OT1-339> STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, AHCA No.: 2007001638 Petitioner, Return Receipt Requested: 7002 2410 0001 4232 0787 v. 7002 2410 0001 4232 0794 7002 2410 0001 4232 0800 DELRAY MEDICAL CENTER, INC. d/b/a DELRAY MEDICAL CENTER Respondent. ADMINISTRATIVE COMPLAINT COMES NOW State of Florida, Agency for Health Care Administration (“AHCA”), by and through the undersigned counsel, and files this administrative complaint against Delray Medical Center, Inc. d/b/a Delray Medical Center (hereinafter “Delray Medical Center”), pursuant to Chapter 395, and Section 120.60, Florida Statutes (2006), and 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), Florida Statutes (2006). JURISDICTION AND VENUE 2. This court has jurisdiction pursuant to Section 120.569 and 120.57 Florida Statutes (2006), and Chapter 28-106 Florida Administrative Code (2006). 3. Venue lies in Palm Beach County, pursuant to 120.57 Florida Statutes (2006), and Chapter 28, Florida Administrative Code (2006). PARTIES 4. AHCA is the regulatory authority responsible for licensure and enforcement of all applicable statutes and rules governing hospital facilities pursuant to Chapter 395 Florida Statutes (2006), and Chapter 59A-3 Florida Administrative Code (2006). 5. Delray Medical Center operates a 403-bed hospital facility located at 5352 Linton Blvd., Delray Beach, Florida 33484. Delray Medical Center is licensed as a hospital facility under license number 4439. Delray Medical Center 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 DELRAY MEDICAL CENTER FAILED TO ENSURE THE PROVISION OF EMERGENCY SERVICES LISTED ON ITS LICENSE TO BE WITHIN THE SCOPE OF SERVICES PROVIDED AND TO ACCEPT A PATIENT AND PROVIDE EMERGENCY SERVICES (NEUROLOGICAL SERVICES). SECTION 395.1041(3) (d)1., FLORIDA STATUTES RULE 59A-3.255(4) (a), FLORIDA ADMINISTRATIVE CODE (EMERGENCY CARE SERVICES) 6. AHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 7. Delray Medical Center was cited with one (1) violation due to a complaint investigation survey that was conducted on December 28, 2006. 8. A complaint investigation was conducted on December 28, 2006. Based on clinical record review, review of the Hospital License, review of the posted inventory list of services provided, review of the specialty on-call schedule, and staff interview on 12/28/06, it was determined the facility failed to ensure the provision of emergency services listed on its license to be within the scope of services provided, and to accept a patient to provide emergency services (neurological service) within the hospital's capabilities. This affected 1 of 20 patients (#1) whose clinical records were reviewed. The findings include the following. 9. Review of the clinical record for patient #1 revealed the patient presented to another local Acute Care Hospital on 11/05/06, with presenting symptoms of dizziness, slurred speech and seizure. The record documents that the patient had been assaulted 5 to 6 days prior to presenting to the local hospital's ED (Emergency bepartment) . At that hospital a Computerized Tomography (CT) scan was done of the patient's brain. 10. A review of the other local hospital's on-call schedule revealed that facility did not have physician on-call coverage for neurosurgery/neurology services on (11/05/06) the day the patient presented to the ED. 11. A review of the request for transfer log at the other local hospital revealed documentation which specifies that on 11/05/2006 at 2220, the transferring facility (other local hospital) placed a call to Delray Medical Center requesting to transfer patient #1 for neurological services. 12. The call to Delray Medical Center, and the ensuing conversation regarding the transfer of patient #1 to Delray Medical Center, is documented to have taken place with Delray | Medical Center's ED physician and the other local hospital ED physician. 13. The documentation regarding the call indicates the request to transfer the patient was denied as "not meeting trauma criteria". 14. A review of. Delray Medical Center's specialty on call schedule revealed a physician was on call at the time the request was made to transfer patient #1 into the facility for neurology/neurosurgery services. 15. During an interview with the ED Nurse Manager on 12/28/2006 at 1:00 P.M. at Delray Medical Center regarding the provision of neurology services, the Nurse Manager said, the facility “definitely provides neurology services." The Nurse Manager continued to say that although the facility has no physician for neurology on the physician on-call - schedule, there is on call neurology listed as TPA/Stroke", which was noted on the on-call schedule on the day the request was made for the patient's transfer. 16. During the continued interview, the Nurse Manager said when a patient presents to the ED or is transferred to the ED with neurological symptoms (seizure, speech difficulty, trans-ischemic attack), the patient is admitted to the service of "medicine" and a neurologist is consulted. "A patient who presents with symptoms of a Stroke is seen by a TPA/Stroke specialist on call". 17. The above reported process regarding the provision of neurology service was substantiated by the review of documentation for patients who were accepted as transfers into the facility, as well as patients who presented directly to the ED and received neurological care and services. 18. A review of Delray Medical Center's documentation relating to transfers revealed there is no documented evidence substantiating that the on-call ED physician at Delray Medical Center consulted by phone or otherwise with the ED attending physician at the transferring facility at the time the request was made to transfer the patient to Delray Medical Center. 19. A review of the facility license issued by the State of Florida revealed neurological service is on the inventory list of services provided as within the capability of the hospital. 20. The State licensure requirements at 59A-3.255(4) (a), F.A.C. specifies as follows: (a) Every hospital providing emergency services shall ensure the provision of services within the serviced capability of the hospital, 24 hours per day, 7 days per week either directly or indirectly through: 1. An agreement with another hospital made prior to receipt of a patient in need of the services; or 2. An agreement with one or “more physicians made prior to receipt of a patient in need of the service; or 3. Any other arrangement made prior to receipt of patient in need of the services. 21. On 11/05/06 Delray Medical Center failed to provide neurological services, which was in the facility’s capability as evidenced by their license and their ability to provide neurology services for other patients who were transferred into the facility or who presented directly to the facility. 22. Based on the foregoing facts, Delray Medical Center violated Section 395.1041(3) (d)1., Florida Statutes (2006), and Rule 59A-3.255(4) (a), Florida Administrative Code (2006), which warrants an assessed fine of $5,000.00. CLAIM FOR RELIEF WHEREFORE, the Petitioner, State of Florida Agency for Health Care Administration requests the following 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 Delray Medical Center on Count I. 2. Assess an administrative fine of $5,000.00 against Delray Medical Center on Count I for the violation cited above. 3. Assess costs related to the investigation and prosecution of this matter, if the Court finds costs applicable. 4. Grant such other relief as this 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 (2006). 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 fl he, Bleaaups ourdes A. Naranjo, —