. The initial and the quarterly assessment were not available for comparison. The resident's date of admission was 06/02/99. At approximately 10:30am, the full assessment was made available to the surveyor for review. 36. Upon request from staff on 12/27/99, surveyors were made aware the facility had placed into each resident's active medical chart a statement pertaining to the location of the "RAI Documents." This policy documents the following items to be kept in the "Care Plan" binders at each Nursing Station: MDS (Including face sheet and signature sheet section), RAP Modules, RAP Summary Protocols, Team Sign-in Sheets, & Care Plans. Based on the findings during the survey, the facility also was not following it's own policy for the storage of resident assessments. 37. Based on the foregoing, Saint Johns violated 42 C.F.R. 483.20(d), incorporated by 59A-4.1288, F.A.C., herein classified as a repeated Class III deficiency, which carries, in this case, an assessed fine of $700.00. COUNT IV SAINT JOHNS FAILED TO ADMINISTER MEDICATIONS AS ORDERED TO MEET THE NEEDS OF A RESIDENT. 42 C.F.R. 483.60(a), and 59A-4.112(1), F.A.C. (PHARMACY SERVICES) 17 REPEATED CLASS III DEFICIENCY 38. AHCA re-alleges and incorporates paragraphs (1) through (5) and paragraph (7) as if fully set forth herein. 39, On 02/13/01, AHCA’s surveyor found that the facility failed to administer medications as ordered to meet the needs of a resident. During an observation tour at 3:00 PM on 2/13/01, Resident #16 complained to the surveyor of pain in his/her right shoulder. Upon further interview with the Resident, the surveyor found that the Physician was aware of this resident’s discomfort and nothing had been done about it. The surveyor reviewed the Physician's orders and found that an order for Motrin 400mg. BID had been prescribed on 02/12/01 but had never been administered to the resident. Based on surveyor intervention with nursing and pharmacy, the Resident was evaluated for pain and was determined to be experiencing pain at a level of 4 out of a scale of 5, with 5 indicating the worst level of pain. The Resident had not received his PM dose on 02/12/01 nor his am dose on 02/13/01. On 02/13/01, a care plan was initiated addressing the resident’s right shoulder pain, with approaches to administer the pain medication as ordered. On 02/15/01, the surveyor interviewed the Resident and he/she indicated that the medication was effective and the pain subsiding. This is a repeated deficiency from the survey of 12/27-29/1999. 40. During the 12/27-29/1999 survey, the surveyor interviewed resident #16 on the morning of 12/28/99, and the surveyor found that this resident was to have cream applied to her body for an itchy rash. The resident stated, "The staff here was too busy to apply my cream last night. The itch drove me crazy all night, so much so I didn't sleep at all last night." The surveyor reviewed the facility's treatment record and found that resident #16 is to have Kenalog cream applied twice a day, at 9:00am and 9:00pm, for a month, starting on 12/18/99. The surveyor further reviewed the treatment record and found that the resident did not have the Kenalog cream applied at 9:00pm on 12/27/99, 41. During the 12/27-29/1999 survey, the surveyor found that Resident #17 was admitted on 12/14/99 with ORIF Right Femur and was alert and oriented at the time of the survey. Upon interviewing the resident and her private duty aide at 10:02 AM on 12-28-99, in the presence of the Assistant Director of Nursing (ADON), the surveyors learned that the unlicensed private duty aide customarily administered Resident #17's Alphagan 0.2% Opthalmic Solution and Trusopt 2% Opthalmic Solution. A subsequent review of the facility's Medication Administration General Guidelines revealed that all medications are to be administered only by licensed nursing, medical, pharmacy or other personnel authorized by state law. 19 42. The surveyors discussed this issue with the ADON at 10:12 AM and again at 11:10 AM on 12-28-99 and found that, while the ADON knew that private duty aides are not allowed to administer medications, she stated that a male LPN had instructed the private aide in administering eye drops and that she assumed that was OK. Consequently, the facility did not assure the accurate administration of all drugs. 43. Based on the foregoing, Saint Johns violated 59A- 4.112(1), F.A.C., and 42 C.F.R. 483.60(a), herein classified as a repeated Class III deficiency, which carries, in this case, an assessed fine of $700.00. PRAYER FOR RELIEF WHEREFORE, the Petitioner, State of Florida Agency for Health Care Administration, requests the following relief: A. Make factual and legal findings in favor of the Agency on all Counts. B. Assess an administrative fine totaling $2,800.00 against Saint Johns Rehabilitation Hospital and Nursing Center for the repeated Class IIT deficiencies in Counts I through IV, in accordance with Section 400.23(8)(c), Fla. Stat. (2000). Cc. Award the Agency for Health Care Administration costs related to the investigation and prosecution of the case 20 in accordance with Section 400.121(1), Fla. Stat., if the Court finds that costs are applicable, and D. Grant such other relief as this Court deems is just and proper. Respondent is notified that it has a right to request an administrative hearing pursuant to Sections 120.569 and 120.57, Florida Statutes (2001). Specific options for administrative action are set out in the attached Election of Rights and explained in the attached Explanation of Rights. All requests for hearing shall be made to the Agency for Health Care Administration, and delivered to the Agency for Health Care Administration, Manchester Building, First Floor, 8355 NW 53°4 Street, Miami, Florida 33166; Kathryn F. Fenske. RESPONDENT IS FURTHER NOTIFIED THAT FAILURE TO REQUEST A HEARING WITHIN TWENTY-ONE (21) DAYS OF RECEIPT OF THIS COMPLAINT, PURSUANT TO THE ATTACHED ELECTION OF RIGHTS, WILL RESULT IN AN ADMISSION OF THE FACTS ALLEGED IN THE COMPLAINT AND THE ENTRY OF A FINAL ORDER BY THE AGENCY. 21 Respectfully submitted, Kathfyn F. Fenske Assistant General Counsel Agency for Health Care Administration Florida Bar No. 0142832 8355 NW 53"' Street Miami, Florida 33166 (305) 499-2165 Copy to: Kathryn F. Fenske, Assistant General Counsel Agency for Health Care Administration Manchester Building 8355 NW 53 Street Miami, Florida 33166 Long Term Care Program Office Agency for Health Care Administration 2727 Mahan Drive Tallahassee, Florida 32308 Gloria Collins, Finance and Accounting Agency for Health Care Administration 2727 Mahan Drive, Mail Stop #14 Tallahassee, Florida 32308 22 CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing has been furnished by U.S. Certified Mail, Return Receipt Requested to Diane A. Dube, Administrator, Saint Johns Rehabilitation Hospital and Nursing Center, 3075 Nw 35'" Avenue, Lauderdale Lakes, Florida 33311, and to Patrick J. Fitzgerald, Registered Agent, 110 Merrick Way, Suite 3-B, Coral Gables, Kathryn F. Fenske 23

Docket for Case No: 02-003769