FILED STATE OF FLORIDA ARCA AGENCY FOR HEALTH CARE ADMINISTRATION AGENCY CLERK 201 UL TT A % 03: HCA HEALTH SERVICES OF FLORIDA, INC. d/b/a ST. LUCIE MEDICAL CENTER, Petitioner, DOAH NO: 05-3577 vs. AHCA NO: 2005006528 STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Respondent . / FINAL ORDER Having reviewed the Notice of Intent to Deny Emergency Services Exemption to provide Oral-Maxillofacial Surgery services on an inpatient basis, attached hereto and incorporated herein (Ex. 1), and other matters of records, the Agency for Health Care Administration (“Agency”) finds and concludes as follows: 1. By Order dated November 17, 2005, the Division of Administrative Hearings closed its files in the above-styled case. Petitioner, HCA Health Services of Florida, Inc. d/b/a St. Lucie Medical Center (hereinafter referred to as the "Petitioner") filed an Unopposed Motion for Continuance of Final Hearing on November 15, 2005, and filed a Notice of Voluntary Dismissal on June 6, 2007, attached hereto and incorporated herein (Ex. 2). 2. The denial of emergency service exemption to provide Oral-Maxillofacial Surgery is upheld. Upon consideration of the foregoing, it is ORDERED that the Agency's file is hereby closed. DONE and ORDERED at Tallahassee, Leon County, Florida this_“@ day of ely , 2007. M.D., Secretary (a Agency for Heglth Care Administration A PARTY WHO IS ADVERSELY AFFECTED BY THIS FINAL ORDER IS ENTITLED TO JUDICIAL REVIEW WHICH SHALL BE INSTITUTED BY FILING ONE COPY OF A NOTICE OF APPEAL WITH THE AGENCY CLERK OF AHCA, AND A SECOND COPY, ALONG WITH FILING FEE AS PRESCRIBED BY LAW, WITH THE DISTRICT COURT OF APPEAL IN THE APPELLATE DISTRICT WHERE THE AGENCY MAINTAINS ITS HEADQUARTERS OR WHERE A PARTY RESIDES. REVIEW PROCEEDING SHALL BE CONDUCTED IN ACCORDANCE WITH THE FLORIDA APPELLATE RULES. THE NOTICE OF APPEAL MUST BE FILED WITHIN THIRTY (30) DAYS OF THE RENDITION OF THE ORDER TO BE REVIEWED. Copies furnished to: Stephen A. Ecenia Rutledge, Ecenia, Purnell & Hoffman, P.A. 215 South Monroe Street, Suite 420 Tallahassee, Florida 32302-0551 (U.S. Certified Mail) Nelson E. Rodney, Assistant General Counsel Agency for Health Care Administration 8350 NW 52" Terrace, Suite #103 Miami, Florida 33166 (Interoffice Mail) Elizabeth Dudek, Deputy Secretary Agency for Health Care Administration’ 2727 Mahan Drive, Bldg. #1, MS #9 Tallahassee, Florida 32308 (Interoffice Mail) Hon. Stuart M. Lerner Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 (U.S. Mail) Jan Mills Agency for Health Care Administration 2727 Mahan Drive, Bldg #3, MS #3 Tallahassee, Florida 32308 (Interoffice Mail) CERTIFICATE OF SERVICE 1 HEREBY CERTIFY that a true copy of the foregoing was sent to the above- named addressees by U.S. Mail, or the method desi ignated, on this It day of C labs , 2007. Richard Shoop. Agency Clerk Agency for Health Care Administration 2727 Mahan Drive, Building 3 Tallahassee, Florida 32308-5403 (850) 922-5873 . FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION JEB BUSH, GOVERNOR : ALAN LEVINE, SECRETARY CERTIFIED MAIL RETURN RECEIPT REQUESTED 7001 0360 0003 3827 6907 July 29, 2005" Mr. Richard M. Ellis Rutledge, Ecenia, Purnell & Hoffman 215 South Monroe Street, Suite 420 Tallahassee, Florida 32301-1841 Re: Emergency Services Exemption for St. Lucie Medical Center (#2005006528) Dear Mr. Ellis: This is in response to St. Lucie Medical Center’s emergency service exemption request, received on June 17, 2005, requesting a partial exemption from providing emergency Neurosurgery, Plastic Surgery, and Oral-Maxillofacial Surgery services. «© ~ ; : Section 395.1041(3), Florida Statutes, requires every hospital to ensure the provision of services within the service capability of the hospital at all times, unless an exemption has been granted by the Agency. Section V of the Application for Service Exemption corresponds to the above section of the law and requires you to present the facts that would support your hospital has exhausted all reasonable efforts to ensure service capability through backup arrangements. Based on the information provided, a partial emergency service exemption is granted in the areas of Neurosurgery and Plastic Surgery. This emergency service exemption is valid through your licensure period, ending September 19, 2007. In order to continue this service exemption beyond your licensure period, an updated Application for Service Exemption must be submitted at the time of license renewal, at least 90 days prior to the expiration of the facility’s license. Under the partial exemptions, St. Lucie Medical Center shall provide emergency on-call coverage for Neurosurgery a minimum of 15 days per month, and shall provide emergency on-call coverage for Plastic Surgery a minimum of 25 days per month. With regard to Oral-Maxillofacial Surgery services, you indicate that St. Lucie Medical Center currently has 4 physicians on its staff providing oral-maxillofacial surgery services that provide 9 days of on-call coverage. While the hospital’s bylaws allow a physician whose age plus years of service equal seventy (70) not be required to participate on the mandatory emergency department on-call service, this would not apply if it has been determined “that such practitioner’s participation on such service is necessary to meet the coverage needs of the hospital.” The documentation you submitted does not demonstrate that St. Lucie Medical Center lacks the ability to ensure service capability in the area of Oral-Maxillofacial Surgery. Pursuant to Section 395.1041(3),Florida Statutes, it is the Agency’s expectation that should St. Lucie Medical Center continue to provide Oral-Maxillofacial Surgery services on an inpatient basis, then EXHIBIT 1 4 Visit AHCA online at 2727: Mahan Drive « Mail Stop #31 www.fdhe. state fl.us Tallahassee, FL 32308 July 29, 2005 Mr. Richard M. Ellis . Rutledge, Ecenia, Purnell & Hoffman Page 2 arrangements should be made to ensure the provision of emergency services in this area, 24 hours per day, 7 days per week. ; HCA Health Services of Florida, Inc. d/b/a St. Lucie Medical Center, has the right to seek administrative review of this decision pursuant to section 120,569 and 120.57, Florida Statutes, (See Attached Forms). In order to obtain a formal hearing before the Division of Administrative Hearings under section 120.57(1), Florida Statutes, your request for an administrative hearing must state the material facts disputed and must conform to the requirements in Section 28-106.201, Florida Administrative Code. Your petition must be filed within 21 days of your receipt of this letter. A copy of this letter and the attached form must be included with your petition. The petition should be sent to the Agency for Health Care Administration, Attention: Agency Clerk, 2727 Mahan Drive, Mail Stop #3, Tallahassee, Florida 32308. . If you have any questions, or would like to discuss this in greater detail, please feel free to contact me at (850) 922-7760. Sincerely, an ) j Hospital and Outpatient Services Unit Bureau of Health Facility Regulation Attachment ce: West Palm Beach Field Office Wendy Adams, AHCA Office of the General Counsel Gary Cantrell, President/CEO, St. Lucie Medical Center STATE OF FLORIDA RECEIVED _ AGENCY FOR HEALTH CARE ADMINISTRATIOQ@ENERAL COUNSEL HCA HEALTH SERVICES OF FLORIDA, SUN 08 2007 INC., d/b/a ST. LUCIE MEDICAL tor Health CENTER, Care Administration Petitioner, vs. AHCA No.: 2005006528 DOAH Case No. 05-3577 STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Respondent. ey NOTI DI PLEASE TAKE NOTICE that HCA Health Services of Florida, Inc. d/b/a St. Lucie Medical Center (“St. Lucie”), by and through undersigned counsel, hereby voluntarily dismisses its Petition for Formal Administrative Hearing dated August 15, 2005 in this case. RESPECTFULLY SUBMITTED this &** day of June, 2007. STEPHEN A, ECE RICHARD M. ELLIS Rutledge, Ecenia, Purnell & Hoffman, P.A. 215 South Monroe St., Suite 420 Post Office Box 551 Tallahassee, FL 32302-0551 (850) 681-6788 Attorneys for St. Lucie Medical Center CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy hereof has been sent by U.S. Mail to Nelson Rodney, Senior Attorney, Agency for Health Care Administration, 8355 N.W. 53rd Street, Koger Center, First Floor Manchester Bidg., Miami, Florida 33166 this Soe day of June, 2007. Attorney F:\USERS\rellis\St. Lucie\notice of voluntary dismissal.wpd

Docket for Case No: 05-003577