a Certified Mail Receipt (7001 0360 0003 3804 8425) STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, Vv. GULF PINES HOSPITAL, INC. yp d/b/a GULF PINES HOSPITAL, CN -\2 Respondent. ADMINISTRATIVE COMPLAINT The AGENCY FOR HEALTH CARE ADMINISTRATION (“AHCA”), by and through undersigned counsel, hereby files this Administrative Complaint against GULF PINES HOSPITAL INC., d/b/a GULF PINES HOSPITAL (“Respondent” or “Gulf Pines Hospital”) pursuant to Section 120.569, and 120.57, Florida Statutes (2004) and alleges: NATURE OF THE ACTION 1, This is an action to impose administrative fines totaling $7,000 against Respondent, pursuant to the various Statutes and rules cited in Counts I through VIII below. This also is an actiou to revoke Respondent's hospital license based on the various violations and deficiencies alleged herein, Revocation is authorized pursuant to Sections 395.003(8)(a), 395.1065(2)(a), 395.1065(4), and 408.831(1)(a), Florida Statutes (2004) which provide in relevant part as follows: §395.003(8) Whenever the agency finds that there has been a substantial failure to comply with the requirements established under this part or in rules, the agency is authorized to deny, modify, suspend, or revoke: (a) A license. §395.1065(2)(a) The agency may deny, revoke, or suspend a license or impose an administrative fine, not to exceed $1,000 per violation, per day, for the violation of any provision of this part or rules adopted under this part. Each day of violation constitutes a separate violation and is subject to a separate fine. §395.1065(4) The agency may issue an emergency order immediately suspending or revoking a license when it determines that any condition in the licensed facility presents a clear and present danger to public health and safety. §408.831(1) In addition to any other remedies provided by law, the agency may deny each application or suspend or revoke each license, registration, or certificate of entities regulated or licensed by it: (a) If the . .. licensee . . . has failed to pay all outstanding fines, liens, or overpayments assessed by final order of the agency... (Emphasis added). To summarize, the matters complained of herein stem from the following dated AHCA surveys and investigations: SEE COUNT(S): | x | Revocation Revisit to Critical Access Hosp. Survey Life Safety Code Monitoring Visit Revocation Moratorium Order (Ex. “B ”) Revocation Monitoring Visit Revocation Financial Monitoring Visit and Risk Management survey Revocation 2. Emergency Suspension Order (Ex. “C”) Revocation JURISDICTION AND VENUE SLEVIN AND VENUE This agency has jurisdiction pursuant to Chapter 395, Part I and Sections 120.569 and 120.57, Florida Statutes (2004). 3. Venue lies in Gulf County, Florida, pursuant to Section 120.57, Florida Statutes (2004); Chapter 59A-3, Florida Administrative Code (2004), and Rule 28.106.207, Florida Administrative Code (2004). 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 (2004), and Chapter 59A-3 Florida Administrative Code (2004). 5. Respondent is a for-profit corporation, whose 45-bed hospital is located at 102 20th Street, Port St. Joe, Florida. Respondent is licensed as a hospital, license #4175; certificate number 2513, dated October 26, 2003 through October 25, 2005. Respondent was at all times material hereto, a licensed facility under the licensing authority of AHCA, and required to comply with all applicable rules, and statutes. COUNT I FOR IMPOSITION OF $1,000 FINE (Failure To Ensure Patient’s Rights As To Confidentiality Of Medical Records) State Tag-H029 (Patient Rights And Care) Section 395.1065(2)(a), Fla. Stat. (2004) (Fines) Rule 59A-3.254(4), Fla. Admin. Code (2004) (Patient Rights And Care) 6. AHCA realleges and incorporates paragraphs | through 5. 7. On or about February 9, 2005, AHCA conducted a licensure revisit at the Respondent’s facility. AHCA cited the Respondent for failing to ensure patient’s rights related to the confidentiality of their medical records, based on the following findings: 1. An interview was conducted on 02/9/05 at 3:30 p.m. and 6:00 p.m. with facility’s Medical Director and CEO. They stated the President of the Governing body requested copies of 8-12 confidential patient medical records and “threatened” a medical records staff member when initially denied. The CEO stated the President was observed to remove the medical records from the building. The CEO stated it was hospital policy for only authorized persons, with authorization to have any access to patient medical records and the actions of the President violated this policy. The Medical Director stated he and the CEO contacted the Sheriff’s Department and the Agency for Health Care to report this action. An interview was conducted on 02/9/05 at 3:45 p.m. with an employee from the medical records department. She stated on 02/3/05 around 2:00 p.m. the President of the hospital came to her and gave her a list of 7-10 patient records and requested copies. She stated she proceeded to make the copies until the Director of the Medical Records department inquired as to what she was doing and instructed her to stop. The employee stated that around 3-3:30 p.m. the President returned to collect the records. The employee stated she explained she was instructed to stop. She stated the President became angry and stated, “I own this hospital and you are to do whatever I say.” She stated he also stated if someone tried to stop him he’d have them escorted out of the building. She stated she then gave him the medical records. An interview was conducted with the facility’s President of the Governing Body on 02/9/05 at 3:15 p.m. He stated he wanted to conduct an internal investigation related to an allegation of unlicensed activity. He stated around mid-November he became aware something was “going on” and heard the Medical Director’s girlfriend was providing respiratory services despite not being licensed to do so in Florida. He stated he instructed the medical records staff to make him copies of 4-10 medical records from 10/31-11/23/04 and when he returned to get them the CEO and the Medical records director tried to prevent him from taking them. He stated he took the records home for review and brought them back the next day and in fact they were still in his office. He stated he had enlisted the help of the facility’s previous Administrator in the investigation. The previous Administrator was interviewed on 02/10/05 at 10:30 a.m. She stated her last full date of employment was 11/15/04, but was asked by the President of the Governing Body to assist him in an internal investigation related to unlicensed activity. She stated she came into the hospital on 1/24-26/05 to conduct interviews. She stated the President of the Governing Body brought her the copies of the medical records to her home for her review on 02/3/05, but “I didn’t get all the ones I wanted, just some”. She stated he also provided her with an internal Occurrence Report for consideration. The previous Administrator stated she had no contract with facility, had no job description, and had no written agreement for her services. An interview with the hospital’s human resources manager was conducted on 02/10/05 at 2:00 p.m. He provided a written statement that verified the previous administrator was not a current employee. The President of the Governing Body removed confidential patient medical records from the building and allowed a non-employee/non-authorized person to review them. The President of the Governing Body threatened hospital staff in order to obtain confidential patient medical records. The President of the Governing Body brought copies of the medical records to the previous Administrator’s home, allowed a non-employee/non-authorized person to enter the hospital on 1/24-26/05, and conduct interviews with staff regarding other hospital employees and an investigation during which confidential patient information was obtained. The President of the Governing Body knowingly violated hospital policy by all of his actions. 8. The above constitutes a violation of Section 59A-3.254(4), Florida Administrative Code (2004), which requires with respect to Patient Rights that each hospital shall develop and adopt policies and procedures to ensure various rights of the patient including: “(e) The right to personal privacy and confidentiality of information including access to information contained in the patient’s medical records as specified under Section 395.3025, F.S.” 9. The above also constitutes a violation of Section 395.1065(2)(a), Florida Statutes (2004) (quoted in paragraph 1 above) (authorizing fine of up to $1,000 per violation per day). 10. The violation warrants a fine of $1,000. Il, AHCA, in determining the penalty imposed, considered the gravity of the violation, the probability that death or serious harm will result, the actions of Respondent and its staff, the financial benefit to the facility of committing or continuing the violation, and the licensed capacity of the facility. WHEREFORE, AHCA demands the following relief: 1. Enter factual and legal findings as set forth in the above allegations. 2. Impose a fine in the amount of $1,000.00. COUNT I FOR IMPOSITION OF $500 FINE (Failure To Post Sign Identifying Service Capability In Either English Or Spanish) State Tag-H030 (Emergency Care) Section 395.1065(2)(a), Fla. Stat. (2004) (Fines) Rule 59A-3.255(1), Fla. Admin. Code (2004) (Emergency Care) 12. AHCA realleges and incorporates paragraphs | through 5. 13. On or about February 9, 2005, AHCA conducted a licensure survey revisit at the Respondent’s facility. AHCA cited the Respondent failing to post a sign identifying service capability of the hospital in either English or Spanish, based on the findings below, to wit: An initial tour of the Emergency Department was conducted on February 9, 2005 at approximately 2:30 p.m. During the tour it was observed that there was no sign listing the Emergency service capability of the hospital posted. In an interview conducted on February 9, 2005 at approximately 4:25 p.m. with the Medical Director and Administrator, both parties stated that they were not aware the signs were not posted and they had no explanation for the findings. 14. The above constitutes a violation of Section 59A-3.255(1), Florida Administrative Code (2004), which requires the following: (a) Each hospital offering emergency services and care shall post, in a conspicuous place in the emergency service area, a sign clearly stating a patient’s right to emergency services and care as set forth in Section 395.1041, F.S. The sign shall be posted in both English and in Spanish. (b) Each hospital offering emergency services and care shall post a sign identifying the service capability of the hospital. The categories of services listed on the sign may be general in nature if the sign refers patients to another location within that facility where a list of the subspecialties is available. The sign identifying the service capability of the hospital and the additional listing of subspecialties, if a separate subspecialty list is maintained, shall be in both English and in Spanish. (c) The signs required by this rule section shall be posted in a location where individuals not yet admitted to the hospital would reasonably be expected to present themselves for emergency services and care. 15. The above also constitutes a violation of Section 395.1065(2)(a), Florida Statutes (2004) (quoted in paragraph 1 above) (authorizing fine of up to $1,000 per violation per day). 16. The violation is an uncorrected deficiency, and warrants a fine of $500. 17. AHCA, in determining the penalty imposed, considered the gravity of the violation, the probability that death or serious harm will result, the uncorrected actions of Respondent and its staff, the financial benefit to the facility of committing or continuing the violation, and the licensed capacity of the facility. WHEREFORE, AHCA demands the following relief: 1. Enter factual and legal findings as set forth in the above allegations. 2. Impose a fine in the amount of $500. COUNT II FOR IMPOSITION OF $1,000 FINE (Failure To Ensure The Consulting Dietician Developed And Implemented Policy’s And Procedures Related To Conducting Required Nutritional Assessments, And Failed To Evaluate Dish Washing Procedures.) State Tag-H067 (Nutritional Care) Section 395.1065(2)(a), Fla. Stat. (2004) (Fines) Rule 59A-3.2085(1)(c), Fla. Admin. Code (2004) (Dietitian and Services) 18. AHCA realleges and incorporates paragraphs | through 5. 19. On or about February 9, 2005, AHCA conducted a licensure survey visit at the Respondent’s facility. AHCA cited the Respondent for failing to ensure the consulting Dietician developed and implemented policies and procedures related to conducting required nutritional assessments, and failed to evaluate dish washing procedures, based on the following findings: On 02/09/2005 at approximately 4:20 p.m. kitchen staff were observed using the three- compartment sink. The staff member was observed to shove a washcloth into the drain hole, then proceeded to fill the sink with approximately 3 inches of water, then pour approximately ‘% paper cup of bleach into the sink. The staff member then was observed to demonstrate a test strip validation of bleach content. The test strip tumed bright yellow indicating the parts per million were not between 50-200 per the test strip scale indicating effective sanitation. An interview was conducted at this time with the staff member. She stated it depends how much washing she has to do as to how much water to fill the sink, but always adds ‘a paper cup of bleach. The staff member was unable to relay any standardized policy or procedure for the sanitation of dishes. The staff member stated she had not received any training on dish sanitation. On 02/10/05 at approximately 10:40 a.m. a staff member was observed using the three- compartment sink. She measured out the bleach into the paper cup. The measured amount was % cup of bleach. At that time the sink was approximately 5 inches full of water. During the period that the test strip testing was conducted, the water drained through the washcloth plug until it had approximately 3 inches of water. The test strip revealed the parts per million of bleach was not within 50-200 ppm bleach. A review of the facility’s current policy for equipment and sanitation revealed the sanitation sink is to contain 50-220 ppm bleach using a sanitizing tablet recommended by the state health department. On 02/10/05 an interview with the Dietary Manager was conducted at approximately 3:10 p.m. She stated, “we don’t use the tablets” and indicated she was not sure how many parts per million a half a cup of bleach contained or why the test strips “weren’t working.” The Dietary Manager had no explanation for the practice not reflecting the facility’s policy. On 02/10/05 at approximately 3:15 p.m. the facility’s consultant dietitian was interviewed over the phone. When she was informed about the observed sanitation procedure, she stated that she was aware of the problem. A review of the dietary procedures revealed there was not a policy for nutritional assessments of acute care patients. An interview with the consultant dietitian at approximately 3:15 p.m. on 02/10/05 revealed that she was aware there was no current policy for acute care patients but she was working on one. A clinical record review of 5 of 5 current in-patients on 02/10/05 revealed no nutritional assessments of patients with potential for nutritional risk with diagnosis of dehydration, nothing per mouth, cirrhosis of the liver, hepatitis C, nausea and vomiting, diabetes, and pneumonia. 20. The above constitutes a violation of Section 59A-3.2085(1)(c), Florida Administrative Code (2004), which requires that whether employed full-time, part-time or on a consulting basis, a registered dietitian shall provide at least the following services to the hospital on the premises on a regularly scheduled basis: YRwn- a 21. Liaison with administration, medical and nursing staffs; Patient and family counseling as needed; Approval of menus and modified diets; Required nutritional assessments; Participation in development of policies, procedures and continuing education programs; and Evaluation of dietetic services. The above also constitutes a violation of Section 395.1065(2)(a), Florida Statutes (2004) (quoted in paragraph 1 above) (authorizing fine of up to $1,000 per violation per day). 22. The violation is an uncorrected deficiency, and warrants a fine of $1,000. 23. AHCA, in determining the penalty imposed, considered the gravity of the violation, the probability that death or serious harm will result, the actions of Respondent and its staff, the financial benefit to the facility of committing or continuing the violation, and the licensed capacity of the facility. WHEREFORE, AHCA demands the following relief: 1. Enter factual and legal findings as set forth in the above allegations. 2. Impose a fine in the amount of $1,000. COUNT IV FOR IMPOSITION OF $500 FINE (Failure To Conduct Quarterly In-Services For Dietary Staff) State Tag-H072 (Nutritional Care) Section 395,1065(2)(a), Fla. Stat. (2004) (Fines) Rule 59A-3.2085(1)(h), Fla. Admin. Code (2004) (Dietitian And Services) 24, AHCA realleges and incorporates paragraphs 1 through 5. 25. On February 9, 2005, AHCA conducted a licensure survey visit at Respondent’s facility and cited failure to conduct in-services for dietary staff, based on the following findings: A review of the dietary in-service log for the past 12 months was conducted on 02/10/05 and it revealed that no in-services were conducted for the months of January, February, March, July, August and September of 2004. The Dietary Manager was interviewed at approximately 3:10 p.m. on 02/10/05. She confirmed no in-services were conducted for the months January, February, March, July, August, and September 2004. 26. The above constitutes a violation of Section 59A-3.2085(1)(h), Florida Administrative Code (2004), which requires that personnel in the dietetic department receive at least quarterly in-service training of which a record shall be kept by the dietetic department. 27. The above also constitutes a violation of Section 395.1065(2)(a), Florida Statutes (2004) (quoted in paragraph 1 above) (authorizing fine of up to $1,000 per violation per day). 28. The violation warrants a fine of $500. 29. AHCA, in determining the penalty imposed, considered the gravity of the violation, the probability that death or serious harm will result, the actions of Respondent and its staff, the financial benefit to the facility of committing or continuing the violation, and the licensed capacity of the facility. WHEREFORE, AHCA demands the following relief: 1, Enter factual and legal findings as set forth in the above allegations. 2. Impose a fine in the amount of $500. COUNT V FOR IMPOSITION OF $1,000 FINE (Failure To Provide And Maintain Equipment So The Dietary Department Could Provide Safe And Sanitary Services) State Tag-H076 (Nutritional Care) Section 395.1065(2)(a), Fla. Stat. (2004) (Fines) Rule 59A-3.2085(1)(j), Fla. Admin. Code (2004) (Dietitian and Services) 30. AHCA realleges and incorporates paragraphs 1 through 5. 31. Onor about February 9, 2005, AHCA conducted a licensure survey revisit at the Respondent’s facility, AHCA cited the Respondent for failing to provide and maintain equipment so the dietary department could provide safe and sanitary services, based on the following findings: On 02/09/05 at approximately 4:20 p.m. kitchen staff were observation using the three- compartment sink. The staff member was observed to shove a washcloth into the drain hole, then proceeded to fill the sink with approximately 3 inches of water, then pour approximately % paper cup of bleach into the sink. The staff member then was observed to demonstrate a test strip validation of bleach content. The test strip tuned bright yellow indicating the parts per million were not between 50-200 ppm bleach per the test strip scale. An Interview was conducted at this time with the staff member. She Stated it depends how much washing she has to do as to how much water to fill the sink, but always adds % paper cup of bleach. The staff member was unable to relay any standardized policy or procedure for the sanitation of dishes. The staff member stated she had not received 10 On 02/10/05 at approximately 10:40 a.m. a staff member was observed using the three- compartment sink. She measured out the bleach into the paper cup. The measured amount was % cup of bleach. At that time the sink was approximately 5 inches full of water. During the period that the test Strip testing was conducted, the water drained through the washcloth plug until it had approximately 3 inches of water. The test strip revealed the parts per million of bleach was greater than 200. An interview was conducted with the Dietary Manager on 02/10/05 at 10:45 a.m. she revealed there was no work order for the sink to be repaired. A review of the facility’s current Policy for equipment and sanitation revealed the sanitation sink is to contain 50-220 ppm bleach using a sanitizing tablet recommended by the state health department. On 02/10/05 an interview with the Dietary Manager was conducted at approximately 3:10 p.m. She stated that [they] don’t use the tablets, and she wasn’t sure how many parts per million a half a cup of bleach contained, and the test strips weren’t working. The dietary manager had no explanation for the practice not reflecting the facility’s policy. The facility Food Service policy for infection control Prevention revealed, “procedures that assure sanitized service ware and prevent recontamination should be used and should be apart from food Preparation areas, All eating and drinking utensils and service ware carts, and trays should be cleaned and sanitized after each use.” On this same date and time racks under the dishwasher were observed to be Tusty and have a flaking paint-like substance. This was around the area where the pots and pans were stored. On 2/10/05 at approximately 10:40 a.m., two baking sheets were observed with layers of dried food-like substance. This substance was approximately 1 inch thick and it was The facility’s Food Service policy for infection control revealed “all working surfaces, especially food contact should be cleaned with appropriate sanitizing agent.” 32. The above constitutes a violation of Section 59A-3.2085(1)(j), Florida Administrative Code (2004), which requires that the dietetic department shall be designed and 11 equipped to facilitate the safe, sanitary, and timely provision of food service to meet the nutritional needs of patients. 33. The above also constitutes a violation of Section 395.1065(2)(a), Florida Statutes (2004) (quoted in paragraph 1 above) (authorizing fine of up to $1,000 per violation per day). 34, The violation warrants a fine of $1,000. 35. AHCA, in determining the penalty imposed, considered the gravity of the violation, the probability that death or serious harm will result, the actions of Respondent and its staff, the financial benefit to the facility of committing or continuing the violation, and the licensed capacity of the facility. WHEREFORE, AHCA demands the following relief: 1. Enter factual and legal findings as set forth in the above allegations. 2. Impose a fine in the amount of $1,000. COUNT VI FOR IMPOSITION OF $1,000 FINE (Failure To Ensure Compliance With Facility Established Infection Control Policies Re Safe Handling Of Biomedical Waste, Hand Washing, Etc.) State Tag-H201 (Infection Control) Safe Handling Of Biomedical Waste, Hand Washing, Etc.) Section 395.1065(2)(a), Fla. Stat, (2004) (Fines) Rule 59A-3.250(3)(a)-(i), Fla. Admin. Code (2004) (Infection Control) 36. AHCA realleges and incorporates Paragraphs 1 through 5. 37. On or about February 9, 2005, AHCA conducted a licensure survey revisit at the Respondent’s facility. AHCA cited the Respondent for failing to ensure compliance with facility established Infection Control policies related to the safe handing of Biomedical Waste, hand washing, and equipment storage, based on the following findings: During a tour of the in-patient unit of the hospital on February 9, 2005 from approximately 3:55 p.m. until 4:02 P.m. overfilled sharps containers were noted in rooms 106, 108 (occupied), 120, 122 (occupied), 124 (occupied). 12 During a tour of the Emergency Department on February 9, 2005 from approximately 4:05 p.m. until 4:07 p.m. overfilled sharps containers were noted in the trauma room and room #1. During a tour of the in-patient unit on February 10, 2005, at approximately 11:33 a.m., overfilled sharps containers were noted in rooms 106, 122 (occupied), 126. A review of the facility’s biomedical waste plan dated March 12, 2004 revealed sharps containers shall not be overfilled and, when inserting sharps into containers, the opening should be observed to make sure nothing is sticking out. Observation on February 10, 2005, at approximately 11:30 a.m. of the crash cart in the west hall revealed the suction machine tubing was exposed, not covered, hanging over other equipment. Observation on February 9, 2005, at approximately 2:30 p.m., revealed the hand- washing sink in the Radiology room was nonfunctional. An interview at this time with the radiology department director revealed the sink had not been functional for “quite some time.” A review of the facility’s hand washing policy and procedure dated December 10, 2004, revealed hand washing is the single most effective means of infection control and preventing nosocomial infections. The facility’s Radiology infection control policy revealed frequent hand washing is to be encouraged before and after patient contact. An observation on February 10, 2005, at approximately 11:30 a.m., revealed a bloody 2x2 gauze in room 106 left on the bedside table of a clean unoccupied room where patients are injected with dye prior to procedures. 38. The above constitutes a violation of Section 59A-3.250(3)(a)-(i), Florida Administrative Code (2004), which Tequires that the policies and procedures devised by the infection control program shall be approved by the governing body, and shall contain at least the following: (a) Specific policies for the shelf life of all stored sterile items, (b) Specific policies and procedures related to Occupational exposure to blood and body fluids. (c) Specific policies and procedures related to admixture and drug reconstitution, and to the manufacture of intravenous and irrigating fluids. (d) Specific policies related to the handling and disposal of biomedical waste in (€) Specific policies related to the selection, storage, handling, use and disposition of disposable items. . . . 39. The above also constitutes a violation of Section 395.1065(2)(a), Florida Statutes (2004) (quoted in paragraph 1 above) (authorizing fine of up to $1,000 per violation per day). 40. The violation is an uncorrected deficiency, and warrants a fine of $1,000. 41. AHCA, in determining the penalty imposed, considered the gravity of the violation, the probability that death or serious harm will result, the uncorrected actions of Respondent and its staff, the financial benefit to the facility of committing or continuing the violation, and the licensed Capacity of the facility. WHEREFORE, AHCA demands the following relief: 1. Enter factual and legal findings as set forth in the above allegations. 2. Impose a fine in the amount of $1,000. COUNT Vil FOR IMPOSITION OF $1,000 FINE (Failure To: (1) Identify The Governing Body; (2) Have Current By Laws; (3) Have Quarterly Governing Body Meetings In Accordance With Policy And Procedure; and (4) To Have An Institutional Plan And Budget) State Tag-H209 (Governing Body) Section 395.1065(2)(a), Fla. Stat. (2004) (Fines) Rule 59A-3.272(2)(a)-(e), Fla. Admin. Code (2004) (Governing Body) 42. AHCA realleges and incorporates paragraphs 1 through 5. 43, On or about February 9, 2005, AHCA conducted a licensure survey revisit at the Respondent’s facility, AHCA cited the Respondent for failing to have current By Laws of the Governing Body, failed to have quarterly Governing Body meetings in accordance with policy and procedure, failed to ensure financial stability, and failed to have an institutional plan and budget, based on the following findings: 14 An interview with the President of the Governing Body on 2/9/05 at 3:15 p.m. stated that he “guessed he and the CEO were the Governing Body”. An interview was conducted on 2/9/05 at 3:30 p.m., with the facility’s CEO. She stated she started in September 2004 as a Tepresentative of the Rainmaker management company. She stated the President of the Governing Body is the sole representative of the Governing Body. Review of the Gulf Pines Hospital Management Agreement between Rainmaker Financial LLC and the President of the Governing Body dated September 1, 2004, States they will jointly hire “a qualified administrator (the “Administrator’), who will be the chief executive officer’ and that Rainmaker Financial LLC will manage the hospital. A record review of the facility’s By Laws for the Governing Body was dated January 1997. Article I defines the Governing Authority as being “composed of the Hospital Administrator”. The By Laws further state that hospital is managed by and a subsidiary of “Marquis Management Group”. The facility’s organization chart revealed the facility’s Chief Executive Officer (CEO) Teports directly to the Governing Body, which consists of only one person, the President of the Governing Body. The By Laws of the Governing Body have not been Teviewed or updated since January 1997 and do not reflect current management agreement with Rainmaker Financial LLC. Review of the Governing Body minutes revealed the Governing Body met quarterly from December 2003 until September 2004. Interview with the CEO on 02/09/05 at approximately 6:00 p.m. she stated the Governing Body has not met since she been at There is no identified, organized, Governing Body; the By Laws of the Governing Body are not current and have not been updated since 1997; the Governing Body has not met since September 2004. On 02/04/05 at approximately 3:00 p.m., the CEO contacted the Agency for Health Care Administration (AHCA) and relayed Drew Medical Corporation had obtained a “Writ of Garnishment” against the hospital for a default on payments related to a On 02/09/05 at 4:48 P.m. and interview was conducted with the Director of Personal and Payroll. He stated the facility has had issues with being able to meet payroll and would pay the lowest paid people first and then work their way up till the money ran out. He stated on 02/03/05 (the last pay period) staff were instructed not to cash their pay checks because there was no money. 15 The CEO also provided a notice from Medical Capital Corporation dated 1/17/05 which revealed: “Please be advised that Gulf Pines Hospital, Inc. is in default under the above reference (security agreement dated 10/21/04). The outstanding balance is $1,735,857.57, Specifically Gulf Pines Hospital, Inc. is in default as follows: Failed to pay obligations when due (sic) Failed to satisfy obligations under the second notice and mortgage modifications (sic) Failed to satisfy tax liens. Be advised that we demand Payment in full or in the alternative tum Over the collateral within ten days. If not cured by 10 days following this letter, the matter will be referred to our legal department for collection effects.” The CEO and the Medical Director also revealed on 02/09/05 at 6:00 p.m., that the Medical Director was not being paid and the hospital owed him for back services, On 02/10/05 at 3:40 p.m. the CEO was asked to Provide the facility’s Institutional Plan and budget, however the facility does not have a current plan and budget, there is no plan for capital expenditures, therefore no plan submitted to AHCA. An interview was conducted on 02/10/05 at 11:20 am. with the facility Chief Operating Officer and she Stated that due to the cost of the background screens for all employees the hospital had not been able to conduct all the background screenings so they started with the employees who had direct patient care first. An interview was conducted on 02/10/05 at 11:15 a.m. with the facility’s human resources manager. He stated he was instructed to start the screening of employees with direct care staff first and had not conducted any other background checks, Interview with the Director of Nurses on 02/10/05 at 11:40 a.m. confirmed that the telemetry equipment had not been working since before she arrived in December 2004 and the hospital had no funds to replace the equipment, An interview with the Plant Manager conducted on 02/ 10/05 at 8:45 a.m. stated he was aware of the generalized disrepair of the hospital, however, the hospital did not currently have the money to make the repairs. The facility failed to ensure financial stability and develop an institutional plan and budget to support daily hospital operations, 16 44. The above constitutes a violation of Section 59A-3.272(2)(a)-(e), Florida Administrative Code (2004), which requires that the governing body shall be organized under written bylaws, rules and regulations which it review at least every two years, dates to indicate time of last review, revises as necessary, and enforces Governing Body By-Laws shall: (a) State the role and purpose of the hospital, including an organizational chart defining the lines of authority. The description of the structure of the hospital shall include full disclosure in writing of the names and address of all owners and persons controlling 5 percent or more interest in the hospital. In the case of corporations, holding companies, partnerships, and similar organizations, the names and address of officers, and stockholders, both beneficial and of record, when holding 5 percent or more interest, shall be disclosed. (b) State the qualifications for governing body membership, and the method of selecting members as well as the terms of appointment or election of members, officers and chairmen of committees. (c) Provide for the designation of officers, their duties, and for the organization of the governing body into essential committees with the number and type consistent with the size and scope of the hospital’s activities. established by the governing body. (e) Specify the frequency of meetings, at regularly stated intervals, the number or percentage of members constituting a quorum, and requires the minutes be recorded and made available to all members of the governing body. 45. The above also constitutes a violation of Section 395.1065(2)(a), Florida Statutes (2004) (quoted in paragraph 1 above) (authorizing fine of up to $1,000 per violation per day). 46. The violation warrants a fine of $1,000. 47. AHCA, in determining the penalty imposed, considered the gravity of the violation, the probability that death or serious harm will result, the actions of Respondent and its staff, the financial benefit to the facility of committing or continuing the violation, and the licensed capacity of the facility. WHEREFORE, AHCA demands the following relief: 17 1. Enter factual and legal findings as set forth in the above allegations. 2. Impose a fine in the amount of $1,000, COUNT VIiI FOR IMPOSITION OF $1,000 FINE (Failure to Ensure Premises Maintained In Clean And Functional Manner) State Tag-H231 (Maintenance) Section 395.1065(2)(a), Fla. Stat. (2004) (Fines) Rule 59A-3.276(1), Fla. Admin. Code (2004) (Maintenance) 48, AHCA tealleges and incorporates paragraphs 1 through 5. 49. On or about February 9, 2005, AHCA conducted a licensure survey revisit at the Respondent’s facility. AHCA cited the Respondent for failing to ensure the hospital premises were maintained in a clean and functional manner, based on the following findings: An initial tour of the facility was conducted on 02/09/05 at 2:30-3:30 p.m. The following was noted: wo Water damaged wall in ultrasound toom with bubbling paint Non-functional sink in x-ray suite and 4x6 inch hole in dry wall with exposed metal Cracked and broken stucco on wall under viewing screen in film storage room. Patient call light in stress lab working, but activated at nursing station as “ER STAT,” activated at 2:50 p.m. and not tesponded to for over 2 hours Patient shower room across from toom 106 noted with copious amount of peeling pink paint and mildew. No patient call alarm cord in ER room 3 Splintered cabinet door in occupied room 114 Large crack in tile floor from entrance of kitchen extending approximately 30 feet Gasket on right freezer failing to hold appropriate temperature 10, Flaking paint and rust on under counter racks in kitchen 11. Broken and missing tile in dining room 12. Floor in dining room gritty with visible dirt An interview with the plant manager was conducted on 02/10/05 at 8:45 a.m. He stated he was aware of some of the items identified, but the facility did not have the funds to make the necessary repairs. The facility’s accepted plan of correction revealed the facility had developed a “check sheet” and a “walk through” would be conducted by the members of the Quality/Safety committee, A 18 The facility’s policy and procedure for Plant Operations revealed, “all surfaces, floors, walls, ceilings should be routinely inspected and Tepaired if necessary in order to maintain a smooth dry and cleanable surface. “Structural inspection should be done to detect any breaks in the walls, foundation, window frames, etc, and repaired if necessary to insure a safe environment.” 50. The above constitutes a violation of Section 59A-3.276(1), Florida Administrative Code (2004), which requires that each hospital shall develop, implement, and maintain a written preventive maintenance plan, in conjunction with the policies and procedures developed by the infection control committee, to ensure that the facility is maintained. 51. The above also constitutes a violation of Section 395.1065(2)(a), Florida Statutes (2004) (quoted in paragraph 1 above) (authorizing fine of up to $1,000 per violation per day). 52. The violation is an uncorrected deficiency, and warrants a fine of $1,000. 53. AHCA, in determining the penalty imposed, considered the gravity of the violation, the probability that death or serious harm will result, the uncorrected actions of Respondent and its staff, the financial benefit to the facility of committing or continuing the violation, and the licensed capacity of the facility. WHEREFORE, AHCA demands the following relief: 1. Enter factual and legal findings as set forth in the above allegations. 2. Impose a fine in the amount of $1,000. COUNT IX FOR REVOCATION OF LICENSE (Based On Failure To Pay Outstanding Fines) Section 408.831(1)(A) Fla. Stat. (2004) 54. AHCA realleges and incorporates paragraphs 1 through 5. 55. On January 31, 2005 a Final Order (Exhibit “A”) was entered by AHCA requiring Respondent to pay $25,000 in fines (the first of two installments) within thirty days of rendition 19 of the Order. The thirtieth day from rendition was March 2. However, no payment was received by that date, nor has payment been received since. 56. Respondent has thus failed to timely pay an outstanding fine and so its license should be revoked pursuant to Section 408.831(1)(a), Florida Statutes (2004) (quoted in paragraph 1 above). WHEREFORE, AHCA demands the following relief: 1. 2, 57. 58. Enter factual and legal findings as set forth in the above allegations; Impose revocation of license for the above referenced matters; and Impose such other relief as this tribunal may find appropriate. COUNT X FOR REVOCATION OF LICENSE (Based On Moratorium Matters) Section 395.003(8)(a) Fla. Stat. (2004) (Revocation) Section 395.1065(2)(a), (4), Fla. Stat. (2004) (Revocation) AHCA realleges and incorporates paragraphs 1 through 5, On or about F ebruary 22, 2005, AHCA, through its Secretary Alan Levine, issued an “Emergency Order of Immediate Moratorium on Elective Admissions” (the “Moratorium”) (Exhibit “B”) to Respondent, finding that various circumstances presented a threat to the health, safety or welfare of the patients and/or a threat to public health or safety. The Moratorium contained various findings of fact, including paragraphs 5 through 17 as follows: 3 6 7. 8 9 The facility’s Medical Director, Dr. White, resigned 2/18/05. The facility’s Director of Nursing resigned 2/19/05, The facility’s Chief Executive Officer, Liz Register, resigned 2/18/05. The facility’s Respiratory Therapist, Andrea Degiorgi, resigned 2/18/05, There is one physician covering the emergency room and only three physicians on hospital staff in total. 20 12, 13. 15, 59. 60. The current hospital license lists the following as service capacity: Emergency Services: Allergy, Burns, Cardiology, Dermatology, Emergency Medicine, Endocrinology, Family Medicine, Gastroenterology, Gynecology, Hematology, Immunology, Infectious Disease, Internal Medicine, Nephrology, Neurology, Obstetrics, Oncology, Ophthalmology, Orthopedics, Otolaryngology, Pediatrics, Podiatry, Pulmonary Medicine, Radiology, Urology. It is not possible to provide all the above service areas with three physicians on staff and with only one taking emergency calls. The hospital has no functioning telemetry equipment, no functioning fluoroscopy equipment, and no CT scan for diagnostic purposes. The facility has no agreement with a radiologist to provide supervision of radiology services. This is a violation of Chapter 395.1041 (2004) as well as Chapter 59A-3.255(6), Florida Administrative Code. The hospital has been having financial difficulties as is evidenced by failure to meet payroll timely and failure to provide needed repairs and background checks for personnel at the hospital due to lack of funds, Due to the questionable financial condition of the hospital it is likely that the high staff turnover and lack of physicians on staff will continue. This emergency order of moratorium for elective admissions is the only way to assure that new patients are not admitted to this hospital where it is unclear that proper services can be delivered. Although the census is six patients currently, the moratorium on elective admissions is the only way the Agency can prevent a further strain on existing services and thereby endanger the newly admitted patients as well as the current patients. Because of the above facts, and because of the impossibility of providing the licensed service capacity, and with the high staff tumover in a short period of time, the hospital cannot assure the provision of care to the existing patients or the general public in a manner consistent with community standards. Therefore, a threat to the safety and welfare of the existing patients exists as well as a threat to public health and safety. The above matters have been continuing and are likely to continue. Each of the above matters individually, and especially collectively, justifies revocation of the license of Respondent. 61. 395.003(8), 395.1065(2)(a), and 395.1065(4), Florida Statutes (2004) (quoted in paragraph 1 Due to the above violations and matters, and pursuant to the authority of Sections above) the license of Respondent should be revoked. WHEREFORE, AHCA demands the following relief: 21 1. Enter factual and legal findings as set forth in the above allegations; 2. Impose revocation of license for the above referenced matters; and 3. Impose such other relief as this tribunal may find appropriate. COUNT XI FOR REVOCATION OF LICENSE (Based On Emergency Suspension Order Matters) Section 395.003(8)(a) Fla. Stat. (2004) (Revocation) Section 395.1065(2)(a), (4), Fla. Stat. (2004) (Revocation) 62. AHCA realleges and incorporates paragraphs 1 through 5. 63. On or about March 1, 2005, AHCA, thorough its Secretary Alan Levine, issued an Emergency Order of Suspension of License (the “ESO”) (Exhibit “C”) to Respondent, finding that the conditions at Respondent presented a clear and present danger to public health and safety. The ESO contained various findings of fact, including paragraphs 3 through 8 as follows: 3. On or about February 9-10, 2005, the Agency conducted a Licensure Revisit Survey at Gulf Pines (“Survey”) evaluating Gulf Pines’ compliance with applicable regulatory laws. At that time, the Agency determined that a) conditions at the Respondent's facility presented a threat to the health, safety, or welfare of Respondent’s patients as well as a threat to public health or safety, and b) a moratorium on elective admissions could be imposed. Said moratorium was imposed on February 22, 2005 (Ex. A). 4. On February 27, 2005, there was approximately a 10' x 10’ area of the kitchen ceiling leaking into the kitchen, with approximately 20' x 20' of standing water on the kitchen floor. Furthermore, on or about February 22, 2005, a Life Safety survey was conducted at Gulf Pines. It was determined that the fire sprinkler system in two areas could not function because there was no viable ceiling Temaining due to water intrusion, causing approximately fifty percent of the ceiling to be missing, presenting a clear and present danger to public health and safety pursuant to §395.1065, Florida Statutes (2004), for which the Agency may revoke or suspend Respondent’s license. If a fire starts in the area not protected by sprinklers, the fire cannot be contained and would spread to other parts of the facility, thus posing a clear and present danger to public health and safety. 5. Unsanitary conditions exist in the kitchen, such as staff washing dishes in a sink stopped with a used rag stuffed in the drain. In the presence of Agency surveyors, Respondent added liquid bleach to water to clean dishes, which was not in accordance with the facility infection control policies and procedures, testing below the standard required to safely sanitize dishes. Furthermore, encrusted bake ware in the kitchen was covered with at least a one-inch layer of flaking food like substance. All of these conditions present a clear and present 22 danger to public health and safety pursuant to §395.1065, Florida Statutes (2004), for which the Agency may revoke or suspend Respondent’s license. Unsanitary conditions in the kitchen of the facility could cause contamination of food, which would be consumed by patients and/ or staff, leading to serious illness, thus posing a clear and present danger to public health and safety. 6. The Respondent has not submitted documentation that it has obtained professional liability coverage in an amount equivalent to $10,000 per claim for each hospital bed in Respondent’s hospital since July 2004 pursuant to §766.105, Florida Statutes (2004) for which the Agency shall revoke or suspend Respondent’s license (Ex. B). Without professional liability insurance, the facility would not take responsibility for harm affecting its patients, thus presenting a clear and present danger to public health and safety. 7. The conduct set forth in these Findings of Fact is likely to continue, as evidenced by the violations set forth in both the surveys of February 9-10, 2005 and February 22, 2005, and the monitoring visit of February 27, 2005. Furthermore, the lack of professional liability coverage has been continuing since July 2004. 8. This drastic remedy is the only way to avoid future harm to public health and safety, as a moratorium on elective admissions has already been imposed. (Note that AHCA, subsequent to the issuance of the ESO, determined that Respondent did in fact have adequate insurance.) 64. The above matters have been continuing and are likely to continue. 65. Each of the above matters individually, and especially collectively, justifies revocation of the license of Respondent. 66. Due to the above violations and matters, and pursuant to the authority of Sections 395.003(8), 395.1065(2)(a), and 395.1 065(4), Florida Statutes (2004) (quoted in paragraph 1 above) the license of Respondent should be revoked. WHEREFORE, AHCA demands the following relief: 1. Enter factual and legal findings as set forth in the above allegations; 2. Impose revocation of license for the above referenced matters; and 3. Impose such other relief as this tribunal may find appropriate. 23 COUNT XII FOR REVOCATION OF LICENSE (Based on Recent Violations of 2/10/05, 2/24/05 and 2/27/05 Surveys) Section 395.003(8)(a) Fla. Stat. (2004) (Revocation) Section 395.1065(2)(a), (4), Fla. Stat. (2004) (Revocation) Section 482.22(c)(5), Fla. Stat. (2004) Section 482.43(a), Fla. Stat. (2004) Section 395.1065(2)(a), Fla. Stat. (2004) Section 482.43(b)(1), Fla. Stat. (2004) Chapter 58A-3, Fla. Admin. Code (2004) Chapter 59A-10, Fla. Admin. Code 67. AHCA realleges and incorporates paragraphs 1 through 5. 68. On or about February 10, 2005, AHCA conducted a follow up risk management Survey at Respondent’s facility. AHCA cited Respondent for a violation of Chapter 59A-10, Florida Administrative Code (Tag “R 006”), for its failure to have completed incident reports, and failing to ensure that all incident Teports contained required information, based on the following findings: 1. Review of incident report #1 revealed a report dated 1-19-05, The physician was called but the report lacked the physician order/recommendations/treatment. 2. Review of incident Teport #3 revealed a report dated 1-20-05. The physician was called but the report lacked physician order/ Tecommendations/ treatment. 3. Review of incident report #6 revealed a report dated 1-25-05. The physician was called but the report lacked the physician order/recommendation/treatment. 4. Review of incident report #7 revealed a report dated 1-28-05. The physician was called but the report lacked the physician order/recommendation/treatment. 69. On or about February 22, 2005, AHCA conducted a monitoring visit at Respondent’s facility. AHCA cited Respondent for a violation of Chapter 59A-3, Florida Administrative Code (Tag “K 062”), for its failure to maintain required automatic sprinkler systems continuously in reliable operating condition, including failure to inspect and test Periodically, based on the following findings: 24 During the Life Safety survey it was determined that the fire sprinkler system installed in the air handler / mechanical room adjacent to the X-ray area was impaired in Operation, because there was no viable ceiling remaining due to water intrusion and the biomedical waste collection area on the West exterior of the facility was approximately 110 square feet in area and 50% of the ceiling was missing and as a result would not allow heat to effectively collect below the ceiling to operate the installed heads. 70. On or about February 22, 2005, AHCA conducted a monitoring visit at Respondent’s facility. AHCA cited Respondent for a violation of Chapter 59A-3, Florida Administrative Code (Tag “K 147”) for its failure to maintain electrical equipment in accordance with code, based on the following findings: During the Life Safety survey a flexible cord was noted as penetrating a wall in the lobby entrance and the surgery suite interior wal] supplying an electronic wash / scrub sink on the opposite side of the wall. The Gift Shop had flexible wiring connected to a light fixture from another light fixture but the connection was not made within an electrical box and the flexible wiring was exposed and an electrical box cover in the ceiling was missing. 71. On or about February 22, 2005, AHCA conducted a monitoring visit at Respondent’s facility. AHCA cited Respondent for a violation of Chapter 59A-3, Florida Administrative Code (Tag “K 018”) for its failure to maintain and have doors with the required smoke resistance, based on the following findings: During the Life Safety survey the following doors were not maintained as required: 1. Six corridor doors in the "Clinic" area did not have latching devices and there was no fire rated separation from the inpatient care areas, 2. The X-ray suite has two corridor doors; a double door assembly does not have latches installed and a "Dutch Door" is not smoke resistant between the top and bottom leaf at the meeting edge. 3. Four doors in the patient sleeping compartment, the Physical Therapy area, rooms 116 and 127 did not have the Tequired resistance (5 pounds) on the roller latches, and the doors on rooms 118 and 122 did not have "Pulls" on the doors to close them. 72. Qn or about February 22, 2005, AHCA conducted a monitoring visit at Respondent’s facility. AHCA cited Respondent for a violation of Chapter 59A-3, Florida 25 Administrative Code (Tag “K 021”) because four of ten doors in hazardous areas were not maintained to automatically close and latch tightly into the frame as required, based on the following findings: During the Life Safety survey the following doors were not maintained to function as required: 1. The door assembly to the Central Supply area, which was larger than 100 square feet in size and considered a hazardous area, had a "friction" door holder built in to the closer and would not automatically close upon detection of smoke or upon operation of the building fire alarm. It also had a gap in excess of 1/8 of an inch at the meeting edge of the door leafs negating the smoke resistance requirement. 2. A room on the South end of the Clinic wing is larger than 100 square feet in size, is being utilized for storage but does not have an automatic closer installed. 3. The gift shop which was larger than 100 square feet in sized had an automatic closing door which was propped on with a wedge but the area enclosure was not smoke resistant above the roll down shutter in the corridor wall because it was enclosed with a perforated metal screen. 4. The soiled utility room door on the "14" (South) corridor did not close tightly into the frame. 5. The soiled utility room door within the emergency department suite did not have a latching device. 73. On or about February 24, 2005, AHCA conducted a monitoring visit at Respondent’s facility. AHCA cited Respondent for a deficiency (Tag “H 190”) for failing to complete an admission history and physical examination in accordance with facility rules and regulations of the medical staff of the hospital on 1 of 2 patients, based on the following findings: Record review of patient #2s medical record on 2/24/05 at 11:40 a.m. revealed patient #2 was admitted to the hospital on 2/19/05 through the emergency room. The "History" hospital form (1 page) was stamped with the name and identifying information of patient #2. The information noted on the "History" form was "CAD/CHF, Angioplasty 5-6 years, *Bowel Resection, Gall Bladder". There was no other information on the "History" form and it was not signed and not dated. There was no other history documentation found in the medical record. 26 The “Physical Examination" form (2 pages) was stamped with the name and identifying information of patient #2. Both pages of the form were blank. There was no other physical examination documentation found in the medical record. Review of the "Rules and Regulations of the Medical Staff of Gulf Pines Hospital" page 8, states, "History and Physicals. A complete admission history and physical examination shall be recorded within twenty-four (24) hours of admission. This report should include all pertinent findings resulting from an assessment of all the systems of the body". Six days after admission of patient #2, the facility failed to complete an admission history and physical examination in accordance with facility rules and regulations of the medical staff. 74, On February 24, 2005, AHCA conducted a monitoring visit at Respondent’s facility. AHCA cited Respondent for a deficiency (Tag “H 022”) for failing to conduct a discharge planning evaluation for 1 of 2 sampled patients, based on the following findings: Record review conducted on 2/24/05 at 11:40 a.m. revealed patient #2 was admitted by Privately owned vehicle through the emergency room on February 19, 2005 with diagnosis of pneumonia, bronchitis, Alzheimer's disease, condition stable but guarded. One of two physician progress notes dated 2/20/05 states, “prepare for DC (discharge) in A.M.". There are no other progress notes in the medical record. Physician order dated 2/22/05 states, "SM7 before discharge". The Admission Discharge Planning assessment sheet (5 pages), stamped with patient #2's name and identifying data was blank 6 days after admission. Interviews with both LPNs on duty, on 2/24/05 at 11:50 a.m., taking care of patient #2 confirmed the Admission Discharge Planning assessment sheets to be blank, neither could locate any discharge information in patient #2s record, and stated they did not know what the discharge plans for this patient might be. Patient #2 did not receive a discharge planning evaluation. 75. On or about February 27, 2005, AHCA conducted an unzanounced financial monitoring visit at Respondent’s facility. AHCA cited Respondent for a deficiency (Tag “H 232”) for failing to maintain an effective maintenance program related to the kitchen ceiling, based on the following findings: A tour of the facility was conducted on 2/27/05 at approximately 1:40 PM. The facility's kitchen area was noted to have an approximately 10X10 foot area of ceiling that was leaking in multiple areas onto the floor. The floor was noted to be visibly wet 27 and puddlings in an area approximately 20X 20 feet. There was also a large white bucket noted located under one of the leaks and was partially full. 76. Each of the above matters have been continuing and are likely to continue. 77. Bach of the above matters individually, and especially collectively, justifies revocation of the license of Gulf Pines Hospital. 78. Due to the above violations and matters, and pursuant to the authority of Sections 395.003(8), 395.1065(2)(a), and 395.1065(4), Florida Statutes (2004) (quoted in paragraph 1 above) the license of Respondent should be revoked. WHEREFORE, AHCA demands the following relief: 1. Enter factual and legal findings as set forth in the above allegations; 2. Impose revocation of license for the above referenced matters; and 3. Impose such other relief as this tribunal may find appropriate. COUNT XHi (FOR REVOCATION OF LICENSE) Section 395.003(8)(a) Fla. Stat. (2004) (Revocation) Section 395.1065(2)(a), (4), Fla. Stat. (2004) (Revocation) 79. AHCA realleges and incorporates Counts [X through XII above. 80. Each of the above matters individually, and especially collectively, justifies revocation of the license of Respondent. 81. Due to the above violations and matters, and pursuant to the authority of Sections 395.003(8), 395.1065(2)(a), and 395.1065(4), Florida Statutes (2004) (quoted in paragraph 1 above) the license of Respondent should be revoked. WHEREFORE, AHCA demands the following relief: 1, Enter factual and legal findings as set forth in the above allegations; 2. Impose fines pursuant to counts I, through VII; 28 Impose revocation of license pursuant to counts [X through XI. Impose such other relief as this tribunal may find appropriate. {THIS PAGE LEFT BLANK INTENTIONALLY] 29 NOTICE Respondent, GULF PINES HOSPITAL, INC., d/b/a GULF PINES HOSPITAL, is notified that it has a right to request an administrative hearing pursuant to Section 120.569, Florida Statutes. Specific options for administrative action are set out in the attached Election of Rights (one page) and explained in the attached Explanation of Rights (one page). 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 Dr., Bldg. 3, MSC 3, Tallahassee, Florida, 32308; Attention: Agency Clerk. THE RESPONDENT IS FURTHER NOTIF TED, IF THE REQUEST FOR HEARING IS NOT RECEIVED BY THE AGENCY FOR HEALTH CARE ADMINISTRATION WITHIN TWENTY-ONE (21) DAYS OF RECEIPT OF THIS ADMINISTRATIVE COMPLAINT, A FINAL ORDER WILL BE ENTERED. Respectfully submitted this _/° aay of March 2005, Tallahassee, Florida. it} Naw. WW: Ww Michael Mathis, Senior Attorney Fla. Bar No. 0325570 Agency for Health Care Administration 2727 Mahan Drive, Bldg. #3, MSC #3 Tallahassee, FL 32308 Phone: (850) 922-5873 Fax: (850) 921-0158 or (850) 413-9313 CERTIFICATE OF SERVICE I HEREBY CERTIFY that the original Administrative Complaint, Explanation of Rights form, and Election of Rights forms have been sent by U.S. Certified Mail, Return Receipt Requested (receipt # 7001 0360 0003 3804 6425), to Mary L. Register, Receiver, Gulf Pines Hospital, 102 20" Street, Port St. Joe, Florida 32456, and George F. Indest, III, The Health Care Law Firm Centerpointe Two, 220 E. Central Pkwy., Suite 2030, Altamonte Springs, FL 32701- 3417. day of Man ce h 2005, fo -/ h, ‘a — Michael Mathis, Senior Attorney Agency for Health Care Administration 4, Submitted on this _/° th 30

Docket for Case No: 05-001312