STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION (03 WAR [8 PM 3:43 re ' AGENCY FOR HEALTH CARE ant ADMINISTRATION, AOMIRE io BEARINGS Petitioner, AHCA No.: 2001056351 AHCA No.: 2001017451 v. Return Receipt Requested: 7000 1670 0011 4847 1959 LAWNWOOD MEDICAL CENTER, INC d/b/a 7000 1670 0011 4847 1966 LAWNWOOD REGIONAL MEDICAL CENTER, 7000 1670 0011 4847 1997 © 2D OFS | Respondent. ADMINISTRATIVE COMPLAINT COMES NOW the Agency for Health Care Administration (“AHCA”), by and through the undersigned counsel, and files this administrative complaint against Lawnwood Medical Center, Inc. d/b/a Lawnwood Regional Medical Center (hereinafter “Lawnwood Regional Medical Center’), pursuant to Chapter 395, Part I, Section 120.60, Florida Statutes (2001) and 59A-3, Florida Administrative Code, and alleges: NATURE OF THE ACTION 1. This is an action to impose the following: a. Administrative fines of $6,000.00 pursuant to § 395,1065(2), Florida Statutes for AHCA Case No. 2001017451 for the protection of the public health, safety and welfare. b. Administrative fines of $2,900.00 pursuant to § 395.1065(2), Florida Statutes for AHCA Case No. 2001056351, for the protection of the public health, safety and welfare. JURISDICTION AND VENUE 2. This Court has jurisdiction pursuant to Sections 120.569 and 120.57 Fla. Stat., Chapter 28-106, Florida Administrative Code. 3. Venue lies in St. Lucie County, pursuant to Section 120.57 Fla. Stat, Rule 28-106.207, Florida Administrative Code. PARTIES 4, AHCA is the regulatory authority responsible for licensure and enforcement of all applicable statutes and rules governing hospitals, pursuant to Chapter 395, Part I, Florida Statutes (2001), and Chapter 58A~3 Florida Administrative Code. S. Lawnwood Regional Medical Center operates a 345- bed hospital located at 1700 S. 23 Street. Ft. Pierce, Florida 34950. Lawnwood Regional Medical Center is licensed as an assisted living facility under license number 4144. Lawnwood Regional Medical Center was at all times material hereto a licensed facility under the licensing authority of AHCA and was required to comply with all applicable rules and statutes. COUNT I LAWNWOOD REGIONAL MEDICAL CENTER TURNED OFF THE TELEMETRY MONITORS, AS A RESULT STAFF WERE UNABLE TO MONITOR THE STATUS OF THE CARDIAC PATIENTS. RULE 59A-3.2085, FLORIDA ADMINISTRATIVE CODE (NURSING SERVICES) 6. AHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 7. Based on the survey conducted on December 18, 2000 and based on interview with Telemetry Monitor Technicians, interview with the nurse manager of the Progressive Care Unit, interview with the Risk Manager, observation of Telemetry Monitors, and review of ECG rhythm strips measures were not in place to ensure that telemetry alarms were turned on at all times to monitor patients who were on telemetry. The findings include the following. 8. HOSPITAL POLICY NO. 900.10.99 6. d. explains that negligent treatment or maltreatment occurs if a patient has been abandoned, or left without proper care... Ww 9. Hospital staff’s failure to ensure that telemetry monitors were turned of was both a violation of applicable state law and the facility’s own policy. 10. The risk manager made an investigation of an occurrence in October 2000. The occurrence involved a patient, Patient #1, who was to be monitored on telemetry. Unfortunately, the telemetry monitor technicians neglected to monitor the patient. The risk manager’s investigation revealed that the patient had a cardiac rhythm change for 24 minutes before the monitor technician visibly noticed it on the screen. Further investigation revealed that the normally audible alarm on this patients telemetry monitor had been turned down to inaudible. Also the print function for the ECG had been disabled. Only the visualization of the cardiac arrhythmia on the screen would have alerted the technicians who did not see it for 24 minutes. The patient went into a cardiac arrest and staff was unable to resuscitate the patient resulting in death. 11. The Risk Managers corrective action plan for this occurrence was that 1) Bio-Med reset all monitors and locked the volume control so the volume of monitor alarms could not be reduced 2) Staff were forbidden to disable alarm and record functions 3) Random checks were to be done to ensure compliance. The Progressive Care nurse Manager was responsible for ensuring that the practice of disabling the alarms on telemetry monitors was stopped. 12. The surveyor's findings during the survey of December 18 and December 19, 2000 were as follows: a. On the morning of December 18, 2000 two Registered Nurse (R.N.) surveyors went to the telemetry room with the R.N. Progressive Care Unit (PCU) Director who is the supervisor of the technicians who are under the nursing department. A monitor technician told the surveyors that he/she does turn off the alarm function on patients monitors for certain cardiac dysrhythmia, atrial fibrillation and patients with one or two premature ventricular contractions. The technician also stated the alarms are turned off for patients with pacemakers. The second day of the survey December 19, 2000 at 6:30 am one of the R.N. surveyors went to the telemetry monitor room to obServe the monitoring and interview the technicians. The surveyor observed that four patients’, Patients #2, #3, #4, #5, telemetry screens had printed boxes reading "some ECG alarms off." One of the technicians stated when asked why alarms are turned off "alarms are turned off if atrial fibrillation or irregular heart beat, or the alarm keeps ringing, the nurse is told, . . . if there is a rate or rhythm change the nurse is told." wa b. One of the technicians spoken with was on duty at the time of the monitoring of the patient who went into arrest in October 2000, he/she was observed to have alarms that were turned off. 13. Additionally, ECG rhythm strips that were to be filed for four patients, Patients # 3, 4, 8, and 9 indicated that some ECG alarms were off. Dates of the strips were October 17, 2000, December 16, 2000 and December 17, 2000. 14. Review of the job description for the telemetry technicians in personnel files revealed there was nothing in it that gave them the authority to disable alarms. 15. Review of the policies and procedures given to the surveyors by the PCU Director revealed there was nothing in policies or procedures that documented monitor technicians are allowed to disable alarms on telemetry monitors. 16. Interview with the PCU Director revealed that the hospital does not retain the daily census of patients who are on telemetry and that he/she was responsible for supervision and the random checks that were to be done to ensure compliance with not disabling alarm functions on monitors. The manager was asked if there was any documentation of random checks and surveyors were told " Since the neglect incident in October the manager had “no. implemented no system or procedure to ensure alarms on telemetry patients were not disabled. 17. Based on these findings the Hospitals Nursing Management did not develop, implement and monitor measures to prevent the practice of turning off alarms for patients monitored by telemetry. 18. Based on the foregoing facts, Lawnwood Medical Center, Inc. violated Rule 59A-3.2085, Florida Administrative Code, which carries an assessed fine of $1.000.00 per day (times 6 days) for a total of $6,000.00 pursuant to § 395.1065(2), Florida Statutes. COUNT II LAWNWOOD REGIONAL MEDICAL CENTER FAILED TO ENSURE TELEMETRY MONITORING WAS IN PLACE AS ORDERED BY THE PHYSICIAN FOR TWO : (2) DAYS. RULE 59A-3.2055(1) (d), FLORIDA ADMINISTRATIVE CODE (PATIENT’S RIGHTS AND CARE) 19. AHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 20. Based on the follow-up survey conducted on June 20, 2001 and based on observations, one (1) of the twenty- eight (28) records reviewed reflected lack of reassessment of telemetry monitoring. The patient was admitted to a medical floor with telemetry capability. For two (2) days the patient did not receive telemetry monitoring as ordered by the attending physician. The physician was not notified of the error. 21. Based on the foregoing, Lawnwood Regional Medical Center violated Rule 59A-3.2055(1) (d), Florida Administrative Code, which carries an assessed fine of $700.00. COUNT III LAWNWOOD MEDICAL CENTER FAILED TO HAVE RESULTS OF TB ACID FAST BACILLI SMEAR FINAL REPORT PRIOR TO PATIENT’S DISCHARGE. HISTORY & PHYSICALS WERE NOT SIGNED AND DATED BY \ THE PHYSICIAN. RULE 59A-3.270(3) (d) (e) (h), FLORIDA ADMINISTRATIVE CODE (HEALTH INFORMATION MANAGEMENT) 22. AHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 23. Based on the follow-up survey conducted on June 20, 2001 and based on observation of the clinical records the sample did not contain complete or signed information needed to evaluate patient care. Findings include the following. 24. Patient record #19 lacked current laboratory results for Acid Fast Bacilli smears and cultures. Specimens were collected on May 6, 8, and 10 2001. Cumulative laboratory results on patient's record dated May 12, 2001, reflected smear collected on May 8, 2001 to have a final result of "no AFB." The May 6, 2001 and May 10, 2001 smears were documented to be preliminary. Patient was discharged on May 14, 2001. As of the survey date the clinical record did not contain final results for the two smear tests. Interview of laboratory staff confirm that smear results should have been final (takes approx. 24 hours for final results). 25. Patient record #4 contained a physician consult conducted on April 27, 2001, which was dictated on June 5, 2001 and was still not signed or dated. The patient was discharged on May 1, 2001. 26. Patient record #5 contained a typed history and physical noted to be dictated on May 14, 2001. There was no physician signature or date of review for this admission history and physical. The patient left against medical advice on May 29, 2001. 27. Based on the foregoing, Lawnwood Regional Medical Center violated Rule 59A-3.270(3) (d) (e) (h), Florida Administrative Code, which carries an assessed fine of $700.00. COUNT IV LAWNWOOD REGIONAL MEDICAL CENTER DID NOT HAVE AN ADEQUATE PROCESS THAT INCORPORATED QUALITY IMPROVEMENT ACTIVITIES AS RELATED TO TRAINING NURSING PERSONNEL IN THE NEW TB PLAN. RULE 59A-3.271(9), FLORIDA ADMINISTRATIVE CODE (QUALITY IMPROVEMENT) 28. AHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 29, The facility has not trained nursing personnel on the newly developed TB Plan which was developed in response to deficiencies cited March 8, 2001. Findings include the following. 30. A patient was briefly removed from respiratory isolation after one of three smear results for Acid Fast Bialli (AFB) was found (negative) Isolation Procedures were corrected thereafter. The patient medical record was not updated as the AFB smear results were finalized. Infection control tracking is non-specific to the exact specimen and cannot be reconciled against the laboratory reports on the patients record. 31. Based on the foregoing, Lawnwood Regional Medical Center violated Rule 59A-3.271(4), Florida Administrative Code, which carries an assessed fine of $1,500.00. CLAIM FOR RELIEF WHEREFORE, the Agency requests the Court to order the following relief: 1. Enter a judgment in favor of the Agency for Health Care Administration against Lawnwood Regional Medical Center on Counts I, II, III, IV. 2. Assess an administrative fine of $8,900.00 against Lawnwood Regional Medical Center on Counts I through IV for violations as cited above. 3. Assess costs related to the investigation and prosecution of this matter, if the Court finds costs applicable. 4. 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 N. W. 53rd Street, Miami, Florida, 33166; Attn: Alba M. Rodriguez. RESPONDENT IS FURTHER NOTIFIED THAT THE FAILURE 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 AGENCY. Copies furnished to: Diane Reiland Field Office Manager Agency for Health Care Administration THE ENTRY OF A FINAL ORDER BY THE Alba M. ith A A 4 Assistant General Counsel Agency for Health Care Administration 8355 N. W. 53 Street Miami, Florida 33166 1710 E. Tiffany Drive - Suite 100 West Palm Beach, Florida 33407 (Ux S. Mail) Jean Lombardi Finance and Accounting Agency for Health Care Administration 2727 Mahan Drive Tallahassee, Florida 32308 (Interoffice Mail) Assisted Living Facility Unit Program Agency for Health Care Administration 2727 Mahan Drive Tallahassee, Florida 32308 (Interoffice Mail) 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 Thomas Pentz, Administrator, Lawnwood Regional Medical Center, 1700 S. 23 Street, Ft. Pierce, Florida 34950; Lawnwood Medical Center, One Park Plaza, Nashville, TN 37205; CT Corporation, 1200 South Pine Island road, Ft. Lauderdale, Florida 33324 on this dand day of Alba M. Rodriguez } a 0 January, 2003. STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION. > Lawnwood Medical Center, Inc. d/b/a AHCA No.: 2001056351 Lawnwood Regional Medical Center AHCA No.: 200101745103 MAR 18 PM 3: 4&4 ELECTION OF RIGHTS FOR ADMINISTRATIVE COMPLAIN pi Wisi’ PLEASE SELECT ONLY 1 OF THE 3 OPTIONS nui Bh An Explanation of Rights is attached. OPTION ONE (1) __ Respondent does not dispute the allegations of fact contained in the Administrative Complaint and waives Respondent’s right to object or to be heard. Respondent understands that by waiving Respondent’s rights, a final order will be issued that adopts the Administrative Complaint and imposes the sanctions sought. OPTION TWO (2) | Respondent does not dispute and Respondent admits the allegations of fact in the Administrative Complaint, but Respondent does wish to be afforded an informal proceeding, pursuant to Section 120.57(2), Florida Statutes, at which time Respondent will be permitted to submit oral and/or written evidence to the Agency in mitigation of the penalty imposed. OPTION THREE (3)___—s Respondent does dispute the allegations of fact contained in the Administrative Complaint and Respondent requests a formal hearing, pursuant to Section 120.57(1), Florida Statutes, before an Administrative Law Judge appointed by the Division of Administrative Hearings. If Respondent chooses OPTION THREE (3), in order to obtain a formal proceeding before the Division of Administrative Hearings under Section 120.57(1), Florida Statutes. Respondent’s request for an administrative hearing must conform to the requirements in Section 28-106.201, Florida Administrative Code (F.A.C), and must state the material facts you dispute. In order to preserve Respondent’s right to a hearing, Respondent’s Election of Rights in this matter must be received by AHCA within twenty-one (21) days from the date Respondent receives the Administrative Complaint. If the election of rights form with Respondent’s selected option is not received by AHCA within twenty-one (21) days from the date of the Respondent’s receipt of the Administrative Complaint, a final order will be issued finding the deficiencies and/or violations charged and imposing the penalty sought in the Complaint. 4 If Respondent has elected either OPTION TWO (2) or THREE (3) above and if Respondent is interested in discussing a settlement of this matter with the Agency, please also mark and check this block. ( ). Mediation under Section 120.573, Florida Statutes, is not available in this matter. SEND NO PAYMENT NOW -- REGARDLESS OF THE OPTION SELECTED, PLEASE WAIT UNTIL RESPONDENT RECEIVES A COPY OF A FINAL ORDER FOR INSTRUCTIONS ON PAYMENT OF ANY FINES. (Please sign and fill in your current address.) Respondent (Licensee) Address: License. No. and facility type: Phone No. PLEASE RETURN YOUR COMPLETED FORM TO: Agency for Health Care Administration, Attention: Alba M. Rodriguez, Assistant General Counsel, 8355 N. W. 53 Street, Miami, Florida 33166. Telephone Number: 305-499-2165 Ext. 163; Fax: 305- 499-2195. STATE OF FLORIDA poe ops AGENCY FOR HEALTH CARE ADMINISTRATION PPL g (To be used with Election of Rights for Administrative Complaint form — attached): ADMINIS TR In response to the allegations set forth in the Administrative Complaint issuedtily te HGS Agency for Health Care Administration (“AHCA” or “Agency”), Respondent must make one of the following elections within twenty-one (21) days from the date of receipt of the Administrative Complaint and your Election of Rights in this matter must be received by AHCA within twenty- one (21) days from the date you receive the Administrative Complaint. Please make your election of the attached Election of Rights form and return it fully executed to the address listed on the form. OPTION 1. If Respondent does not dispute the allegations in the Administrative Complaint and Respondent elects to waive the right to be heard, Respondent should select OPTION 1 on the election of rights form. A final order will be entered finding you guilty of the violations charged and imposing the penalty sought in the Complaint. You will be provided a copy of the final order. OPTION 2. ‘If Respondent does not dispute any material fact alleged in the Administrative Complaint (Respondent admits all the material facts alleged in the Administrative Complaint.), Respondent may request an informal hearing pursuant to Section 120.57(2), Florida Statutes before the Agency. At the informal hearing, Respondent will be given an opportunity to present both written and oral evidence to reduce the penalty being imposed for the violations set out in the Complaint. For an informal hearing, Respondent should select OPTION 2 on the Election of Rights form. OPTION 3. If the Respondent disputes the allegations set forth in the Administrative Complaint (you do not admit them) you may request a formal hearing pursuant to Section 120.57(1), Florida Statutes. To obtain a formal hearing, Respondent should select OPTION 3 on the Election of Rights form. In order to obtain a formal proceeding before the Division of Administrative Hearings under Section 120.57(1), F.S., Respondent’s request for an administrative hearing must conform to the requirements in Section 28-106.201, Florida Administrative Code (F.A.C), and must state the material facts disputed. IF YOU SELECT OPTION 3, PLEASE CAREFULLY READ THE FOLLOWING PARAGRAPH: In order to preserve the right to a hearing, Respondent’s Election of Rights in this matter must be RECEIVED by AHCA within twenty-one (21) days from the date Respondent receives the Administrative Complaint. If the election of rights form with Respondent’s selected option is not received by AHCA within twenty-one (21) days from the date of Respondent’s receipt of the Administrative Complaint, a final order will be issued finding the deficiencies and/or violations charged and imposing the penalty sought in the Complaint. STATE OF FLORIDA BIVESTON OF ADMINISTRATIVE HEARINGS SEBRING SENIOR CARE, LEC iba Whe Palms of Sehring, Pentioner, YR. AGEING V ROR HEAR TE CARE ADMINIS THA TION, Kespondeni. DOAH Case Na, 07-4936 CON BCeVETNER'S & 7 formal adinta RING CARE € The Peanion the game 2 The eorcect nome of the entity is “SEBRING SENIOR CARI, LL ‘Thu Palms of Sebring.” ior ealth Ca, WEEP IORE, Pealioner respectfully reque: of tins case to reflect the real party in fiteres Respecttally subinitled this [it aay of March, £003, RK. BRIE MckI BREN PLA. ge, Sule 2 $G/ZG BDNd Vd N3@aIMOW 30nd & bZS8er6 OSE wapuag Wd €Z:1 Tow vive hearing inthis matter w NTER, LLC dfia The Patras ot Sebring cussed this matter with the legal representative for the Adininistration and AHCA dos not oppose this motiia cer, Sebring Senior Care, LLC, maves for entry of an Order correcting, 3. vain the Petition filed in this matter, statiuy as follows ed unes arr Ce specifically Page one ofthe ARE ICY entry of an Order ameuding the style t, Sebring Seniar Cage, 1A PZSBZPE-BG8 LABIA (EROZ ELEY rowey v :sabed EO/6L/E ed (papaasans jusag) }U9Aq paalooay CERTRICATE OF SERVICE val (uised, S230 Pa/E@ sed Vd NaadIMoW Sond PUSBZPE-OSE p7eBIA (EBT RHE aqouey yeS8Zr6 OSE sapueg v :sebeg Wd €2:+ SOUL E0/6L/E a7eqg (pepessong jUaAg) JUsAQ paaiasoy v PALHS OF SEBRING too? GA/O8 2003 16:32 Fal 863 395 2345 . Sd STALE AGENCY ACTION REPORT ON APPLICATION FOR CERTIFICATE OF NEED A. PROJECT IDEWLTICATION } Applicant/CON Action Nuraber Authorized Repriseatative Joho HE. McMulien, Presider (404) 875-3434 vs Service District/ Subdistrict Imstniet 6, Subdiztricr 4, Highlands County B, PUBLIC HEARING No public bearing was held or requested regarding the propased project. The applicant sutunitted 41 letters of support for the CON transfer frou vanous health care providers, government officials saad representatives, business owners, church officials, and area residents. All of the letters submited were in, support of the need for additional nursin g home beds in the stabdistrict. ‘ t. PROJECT SUMMARY Sebring Senior Care, LLC is a for-profit corporation that operates The Palins of Sebring (The Palms), a retirement community Consisting of independent living units, assisted. living units, and 120 marsing hone becis! in District G, Subdistrict 4, Highlands County. The applicant steics ts abtain 60 community cursing home beda thre wh the transfer of combined Certificate uf Need #s 9275 and 9452 from Tandem Healch, Care, luc. Thirty-three out of the 60 community nursing home beci« proposed for transfer to The Palms of Sebring will be iorplementect ‘The Pabrs (0 skifed nursing heds consist of @7oonunuuity skilled bunsing beds and 24 vheltered skilled naiging, beds. Sheltered skilted nursing beds are anthorizer! wider Chapier 641 of the Florida Strtues and are for the exclusive ob residents ofa continuing care poluccnent Community 24 detined under Chapter 631, Flonida Stames. b@/PB Nd Yd NAM@IMOW Sonya PZEBZPE-BS8 ,eBALB nBG2> SHEE? oyoway ¥7S87PE OSE ‘Jepusg v :sebeg Wd €z'L TOWLL CO/EL/E 79jeq (papessong jUaAg) JUsAQ paaisooy

Docket for Case No: 03-000951