STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, AHCA No.: 2006006687 " Ny, Petitioner, Return Receipt Requested: haf Sioy 7002 2410 0001 4235 1439 fay Teg TF v. 7002 2410 0001 4235 1446 Ade ‘be 7002 2410 0001 4235 1453 TENET ST. MARY’S, INC. d/b/a SAINT MARY’S MEDICAL CENTER, Respondent. a) lo . Cf q 4 ( ADMINISTRATIVE COMPLAINT COMES NOW the State of Florida, Agency for Health Care Administration (hereinafter “AHCA”), by and through the undersigned counsel, files this administrative complaint against Tenet St. Mary’s, Inc. d/b/a Saint Mary's Medical Center (hereinafter “Saint Mary's Medical Center”), pursuant to 28-106.111 Florida Administrative Code (2005) and Chapter 120, Florida Statutes (2005) hereinafter alleges: NATURE OF THE ACTION 1. This is an action to impose an administrative fine in the amount of $5,000.00 pursuant to Section 395.1041(5) (a) Florida Statutes (2005). JURISDICTION AND VENUE 2. This court has jurisdiction pursuant to Section 120.569 and 120.57 Florida Statutes (2005) and Chapter 28-106 Florida Administrative Code (2005). 3. Venue lies in Palm Beach County, pursuant to 120.57 Florida Statutes (2005) and Chapter 28, Florida Administrative Code (2005). PARTIES 4. AHCA is the enforcing authority with regard to hospital licensure law pursuant to Chapter 395, Part I, Florida Statutes (2005) and Rules 59A-3 Florida Administrative Code * (2005). 5. Saint Mary’s Medical ‘Center is a hospital facility located at 901 45th Street, West Palm Beach, Florida 33407 and is licensed under Chapter 395, Part I, Florida Statutes (2005) and Chapter 59A-3 Florida Administrative Code (2005). COUNT I SAINT MARY’S MEDICAL CENTER FAILED TO PROVIDE FURTHER MEDICAL/PSYCHIATRIC EXAMINATION AND TREATMENT TO STABILIZE THE CONDITION OF PATIENT PRESENTING TO THE EMERGENCY DEPARTMENT WITH AN ACUTE ONSET OF PSYCHOSIS. RULE 59A-3.255(6) (a)1, FLORIDA ADMINISTRATIVE CODE SECTION 395.002(10), FLORIDA STATUTES (EMERGENCY CARE) 6. AHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 7. Saint Mary’s Medical Center was cited with one (1) deficiency due to an Emergency Access Investigation survey that was conducted on June 7, 2006. 8. An Emergency Access Investigation survey was conducted on June 7, 2006. Based on clinical record review, review of the facility policies and procedures, and interview with facility staff, it was determined the facility failed to provide further medical/psychiatric examination and treatment as required to stabilize the medical/psychiatric condition in a patient presenting to the emergency department with an acute onset of Psychosis. The findings are as follows. 9. Clinical record review for the subject patient revealed the patient presented to the dedicated emergency department (DED) on 06/03/2006 via medical transport,, from a skilled nursing facility (SNF) with a chief complaint of increased agitation and refusal of medications. A review of the 3 documentation in the triage record, dated 06/03/2006 at 3:20A.M., revealed the patient was alert, anxious, and irritable. A review of the emergency physician record, dated 06/03/2006 at 4:00A.M., revealed the patient was agitated, hallucinating, angry and belligerent. Further review of the emergency room clinical record revealed the patient was uncooperative during the medical examination. 10. Further review of the emergency room physician's medical examination revealed a clinical impression of Psychosis, Schizophrenia with acute exacerbation. Further documentation on the medical examination record revealed the physician medically cleared the patient for a psychiatric referral. A review of the physician's orders, dated 06/03/2006 revealed an order for Haldol 10mg. to be given intramuscularly (IM) and Ativan 2mg. IM. A review of the emergency room patient care record revealed the medication was administered as ordered at 4:10 A.M. A review of the documentation in the supplemental nurse’s notes revealed the patient was asleep at 5:00 A.M. 11. Further documentation in the nurse notes revealed the patient was sent back to the skilled nursing facility at 5:10 A.M. via non-emergency transport. A thorough review of the emergency room clinical record revealed no documentation that a psychiatric referral was ever made as was determined by the emergency room physician. There was no documentation in the clinical record that the emergency room physician attempted to contact the psychiatrist on call, for further examination, to determine if the patient was stable for discharge back to the skilled nursing facility. 12. Interview with the emergency room nursing director at 1:30 P.M. in the administrative conference room, was questioned as to why the emergency room physician, who was not on duty on the day of the investigation, would document the patient was medically cleared for a psychiatric referral with no further psychiatric examination and/or treatment; with a clinical impression of psychosis, Schizophrenia with acute exacerbation. The emergency room director stated, "that does not mean the patient has to be admitted or the emergency room physician would, at his or her discretion, baker act the patient. 13. Further interview with the emergency room director revealed a statement that, "while the patient was here, he/she was asleep at 5:00A.M." 14. There is no documentation in the clinical record by the emergency room physician or the emergency room nurse clarifying the patient's stability to be returned to the skilled nursing facility. There is no documentation in the clinical record that the patient was protected and prevented from injuring himself/herself or others. 15. A review of the closed record for the subject patent revealed the patient was admitted to the Mental Health Inpatient facility on 05/11/2006, from another skilled nursing facility, with a diagnosis of Paranoid Schizophrenia with acute exacerbation. The patient was hospitalized for this psychosis from 05/11/2006 through June 1, 2006. On June 1, 2006, the patient was transferred to the skilled nursing facility. 16. A review of the closed record of the subject patient from the skilled nursing facility, dated 06/03/2006 at 1:00A.M., revealed documentation in the nurses notes that the patient had refused medication, had increased agitation, disruptive, banging on the wall with the wheel chair, leaving the building and rambling. 17. Further documentation in the nurses’ note revealed the patient was uncontrollable. Further documentation in the nurses’ notes revealed the patient was sent out to the emergency room via medical transport for psychiatric evaluation and treatment. 18. A review of the closed record of the subject patient from the skilled nursing facility on 06/03/2006 revealed the subject patient returned from the emergency room and exhibited severe confusion and agitation. Further review of the nurse’s notes from 06/03/2006 through 06/04/2006 revealed the patients behavior continued to escalate with increased agitation, belligerence, slamming the walker, and yelling profanities at other residents and staff. On 06/04/2006 the psychiatrist was in to see the patient and documented the patient was seen holding the walker in the air towards CNA and other residents. Further documentation by the psychiatrist revealed the other residents and staff are frightened of the subject patient and the patient is not safe for a nursing home and should not have been discharged. ) 19. The patient was eventually baker acted to another acute care receiving facility on 06/04/2006 at 4:00 P.M. and admitted. 20. Based on the foregoing, Saint Mary’s Medical Center violated Rule 59A-3.255(6) (a)1 and Section 395.002(10), Florida Statutes, which warrants an assessed fine of 5,000.00 pursuant to Section 395.1041(5) (a). CLAIM FOR RELIEF WHEREFORE, the Petitioner, State of Florida Agency for Health Care Administration requests the following relief: 1. Make factual and legal findings in favor of the Agency on Count I. 2. Assess against Saint Mary’s Medical Center an administrative fine of $5,000.00 for the violation cited above. 3. Assess costs related to the investigation and prosecution of this matter, if applicable. 4. Grant such other relief as the 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 (2005). Specific optioris for administrative action are set out in the attached Blection of Rights. All requests for hearing shall be made to the Agency for Health Care Administration, and’ delivered to the Agency Clerk, Agency. for Health Care Administration, 2727 Mahan Drive, MS #3, Tallahassee, Florida 32308. RESPONDENT IS FURTHER NOTIFIED THAT THE FAILURE TO RECEIVE A REQUEST FOR A HEARING WITHIN TWENTY-ONE (21) DAYS OF RECEIPT OF THIS COMPLAINT WILL RESULT IN AN ADMISSION OF THE FACTS ALLEGED IN THE COMPLAINT AND THE ENTRY OF A FINAL ORDER BY THE AGENCY. Alba M. Rodriguez, Esq/ FL Bar No.: 0880175 Assistant General Counsel Agency for Health Care Administration 8350 N.W. 52 Terrace - #103 Miami, Florida 33166 Copies furnished to: Diane Reiland Field Office Manager Agency for Health Care Administration 5150 Linton Blvd. - Suite 500 Delray Beach, Florida 33484 (U.S. Mail) Jean Lombardi Agency for Health Care Administration Finance and Accounting 2727 Mahan Drive, Mail Stop #14 Tallahassee, Florida 32308 (Interoffice mail) Hospital Program Office Agency for Health Care Administration 2727 Mahan Drive, Mail Stop #31 Tallahassee, Florida 32308 (Interoffice mail) CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true copy hereof was sent by U.S. Mail, Return Receipt Requested to David Carbone, Administrator, Saint Mary’s Medical Center, 901 45° street, West Palm Beach, Florida 33407; Tenet St Mary's, Inc., 13737 Noel Road, Suite 100, Dallas, Texas 75240; CT Corporation System, 1200 South Pine Island Road, Plantation, Florida 33324 on this 3™¢ day of November 2006. QLra 27) Nada git ; Alba M. Rodriguez, ‘Esq. SENDER: COMPLETE THIS SECTION U.S. Postal Servicer CERTIFIED MAIL. RE§ (Domestic Mail Only; No insurance ‘Complete items.1, 2, and 3. Also | complete |": Item 4 if Restrictad Dalivary is desired.’ “Printyour name and addréss on the. reverse a so that We can.return-the.card to you: : Cece Ml Attach this card to the back of the mailplece oron the front if space permits. : Aetum 1m Feéiept Fee {Endorsement Required) Restricted Delivery Fee {Endersament Requrad) ema at, a. Service Type Certified Mall 1 Express Mall Went Palin Roach, Fiouite : ant 4 Qo Regletred | a Ratu Recelpt for Merchandise Jenene nnenpuecmne ciate sieruaie wed Restricted Dal 7002 2430 ooo. W235 4435 —ew—err fone 2410 0001 42355 1434 patna Yip iE Na ; : aT ee St aE Te ba PACPREOS-2-0985 U.S. Postal Servicem ne z : CERTIFIED MAIL. F SENDER: COMPLETE THIS SECTION (Domestic Mail O1 2 (Domestic Mail nly; No insura . and 3: Also complate For delivery information vi t our wee item 4 Restrict Ivery'is desired. Print’ your name and address on the reverse an sa that we can-return the card to you. dName) | G.- Date of Deliv @ Attach this card to the back of the mailplece, , "inte Cole ) ; Date of Delivery , or.on.the front if space permits. le D, fs delivery address ciiférant from ifm1? [1 Yes. nmumme : | 4, Article Addressed to: + IVES, enter dalivery address below: © CI No cena nen Temol Sy: M ac. Restricted Delivery Fae (Endorsement aquired) 1343t Nad - to Dalen. Teron 5240 ‘Total Postage & Fees mor ‘Sireaf, Apt. ad ?o0e 2410 00032 42355 Ly4n- §'1, 2, and 3, "Also complete a = Complete Item: item 4 if Restricted Delivery is desired. . 4 @ Print your name and address on the reverse PS Farm 3600, dune 2002 Domestic ‘Mail Only 3 No Insura so that:we can_return the card to you. 8. Hi ST 'c. (i vs 'PS. mi Attach'this card to the back of the mailpiece, Mt We tifa Ly Aa, Far delivery infarmation visit our wel n the front if space permits. ra NY 3 ore D..is a ‘acidress different fram tem {2 (Cl Ye: QO FE F 1 C i A if 4, Anticle i Aprons to: . HW YES, enter delivery address below: D.No ~poswge [st FiCarperotum Cortiied Fea i F | Return Reciept Fee (Endorsement Required) - |g, Service Type Cicertfied Mail [1 Express Mall C1 Registered 1D Retum Receipt for Merchandise Oo Insured Mail O cod. Restricted Dellvary Feo (Endorsement Required) 7OOe 2410 0001 4235 145: PS Farm 3600, June 2002

Docket for Case No: 06-004930