STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, vs. THE HEALTH CENTER OF STUART, INC., d/b/a PARKWAY HEALTH & REHABILITATION CENTER, Respondent / AHCA No: 2003003200 Return Receipt Requested 7002 2410 0001 4236 8086 7002 2410 0001 4236 8093 O2> 2589 ADMINISTRATIVE COMPLAINT COMES NOW the Agency for (hereinafter “AHCA” or the undersigned counsel, and files against The Health Center of Health & Rehabilitation Center, Rehabilitation Center” or the 196.111, Florida “T.ALC.7), and Chapter (2001) (hereinafter “Fla. Administrative Stat.”), Health Care Administration “Agency”), by and through this Administrative Complaint Stuart, Inc., d/b/a Parkway (hereinafter “Parkway Health «& “facility”), pursuant to 28- Code (2001) (hereinafter 120, Florida Statutes and alleges: NATURE OF ACTION 1. This is an action to impose and maintain the Agency’s administrative fine against Parkway Health 6 Rehabilitation Center totaling sixteen thousand dollars ($16,000), pursuant to Sections 400.102, 400.19, 400.121 and 400.23, Fla. Stat. JURISDICTION AND VENUE 2. This Court has jurisdiction pursuant to Sections 120.569 and 120.57, Fla. Stat., and Chapter 28-106, F.A.c. 3. Venue lies in Martin County, pursuant to 120.57, Fla. Stat., and Chapter 28-106.207, F.A.Cc. PARTIES 4. AHCA is the enforcing authority with regard to nursing home licensure, pursuant to Chapter 400, Part II, Fla. Stat. and Rule 59A-4 F.A.C. 5. Parkway Health & Rehabilitation Center is a nursing home located at 800 S.E. Central Parkway, Stuart, Florida 34994, and is licensed by the Agency under Chapter 400, Part Ii, Fla. Stat., and Chapters 59A-4, F.A.C.; license number 10020961. COUNT I PARKWAY HEALTH & REHABILITATION CENTER FAILED TO PROVIDE ADEQUATE AND APPROPRIATE SERVICES FOR A RESIDENT, FAILED TO PROVIDE ORDERED ANTIBIOTIC EYE DROPS TO A RESIDENT IN A TIMELY MANNER, FAILED TO FOLLOW PHYSICIAN ORDERS AS PRESCRIBED, AND FAILED TO ADEQUATELY ASSESS THE VISION OF THE RESIDENT AND REPORT CHANGES, RESULTING IN THE RESIDENT’S LOSS OF VISION. Section 400.022(1) (I),AND (3), Fla. Stat., and/or Rule 59A~A- 4.107(5), F.A.C., and/or 42 C.F.R. 483.13(c), as incorporated by 59A-4.1288, F.A.C. (TREATMENT OF RESIDENTS) CLASS I DEFICIENCY 6. AHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 7. During an abbreviated survey conducted by the Agency on April 17, 2003 and based on record review and interview, the Agency found that Parkway Health & Rehabilitation Center failed to provide adequate and appropriate services for a resident, failed to provide ordered antibiotic eye drops to a resident in a timely manner, failed to follow physician orders as prescribed, and failed to adequately assess the vision of the resident and report changes, resulting in the resident's loss of vision. Pursuant to the survey conducted, the Agency's surveyor(s) reported that the facility neglected to ensure the timely administration of antibiotic eye drops to Resident #1 (as identified by number in the survey, to protect the resident's privacy and confidentiality), neglected to demonstrate and to document notification of the physician regarding delay in administration of the eye drops as the delay occurred, neglected to ensure and demonstrate that an ongoing nursing assessment of the eyes of the resident with an eye infection was provided, and that it met professional standards of quality, and neglected to demonstrate the physician was informed of additional Symptoms without delay. It was indicated to the Agency that this resident had a permanent vision loss in the right eye. This finding was for one resident in a sample of six residents (for Resident #1). Findings include the following, to wit: 8. Resident #1 was 81 years old and was admitted to the facility for skilled rehabilitation following an Intracranial Hemorrhage, on October 9, 2002. The resident was admitted with adequate vision as assessed on the initial nursing assessment; this is documented on page 1: CONDITION OF EYES: Clear of symptoms, PEARL. VISUAL LIMITATIONS: No VISUAL STATUS: Adequate VISUAL APPLIANCES: Glasses used. 9. The first documentation in the clinical record about a problem with the resident's eye is on Sunday October 13, 2002. The physician documented, "The patient is seen on her nurse's request because of congestion of the right eye." "SEENT: Normocephalic a traumatic patient. PERLA. Congestion of the ocular conjunctiva of the right eye." 10. Record review revealed that the physician wrote a prescription on 10/13/02 on the Physician's telephone order sheet, at 2 pm, for “Gentamycin ophthalmic solution 1 gtt at right eye Q 4 hr. while awake X seven days (conjunctivitis riught eye).” The medication administration record documented no Gentamycin eye drops were administered in the resident's right eye on Sunday October 13 or on Monday October 14, 2002. The nurse’s notes do not document an assessment of the resident’s eyes on October 13 and 14, 2002. The nurse’s notes and medication administration record did not document the reason the eye drops were not administered to the resident on Cctober 13 and 14, 2002. The nurse’s notes from Tuesday Cctober 15, 2002 at 5 pm document that the "Right eye is red and swollen, eye drop ABT received from pharmacy and administered to right eye, patient alert, confusion present." There was no documentation that the physician was called regarding the new symptom of swelling. ll. The nurse's notes on October 16 at 4:15 pm documented, "Right eye swelling (arrow pointing down), warm compresses applied, green drainage, no odor, Tylenol given for discomfort right eye." A second nurse’s note this date at 9:30 pm documented green drainage was present, eye cleaned X 2 with warm compress. The nurse’s notes did not document any further assessment of the right eye, or visual acuity was not documented as assessed. 12. On Thursday October 17, 2002, the nurse documented at 2:30 pm that the resident was "lethargic, right eye with yellow exudates and edema and that the doctor was coming in." The next note on the same date documented, "Patient sent to north ER for R eye evaluation per Doctor (name), green exudates-unable to see pupil-eye is very cloudy and red.” 23. When the Agency’s surveyor met with the Administrator and the Director of Nursing and asked why the Gentamycin eye drops were not started for the resident on October 13, 2002, both stated that there was a problem with the prior pharmacy provider for the facility, especially with cbtaining medication on weekends. They indicated that the facility had provided some corrective action since, in that they had changed pharmacy providers in February 2003. The Director of Nursing stated that at the time of this occurrence (which is the subject of the deficiency), the pharmacy provider for the facility was in Pompano Beach, and the backup pharmacy for the facility was Walgreens pharmacy. The Director of Nursing offered no explanation for why the staff of the facility did not ensure the eye drops were obtained from the backup pharmacy, Walgreens Pharmacy, so that they could be administered in a timely way. 14. On April 17, 2003, the Agency made a site visit at Martin Memorial Hospital to review the closed clinical record of Resident #1, to ascertain the outcome of the resident’s emergency room visit of October 17, 2002. The resident was documented on the hospital record at Martin Memorial Hospital for the admission of October 17, 2002 as having the new diagnoses of: Acute Endophalmitis, Corneal Ulcer NOS, and Bacterial Infection due to Staphylococcus Aureus. The emergency room physician documented at 17:50 (5:50 pm), "Eye hurts, bulging and purulent", "unable to see." The emergency room physician was noted to have called an ophthalmology consultant in. The ophthalmologist documented on the October 17, 2002 progress note that the right eye has, "4+ purulent discharge, 4+ infected opaque cornea and that the patient denied light perception in the right eye". Confidential interview revealed that the resident had a permanent vision loss in the right eye. 15. Based on the Agency’s record review and interview with the Director of Nursing and Administrator, the Agency found that one resident in a sample of six, Resident #1, did not receive nursing care that met professional standards of quality for the care of Conjunctivitis (inflammation of the conjunctive of the right eye). Nursing staff did not follow doctor’s orders, did not administer antibiotic eye drops ina timely way and did not notify the resident’s physician of the delay in treatment. Further nurses did not document ongoing assessments of the condition and vision of the right eye of resident #1, and did not notify the physician when additional symptoms were observed. The facility’s noncompliance caused serious injury, harm or impairment to Resident #1. lo. Nursing assessment of the eye should include: a) A simple test for vision of the eye is to ask the patient the number of fingers that the examiner holds up in their field of vision (with glasses on in the case of resident #1.). b) Assess skin and tissue surrounding the eye. c) Assess the condition of the eyelid when the eye is closed. c) Assess the conjunctiva, particularly for any signs of irritation. 4d) Assess the pupils to see whether they are unusually small and show a slowed reflex response. (Source GERONTOLOGIC NURSING Wholistic Care of the Older Adult, Mary M. Burke & Mary B. Walsh: MOSBY Second Edition 1997). 17. Based on the foregoing, Parkway Health and Rehabilitation Center violated 400.022(1) (Il), (3), Fla. Stat., and/or 59A-4.107(5), F.A.C., and/or 42 CFR 483.13(c), as incorporated by 59A-4.1288, herein classified as a Class I deficiency pursuant to 400.23(8) (a), Fla. Stat., which carries an assessed fine, per statute, of $10,000. 18. The facility has a Class I deficiency found in the 4/17/03 survey. Because the facility had one Class I deficiency, it is subject to a 6-month survey cycle, per Section 400.19(3), Fla. Stat. Per the statute, the fine for the 2-year period shall be $6,000.00, to cover the costs of the additional surveys. 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 Count I. B. Assess and maintain the Agency’s administrative fine totaling $16,000 against Parkway Health & Rehabilitation Center, for the Class I deficiency and the survey fee, in accordance with Sections 400.23(8) (a) and 400.19(3), Fla. Stat. Cc. Award the Agency for Health Care Administration costs related to the investigation and prosecution of the case, in accordance with Section 400.121(10), Fla. Stat., and D. Grant such other relief as this Court deems is just and proper. Respondent is notified that it has a right to request an administrative hearing pursuant to Sections 120.569 and 120.57, Florida Statutes (2002). Specific options for administrative action are set out in the attached Election of Rights and explained in the attached Explanation of Rights. All requests for hearing shall be made to the Agency for Health Care Administration, and delivered to the Agency for Health Care Administration, 2727 Mahan Drive, Building 3, Mail Stop #3, Tallahassee, Florida 32308. Telephone (850) 922- 5873. RESPONDENT IS FURTHER NOTIFIED THAT FAILURE TO RECEIVE A REQUEST FOR A HEARING WITHIN TWENTY-ONE (21) DAYS OF RECEIPT OF THIS COMPLAINT, PURSUANT TO THE ATTACHED ELECTION OF RIGHTS, WILL RESULT IN AN ADMISSION OF THE FACTS ALLEGED IN THE COMPLAINT AND THE ENTRY OF A FINAL ORDER BY THE AGENCY. Respectfully submitted, Kathtyn F. Fenske, Esq. ~ Assistant General Counsel Agency for Health Care Administration Florida Bar No. 0142832 8355 NW 53*" Street Miami, Florida 33166 (305) 499-2165 Copy to: Long Term Care Program Office Agency for Health Care Administration 2727 Mahan Drive Tallahassee, Florida 32308 Jean Lombardi, Finance and Accounting Agency for Health Care Administration 2727 Mahan Drive, Mail Stop #14 Tallahassee, Florida 32308 CERTIFICATE OF SERVICE — SEE I HEREBY CERTIFY that a true and correct copy of the foregoing has been furnished by U.S. Certified Mail, Return Receipt Requested to Linda C. Winters, NHA, Parkway Health «& Rehabilitation Center, 800 S$.F. Central Parkway, Stuart, Florida 34994, and to Corporation Service Company, 1201 Hays Street, Tallahassee, Florida 32301-2525 on Wes -5.0 , 2003 Kathfyn Fenske, Esq.

Docket for Case No: 03-002559