STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION, 7 (T] Petitioner, 0 vs. AHCA NO.2007000829 Return Receipt Requested GLADES HOSPITAL HOLDING, INC. 7002 2410 0001 4235 5611 d/b/a GLADES GENERAL HOSPITAL, 7002 2410 0001 4235 5628 Respondent. / ADMINISTRATIVE COMPLAINT COMES NOW the Agency for Health Care Administration (hereinafter “AHCA”), by and through the undersigned counsel, files this Administrative Complaint against Glades Hospital Holding, Inc. d/b/a Glades General Hospital (hereinafter “Glades General Hospital”) pursuant to 28-106.111 Florida Administrative Code (2006) and Chapter 120, Florida Statutes (2006) hereinafter alleges: NATURE OF THE ACTION 1. This is an action to impose an administrative fine in the amount $5,000.00 pursuant to Section 395.1041(5) (a) Florida Statutes. JURISDICTION AND VENUE 2. This court has jurisdiction pursuant to Section 120.569 and 120.57 Florida Statutes and Chapter 28-106 Florida Administrative Code. 3. Venue lies in Palm Beach County, pursuant to 120.57 Florida Statutes and Chapter 28, Florida Administrative Code. PARTIES 4. AHCA is the enforcing authority with regard to Hospital licensure law pursuant to Chapter 395, Part I, Florida Statutes and Rules 59A-3 Florida Administrative Code. 5. Glades General Hospital is a hospital facility located at 1201 S. Main Street, Belle Glade, Florida 33430 and is licensed under Chapter 395, Part I, Florida Statutes and Chapter 59A-3. Florida Administrative Code, license #3992 with an expiration date of 5/05/08. COUNT I GLADES GENERAL HOSPITAL FAILED TO MAINTAIN A LIST OF RECEIVING HOSPITALS WITH SPECIAL CARE CAPABILITIES Rule 59A-3.255(6)(c)2, Florida Administrative Code (EMERGENCY CARE) 6. AHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 7. During the complaint investigation (#2006010266) conducted on 11/29-30/06 and based on observation and staff interview the hospital does not maintain a list of receiving hospitals with special care capabilities. 8. During the tour of the Emergency Room of the hospital on 11/29/06 between 10 and 11 AM, the surveyor asked for the facility’s Transfer Manual. A Registered Nurse gave the Transfer Manual to the surveyor. A review of the Transfer Manual revealed it documents only a list of hospital names and telephone numbers, but it does not document the hospitals’ special care capabilities so that this required information is readily accessible and available in making a decision as to which facility provides the special care capabilities required by any given patient. 17. Based on the foregoing, Glades General Hospital violated Rule 59A-3.255(6)(c)2, Florida Administrative Code, carrying in this case, an assessed fine of $5,000.00. CLAIM FOR RELIEF WHEREFORE, AHCA requests the following relief: A. Make factual and legal findings in favor of the Agency on Count I. B. Assess a fine against the facility in the amount of $5,000.00. Cc. Grant such other relief as the court deems proper. The Respondent 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 Explanation of Rights (one page) and Election of Rights (one page). All requests for hearing shall be made to the Agency for Health Care Administration, attention Agency Clerk, 2727 Mahan Drive, Mail Stop #3, Tallahassee, Florida 32308, Telephone (850) 922-5873. RESPONDENT IS FURTHER NOTIFIED THAT FAILURE TO RECEIVE A REQUEST FOR A HEARING WITHIN 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 PRESENTED BY AN ATTORNEY IN THIS MATVER. Spokane Bldg., Suite #103 8350 NW 52°? Terrace Miami, Florida 33166 (305) 470-6801 Copies furnished to: Diane Reiland Field Office Manager Agency for Health Care Administration 5150 Linton Boulevard, Suite 500 Delray Beach, Florida 33484 (U.S. Mail Hospital Program Office Agency for Health Care Administration 2727 Mahan Drive, Mail Stop #31 Tallahassee, Florida 32308 (Interoffice mail) Jean Lombardi Agency for Health Care Administration Finance and Accounting 2727 Mahan Drive, Mail Stop #14 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 Ronald Wievora, Administrator, Glades General Hospital, 1201 S. Main Street, Belle Glade, Florida 33430, and to Sachs Sax Klein, Registered Agent 301 Yamato Road, Suite 4150, Boca Raton, Florida 334310n QD _, 2007. ria Lawtori-Russell, Esq. a O7APRI6 PH &: IQ DIVISION oF ADMINISTRATIVE HEARINGS a Pan - —w SENDER: COMPLETE pols. ‘ate, Meade, FL 33 ¥3D ;

Docket for Case No: 07-001714