Petitioner: AGENCY FOR HEALTH CARE ADMINISTRATION
Respondent: AMEDISYS SOUTH FLORIDA, LLC, D/B/A AMEDISYS HOME HEALTH OF MIAMI-DADE
Judges: ERROL H. POWELL
Agency: Agency for Health Care Administration
Locations: Miami, Florida
Filed: Apr. 11, 2007
Status: Closed
Settled and/or Dismissed prior to entry of RO/FO on Wednesday, April 18, 2007.
Latest Update: Dec. 23, 2024
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STATE OF FLORIDA : ADSL / fy “
AGENCY FOR HEALTH CARE ADMINISTRATION uy So, PR,
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STATE OF FLORIDA, AGENCY FOR HEALTH Wyre yy
CARE ADMINISTRATION, oe
Petitioner,
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AMEDISYS SOUTH FLORIDA, L.L.C. d/b/a
AMEDISYS HOME HEALTH OF MIAMI-DADE,
Respondent.
AHCA No.: 2007001660
Return Receipt Requested:
7002 2410 0001 4235 2405
7002 2410 0001 4235 2412
7002 2410 0001 4235 2429
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ADMINISTRATIVE COMPLAINT
COMES NOW the State of Florida,
Administration (“AHCA” or
undersigned counsel, and files
against Amedisys South Florida,
Health of Miami-Dade (hereinafter
Miami-Dade”),
“Agency” ) ,
this
L.L.C.
pursuant to Chapter 400,
Agency for Health Care
by and through the
administrative complaint
d/b/a Amedisys Home
“Amedisys Home Health of
Part III, and Section
120.60, Florida Statutes (2006), and herein alleges:
NATURE OF THE ACTION
1. This is an action to impose an administrative fine of
$10,000.00 pursuant to Section 400.484, Florida Statutes (2006),
for the protection of public health, safety and welfare.
2. A re-licensure survey was conducted at the home health
care agency from November 27 through November 30, 2006, in which
AHCA found numerous deficiencies. As a result of the findings of
the survey, an Amended Emergency Order of Immediate Moratorium
on Admissions was imposed on the facility on December 6, 2006.
[AHCA No.: 2006006963]
JURISDICTION AND VENUE
3. AHCA has jurisdiction pursuant to Chapter 400, Part
III, Florida Statutes (2006).
4. Venue lies in Miami-Dade County pursuant to Rule
28.106.207, Florida Administrative Code.
PARTIES
5. AHCA is the regulatory authority responsible for
licensure and enforcement of all applicable statutes and rules
governing home health agencies, pursuant to Chapter 400, Part
Iii, Florida Statutes (2006), and Chapter 59A-8 Florida
Administrative Code.
6. Amedisys Home Health of Miami-Dade operates a home
health agency located at 8181 N. w. isa4th Street, Miami Lakes,
Florida 33016-5861. Amedisys Home Health of Miami-Dade is
licensed as a home health agency under license number 209820951.
w
Amedisys Home Health of Miami-Dade was at all times material
hereto a licensed facility under the licensing authority of AHCA
and was required to comply with all applicable rules and
statutes.
COUNT I
AMEDISYS HOME HEALTH OF MIAMI-DADE FAILED TO COORDINATE PATIENT
CARE SERVICES PROVIDED BY THE REGISTERED NURSE, PHYSICAL
THERAPIST, OCCUPATIONAL THERAPIST, AND SOCIAL WORKER.
RULE 59A-8.0095(2) (b), FLORIDA ADMINISTRATIVE CODE.
(PERSONNEL - DIRECTOR OF NURSING)
7. AHCA re-alleges and incorporates paragraphs (1)
through (6) as if fully set forth herein.
8. Amedisys Home Health of Miami-Dade was cited with two
(2) Class I deficiencies due to a re-licensure survey conducted
from November 27, 2006 through November 30, 2006.
9. A re-licensure survey was conducted from November 27,
2006 through November 30, 2006. Based on observation, record
review and interview, it was determined that the agency failed
to ensure that the Administrator (who is a Registered Nurse),
coordinated patient care services provided by the registered
nurse, physical therapist, occupational therapist and social
worker for 5 of 15 (#1,#4, #10, #14, #15) sampled clinical
records reviewed. The findings include the following.
10. Review of the clinical record of sample patient 1,
start of care 9/19/06, revealed that the patient had a sacral
decubitus ulcer and was bed bound, requiring help with all
activities of daily living. Observation of the patient during
the home visit on 11/27/06 at. 4 pm revealed a semi-comatose,
emaciated patient who had not eaten in 12 hours, lying in a
small amount of yellowish fluid. )
11. The living environment was extremely cluttered and
dirty, and the patient's adult child had made a pathway through
the house so the surveyors. could reach the patient. The record
revealed that the patient was seen by the registered nurse twice
daily for assessment and wound care.
12. The physician was not notified of the change in the
patient's status: semi-comatose, emaciated patient being unable
to eat or drink for 12 hours. On 10/18/06, the agency's social
worker visited the patient and family. It was documented by the
social worker that the patient was emaciated with poor food
intake, and the social worker had documented the suggested
assistance with homemaking, but the suggestion was not ‘reported
to the agency and the service was never provided by the agency.
| 13. The registered nurse documented wound care but did not
inform the agency DON or Administrator or the patient's
physician of the change in the patient’s condition. There was no
evidence of documentation in the record that case management
conferences were conducted for the purpose of coordination of
care and services. The administrator was present at the home’
visit to confirm the findings.
14. ‘Review of the clinical record of sample patient #4,
start of care 10/28/06, revealed that the patient had a
diagnosis of abnormality of gait, joint pain and Diabetes. The
patient was ordered nursing services, physical therapy and an
evaluation by the social worker.
15. There was no evidence in the clinical record that the
social worker conducted an evaluation of the patient. There was
no evidence of documentation in the record that case management
conferences were conducted for the purpose of coordination of
care and services.
16. Review of the clinical record of sample patient #10,
start of care 9/29/06, revealed a patient with urinary
incontinence. Per plan of care, the patient was being treated
for diabetes, Foley maintenance, and would be monitored by the
skilled nurse and modified as needed by the physician.
Documentation in the record identified that on 10/11/06, the
Foley was not draining any urine, and the patient was wet with
urine.
17. The information was not reported to the agency or the
physician. The nurse's note of 10-11-06 stated that the Foley
would be replaced on Monday, November 13th, 2006. There was no
documentation in the record for 11-13-06 to support that the
Foley was changed. There was no evidence of documentation in the
record that case management conferences were conducted for the
purpose of coordination of care and services.
18. Record review of clinical record #14 (start of care
10-30-06) revealed a patient with a primary diagnosis of
Physical therapy, and Type i Insulin dependant, uncontrolled
Diabetes.
19. The patient was ordered Novolin Insulin 70/30, 40
units, twice daily. The patient was seen by the registered nurse
2 times a week for 2 weeks, 1 time per week for 3 weeks, and
once every other week for 4 weeks. Physical therapy was ordered
2 times per week for 5 weeks. The Initial Oasis assessment on
10/3/06 revealed that the patient was not able to give
him/herself the Insulin injections.
20. The skilled nurse reported in the notes that the
patient was non compliant with the insulin injections,
medications, had elevated blood sugars. There was documentation
in the record that the patient had no physician. The orders came
from the hospital based physician. The nurse reported the
information to the Director of Nurses on 10-9-06. There was no
evidence of documentation in the record that case Management
conferences were conducted for the purpose of coordination of
care and services.
21. Record review of clinical record #15 (start of care 2-
10-06) revealed a patient with a Diabetes/Copp (chronic
obstructive pulmonary disease) who was ordered to have physical
therapy and occupational therapy. The physical therapy was
given, but the patient was never evaluated for occupational
therapy. There was no evidence in the record that the agency
followed up on the evaluations. There was no evidence of
documentation in the record that case Management conferences
were conducted for the purpose of coordination of care and
services.
22. Review of the current policy for Coordination of Care
and Services revealed that each discipline's role is clearly
defined in the provisions of each patients care. Case
conferences and verbal communication between or among
disciplines is documented in the clinical record. The agency
provides information in a timely manner to physicians and
includes as appropriate the patients’ current condition, changes
in condition, patients’ response to treatment, outcomes of
treatment.
23. Based on the foregoing facts, Amedisys Home Health of
Miami-Dade violated Rule 59A-8.0095(2) (b), Florida
Administrative Code, herein classified as a Class I violation,
which warrants an assessed fine of $5,000.00.
COUNT IT
AMEDISYS HOME HEALTH OF MIAMI-DADE FAILED TO PROVIDE ADEQUATE
CARE TO A PATIENT AND REPORT CHANGE IN CONDITION TO PHYSICIAN.
RULE 59A~-8.0095(3) (a), FLORIDA ADMINISTRATIVE CODE.
(PERSONNEL ~ REGISTERED NURSE)
CLASS I
24, AHCA re-alleges and incorporates paragraphs (1)
through (6) as if fully set forth herein.
25. A licensure annual survey was conducted from November
27, 2006 through November 30, 2006. Based on record review and
interview, it was determined that the agency registered nurse
failed to provide adequate care to the patient and report to the
physician the change in condition as evidenced by the decline of
sample patient #14 resulting in immediate jeopardy and 2
subsequent admissions to the hospital. The findings include the
following.
26. Review of the clinical record of sample patient #14,
start of care 10/3/06, revealed a patient with a diagnosis of
Type 1 insulin dependant uncontrolled Diabetes.
27. The patient was ordered Novolin Insulin 70/30, 40
units, twice daily by the physician. The patient was seen by the
registered nurse 2 times a week for 2 weeks, 1 time per week for
3 weeks, and once every other week for 4 weeks. Physical therapy
was ordered 2 times per week for 5 weeks. The patient was unable
to self inject and should have been seen by the registered nurse
BID (twice daily) for administration of Insulin, blood sugar
checks, and general Diabetic teaching. The initial orders were
sent to the agency by a hospital based physician.
28. The Initial Oasis assessment on 10/3/06 revealed that
the patient was not able to give him/herself the insulin
injections. The first skilled nurses visit after the initial
assessment was on 10/6/06 which revealed from the skilled nurse
note that the patient was non-compliant with medicine and
Insulin as ordered. "Don't take medicine and insulin as
ordered."
29. There was no evidence in the record that the initial
assessment or the patient’s ability to inject insulin was taken
into consideration when providing the nursing care to the
patient. The blood sugar testing was consistently not documented
in the visit records by the nurse. The skilled nurse gave
morning Insulin dose at 12:45 PM. The pM dosage of Novolin
Insulin was prepared, and the syringe was pre-filled for the
patient. There was no evidence in the record that pre-filled
syringes were to be prepared and left for the patient, who was
unable to self inject the medication.
30. The patient should have had complete Diabetic
instructions on administration of Insulin, storage, and proper
care of a Diabetic patient; foot care, daily exercises,
prevention of infections and there was no evidence of this in
the record. There was no indication that the nurse instructed
the patient in the procedure for giving insulin or if there was
a return demonstration by the patient.
31. The nurse visited the patient 2 times a week, so the
insulin may not have been given at all by the patient
contributing to the decline of the patient.
32. The next skilled visit was on 10/9/06 revealed that
the blood sugar was 485 (norm 60-100). The skilled nurse noted
that the patient had no primary care physician (PCP) at the time
to report the very high blood sugar. This was reported to the
Director of Nursing at the agency.
33. Insulin was given, but the dosage was not specified.
The PM dosage of Insulin was prepared; the syringe pre-filled
for the patient to administer later in the day. The patient had
no current physician and the agency staff failed to notify the
hospital based physician and let him/her refer the patient to a
PCP.
34. The registered nurse visited the patient on 10/11/06.
No evidence of any vital signs (blood pressure, pulse,
temperature, and respirations) was documented. The blood sugar
testing was not documented in the visit record by the nurse. The
nurse stated that the patient was non-complaint with medication
regimen.
10
35. The skilled nurse noted +4 edema and cyanotic feet. It
was also documented that there was no PCP to report the blood
glucose level. There was no documentation that the Insulin was
given.
36. On 10/17/06 the skilled nurse visited the patient. The
blood sugar was 380, and again the skilled nurse documented that
there was no PCP to give the blood sugar results to. There was
no documentation that Insulin was given.
37. On 10/24/06, 7 days later, the skilled nurse
documented that Insulin was given by the patient, and the blood
sugar was tested which was 438. The registered nurse documented
that there was a new onset of wound; blisters on the left hand,
with green tissue at the wound bed, and no drainage. The feet
were cyanotic. It was documented that the patient had no PCP. It
was documented that the agency would send a Doctor to see the
patient, but there was no documentation to show that a physician
saw the patient.
38. The record revealed that the patient was hospitalized
from 10/26/06 through 11/8/06. Consultation done by a physician
on 10/27/06 stated that the "wound on the left middle finger,
most likely secondary to peripheral vascular disease, is
associated with his diabetes." Resumption of care started on
11/9/06.
39. The patient was discharged home with a VAC wound
dressing to be changed every Monday, Wednesday, and Friday. The
patient went to the wound care clinic every Monday, and the
agency was to provide care to the wound every Wednesday and
Friday. It was noted on the Oasis assessment done on 11/9/06,
that the patient has MRSA, which is a bacteria that is resistant
to many antibiotics.
40. The next visiting nurse note was dated 11/15/06, 6
days later, on Wednesday, and the blood sugar was noted to be
263. Wound care was given, but no mention of the Insulin dosage
was documented. The blood pressure was documented as 102/60,
pulse was 76. No further Diabetic care or instructions was given
at this time.
41. On 11/17/06, 2 days later, on Friday, the registered
nurse saw the patient. The blood sugar was documented as 275.
There was no documentation of Insulin given at this time. Wound
care was given appropriately, but no mention of proper bio-
hazardous waste management and the patient had MRSA.
42. Five days later, on 11/22/06, Wednesday, the fasting
blood sugar was 289. Blood pressure was documented as 92/60 and
a regular pulse.of 92. The Insulin dosage was not documented,
and there were no further Diabetic instructions or education was
given at this time.
43. Two days later, on 11/24/06, on Friday, the fasting
blood sugar was 428. There was no documentation of the Insulin
given. The blood pressure was documented as 50/40, pulse 100 and
regular. The skilled nurse called 911 and the patient was
transported to the hospital.
44. The patient had been diagnosed with MRSA (methcillin
resistant staphylococcus aureus) and there was no evidence in
the home visit notes that included biohazard management of the
soiled dressings or aseptic technique used during the treatment
and the wound care.
45. Review of the current agency policy for Patient
Assessment and Reassessment revealed that additional assessments
will be conducted as frequently as the patient condition
warrants.
46. Review of the current policy for Coordination of Care
and Services revealed that each discipline's role is clearly
defined in the provisions of each patients care. Case
conferences and verbal communication between or among
disciplines is documented in the clinical record. The agency
provides information in a timely manner to physicians and
includes as appropriate the patients’ current condition, changes
in condition, patients’ response to treatment, outcomes of
treatment.
13
47. Interview with Director of Nurses, Administrator, and
Clinical Manager on 11-30-06 at 4:00 pm confirmed the findings.
The Administrator revealed that if he/she had known that the
patient could not inject him/herself, they would have sent a
nurse out 2 times day.
48. Based on the foregoing facts, Amedisys Home Health of
Miami-Dade violated Rule 59A-8.0095(3) (a), Florida
Administrative Code, herein classified as a Class I deficiency,
which warrants an assessed fine of $5,000.00.
CLAIM FOR RELIEF
WHEREFORE, the Agency requests the Court to order the
following relief:
1. Enter a judgment in favor of the Agency for Health
Care Administration against Amedisys Home Health of Miami-Dade
on Counts I and II.
2. Assess against Amedisys Home Health of Miami-Dade an
administrative fine of $10,000.00 on Counts I and II for
violations cited above. This re-licensure survey also resulted
in an imposition of an Amended Emergency Order of Immediate
Moratorium on Admission [AHCA No.: 2006006963].
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
14
proper on Counts I and II.
Respondent is notified that it has a right to request an
administrative hearing pursuant to Sections 120.569 and 120.57,
Florida Statutes. Specific options for administrative action are
set out in the attached Election 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.
IF YOU WANT TO HIRE AN ATTORNEY, YOU HAVE THE RIGHT TO BE
REPRESENTED BY AN ATTORNEY IN THIS MATTER
Aes be Uilearen,
rdes A. Naranjo, aa
a. Bar No.: 997315
Assistant General Counsel
Agency for Health Care
Administration
8350 N.W. 52 Terrace - #103
Miami, Florida 33166
15
Copies furnished to:
Harold Williams
Field Office Manager
Agency for Health Care Administration
8355 N. W. 53 Street
Miami, Florida 33166
(U.S. Mail)
‘Jean Lombardi
Finance and Accounting
Agency for Health Care Administration
2727 Mahan Drive
Tallahassee, Florida 32308
(Interoffice Mail)
Home Health Agency Unit Program
Agency for Health Care Administration
2727 Mahan Drive
Tallahassee, Florida 32308
(Interoffice Mail)
CERTIFICATE OF SERVICE
I HEREBY CERTIFY that a true and correct copy of the
foregoing has been furnished by U.S. Certified .Mail, Return
Receipt Requested to Olga Cotera, Administrator, Amedisys Home
Health of Miami-Dade, Inc., 8181 N. W. 154™ Street, Miami Lakes,
Florida 33016-5861; Amedisys South Florida, L.L.c., 5959 8S.
Sherwood Forest Boulevard, Baton Rouge, Louisiana 70816; CT
Corporation System, 1200 South Pine Island Road, Plantation,
Florida 33324 on this 20% day of FA pecwey-to07.
Mire, U4, Caacuse:
urdes A. Naranjo,
SENDER: COMPLETE THIS SECTION
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@ Print your name and address on the reverse
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(Domestic Mail Only; No Insurance
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(Endorsement Required)
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Docket for Case No: 07-001662
Issue Date |
Proceedings |
Sep. 13, 2007 |
Final Order filed.
|
Apr. 18, 2007 |
Order Closing File. CASE CLOSED.
|
Apr. 18, 2007 |
Joint Motion to Relinquish Jurisdiction filed.
|
Apr. 12, 2007 |
Initial Order.
|
Apr. 11, 2007 |
Administrative Complaint filed.
|
Apr. 11, 2007 |
Petition for Formal Administrative Hearing filed.
|
Apr. 11, 2007 |
Order of Dismissal without Prejudice Pursuant to Section 120.569(2)(c), Florida Statutes, to Allow for Amendment and Resubmission of Petition filed.
|
Apr. 11, 2007 |
Election of Rights filed.
|
Apr. 11, 2007 |
Amended Petition for Formal Administrative Hearing filed.
|
Apr. 11, 2007 |
Notice (of Agency referral) filed.
|