PILED NEA eye. ERK WP Dee 2 Ae 1b STATE OF FLORIDA cig a AGENCY FOR HEALTH CARE ADMINISTRATION AREidt ibe q ui: an I fa] A! HCA HEALTH SERVICES OF FLORIDA, INC. d/b/a ST. LUCIE MEDICAL CENTER, Petitioner, AHCA NO: 2007007699 v. DOAH NO: 07-3770 RENDITION NO.; AHCA-07-O"U'T -S-OLC STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Respondent. ee ORDE Having reviewed the Notice of Intent to Deny dated July 17, 2007, attached hereto and incorporated herein (Ex. 1), and all other matters of record, the Agency for Health Care Administration (“Agency”) has entered into a Settlement Agreement (Ex. 2) with the parties to these proceedings, and being otherwise well-advised in the premises, finds and concludes as follows: ORDERED: 1. The attached Settlement Agreement is approved and adopted as part of this Final Order, and the parties are directed to comply with the terms of the Settlement Agreement. 2. The Petitioner’s request to provide emergency plastic surgery services 14 days per month shall be deemed approved. If Petitioner’s current circumstances change regarding the provision of plastic surgery services, Petitioner shall immediately report to the Agency any changes which led to the approval of the exemption. 3. The approved exemption will be valid through Petitioner’s current licensure period. 4. Each party shall bear its own costs and attorney’s fees. 5. The above-styled case is hereby closed DONE and ORDERED this fesay of Weradee) 2087 in Tallahassee, Leon County, Florida. it Cc. Late ee Zocretary Agency for Health 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 OF PROCEEDINGS SHALL BE CONDUCTED IN ACCORDANCE WITH THE FLORIDA APPELLATE RULES. THE NOTICE OF APPEAL MUST BE FILED WITHIN 30 DAYS OF RENDITION OF THE ORDER TO BE REVIEWED. Copies furnished to: Richard M. Ellis, Esq. Nelson E. Rodney Attorney for Petitioner Assistant General Counsel Rutledge, Ecenia, Purnell Agency for Health Care & Hoffman, P.A. Administration Post Office Box 551 8350 NW 52™ Terrace, Suite 103 Tallahassee, FL 32302 Miami, Florida 33166 (U. S. Certified Mail) {Interoffice Mail) Jan Mills Agency for Health Care Administration 2727 Mahan Drive, Bidg #3, MS #3 Tallahassee, Florida 32308 (Interoffice Mail) Hon. J. D. Parrish Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 (U.S, Mail) Elizabeth Dudek Deputy Secretary Agency for Health Care Administration 2727 Mahan Drive, Bldg #1, MS #9 Tallahassee, Florida 32308 (Interoffice Mail) CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of this Final Order was served on the above-named person(s) and entities by U.S. Mail, or the method designated, on this the 7 day of Lee ber, 2007 ee” Richard Shoop, Agency Clerk Agency for Health Care Administration 2727 Mahan Drive, Building #3 Tallahassee, Florida 32308-5403 (850) 922-5873 FIORIDA AGENCY FOR HEALTH CARE ADMINSTRATION CHARLIE CRIST GOVERNOR Laren July 17, 2007 Certified Ar 7460 3902 9845 DL8s 9563 SENDERS RECORD. ticle: Number: Mr. Richard M. Ellis Rutledge, Ecenia, Purell & Hoffman 215 South Monroe Street, Suite 420 Tallahassee, Florida 32301-1841 Re: Emergency Services Exemption for St. Lucie Medical Center (#2007007699) Dear Mr. Ellis: This is in response to St. Lucie Medical Center’s emergency service exemption request, received on June 12, 2007, requesting a partial exemption from providing emergency plastic surgery and neurosurgery © 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. With regard to plastic surgery services, you indicate that St. Lucie Medical Center currently has five specialists providing plastic surgery services, One of the specialists is exempt from providing emergency coverage due to age. Two of the specialists are on courtesy staff and are not required to take emergency call. That leaves two specialists on the active medical staff to cover emergency services. During the period from May 2006 to April 2007, one patient presented to the emergency department who required plastic surgery services. None had to be transferred to other facilities to obtain services. Fifty patients received inpatient services in plastic surgery during that same time period. With regard to Neurosurgery services, you indicate that St. Lucie Medical Center has one neurosurgeon on regular staff who is available to take emergency call and one on courtesy staff, although this physician is not required to take emergency call. St. Lucie Medical Center has transfer agreements with Martin Memorial, Lawnwood Regional Medical Center, and Indian River Memorial Hospital for additional neurosurgical coverage. Approximately five days per month remais: uncovered by the agreements. During the period from May 2006 to April 2007, thirty-four patients presented to the emergency department who required neurosurgery services. Twenty-six had to be transferred to other facilities to obtain services. Two hundred twenty-seven patients received inpatient services in neurosurgery during that same time period. Based on the information provided, a partial emergency service exemption is granted in the areas of plastic surgery and neurosurgery. Under the partial exemption, St, Lucie Medical Center shall provide emergency on-cal] coverage for plastic surgery a minimum of 20 days per month. Emergency on-call coverage for neurosurgery will be provided a minimum of 25 days per month either directly by the hospital or through an arrangement with other hospitals in the area. Please note that should your current 2727 Mahan Drive, MS#31 Tallanassee, Florida 32308 ee EXHIBIT Visit ANCA online at hitp:/ahca.myfiorida.com ft July 17, 2007 Mr. Richard M. Ellis - Rutledge, Ecenia, Purell & Hoffman Page 2 circumstances change regarding the provision of plastic surgery and neurosurgery services, pursuant to Rule 59A-3.255(4)(f), Florida Administrative Code, you shall immediately report to the Agency any change in the conditions which led to the granting of an exemption. This emergency service exemption is valid through your licensure period ending September 19, 2009. In order to continue this service exemption beyond your current licensure period, an updated Application for Service Exemption must be submitted at the time of license renewal, or 45 days prior to the expiration of this exemption. HICA 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). Ih 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, Laura allen Hospital and Outpatient Services Unit Bureau of Health Facility Regulation Attachment cc: . Delray Beach Field Office Jan Mills, AHCA Office of the General Counsel Gary Cantrell, President/CEO, St. Lucie Medical Center STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION . riLeo RE: Case Name Saint Lucie Medical Center por ttCa CASE NO: 2007007699 AGERCY CLERK 1001 JUL 27 P35) ELECTION OF RIGHTS ELECTION OF Rie This Election of Rights form is attached to a proposed administrative action by the Agency for Health Care Administration (AHCA). The title may be Notice of Intent to Deny, Notice of Intent to Impose a Late Fine, Administrative Complaint, or some other notice of intended action by AHCA. An Election of Rights must be returned by mail or by fax within 21 days of the day you receive the attached Notice of Intent to Deny, Notice of Intent to Impose a Late Fine, Administrative Complaint or any other proposed action by AHCA. --‘Tfan election of rights with your selected option isnot received by AHCA within twenty-one (21) days from the date you received a notice of proposed action by AHCA, you will have given up your right to contest the Agency’s proposed action and a final order will be issued. PLEASE RETURN YOUR ELECTION OF RIGHTS TO: Agency for Health Care Administration Attention: Agency Clerk 2727 Mahan Drive, Mail Stop #3 Tallahassee, Florida 32308. Phone: 850-922-5873 Fax: 850-921-0158 PLEASE SELECT ONLY 1 OF THESE 3 OPTIONS OPTION ONE (1) I admit to the allegations of facts and law contained in the Notice of Intent to Deny, Notice of Intent to Impose a Late Fine, Administrative Complaint, or other notice of intended action by AHCA and I waive my right to object or to have a hearing. I understand that by giving up my right to a hearing, a final order will be issued that adopts the proposed agency action and imposes the penalty, fine or action. OPTION TWO (2) ___ L admit to the allegations of facts contained in the Notice of Intent to Deny, Notice of Intent to Impose a Late Fine, Administrative Complaint, or other proposed action by AHCA, but I wish to be heard at an informal proceeding (pursuant to Section 120.57(2), Florida Statutes) where I may submit testimony and written evidence to the Agency to show that the proposed administrative action is too severe or that the fine should be reduced. . OPTION THREE (3) x 1 do dispute the allegations of fact contained in the Notice of Intent to. Deny, Notice of Intent to Impose a Late Fine, Administrative Complaint, or other proposed action by AHCA, and I request a formal hearing (pursuant to Section 120.57(1), Florida Statutes (2006) before an Administrative Law Judge appointed by the Division of Administrative Hearings. PLEASE NOTE: Choosing OPTION THREE (3), by itself, is NOT sufficient to obtain a formal hearing. You must file a written petition in order to obtain a formal hearing before the Division of Administrative Hearings under Section 120.57(1), Florida Statutes. It must be * received by the Agency ¢ -k at the address above within 21 de of receipt of this proposed administrative action. The request for formal hearing must conform to the requirements of Rule 28-106.201, Florida Administrative Code, which requires that it contain: 1. The name and address of each agency affected and each agency’s file or identification number, if known; 2. Your name, address, and telephone number, and the name, address, and telephone number of your representative or lawyer, if any; 3. An explanation of how your substantial interests will be affected by the Agency’s proposed action; 4. A statement of when and how you received notice of the Agency’s proposed action; 5. A statement of all disputed issues of material fact. If there are none, you must state that there are none, 6. Aconcise statement of the ultimate facts alleged, including the specific facts you contend warrant reversal or modification of the Agency’s proposed action; 7, A statement of the specific rules or statutes you claim require reversal or modification of the Agency’s proposed action; and - : 8. A’statement ief yor cirg, statir batacticn wistrthe Agency to take with respect to its proposed action. Mediation under Section 120.573, Florida Statutes, may be available in this matter if the Agency agrees. : Provider type: Hospital Facility Name: Saint Lucie Medical Center License number: 4193 Contact person (or attorney or representative): Richard M. Ellis, Atty. for Pet itioner Name Title Address: 215 S. Monroe st., Ste, 420, Tallahassee, FL 32301 Street and number City Zip Code Telephone No850- 681 6788 Fax No.850-681-6515 Email 7/27/07 Date: NOTE: If your facility is owned or operated by a business entity (corporation, LLC, etc.) please include a written statement from one of the officers or managers that you are the authorized representative. If you are one of the managers or officers, please state which office you hold. Entity name: Name of office you hold: You, your attorney or representative may reply according Subsection 120.54 Florida Statutes (2006) and Rule 28, Florida Administrative Code or you may use this recommended form. UNITED STATES. POSTAL SERVICE® Home | Help | Sigo tn Track & Gonfirm Track & Confirm Search Results Label/Receipt Number: 7160 3901 9845 1188 9563 er ET Status: Delivered ‘ Track & Confirm tee Enter Label/Receipt Number. Your item was delivered at 3:45 PM on July 20, 2007 in TALLAHASSEE, rT... FL 32301. coe ce Notification Options Track & Confirm by email Get current event information or updates for your item sent to you or others by email (Ga>) POSTALINSPECTORS Site map contact us government services jobs National & Premier Accounts Preserving the Trust Copyright © 1999-2004 USPS, All Rights Reserved. Terms of Use Privacy Policy hitp://trkenfrm1 _smi.usps.com/PTSInternet Web/InterLabelinguiry do 07/23/2007 * atet-2007 18:89 From-RUTLEDGE ECENIA et a! S506R1E516 T-287 =P. 002 F352 STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION HCA HEALTH SERVICES OF FLORIDA, INC. d/b/a ST. LUCIE MEDICAL CENTER, Petitioner, vs. AHCA No. 2007007699 DOAH No. 07-3770 STATE OF FLORIDA, AGENCY FOR HEALTH CARE AMINISTRATION, Respondent. a SETTLEMENT AGREEMENT Respondent, State of Florida, Agency for Health Care Administration (hereinafter the *agency”), through its undersigned representatives, and Petitioner, HCA Health Services of Florida, Inc. d/b/a St. Lucie Medical Center (hereinafter *Petitioner”), pursuant to Section 120.57(4), Florida Statutes, each individually, a “party,” collectively as “parties,” hereby enter into this Settlement Agreement (“Agreement”) and agree as follows: WHEREAS, the Petitioner is a hospital, requesting a partial exemption from providing emergency plastic surgery services; and WHEREAS, the Agency has jurisdiction by virtue of being the regulatory authority over the request made by Petitioner; and 21-1 t-2007 18:89 From-RUTLEDGE ECENIA et ai BS0GR1ESi6 T-287 = P00 F-52 WHEREAS, by letter dated July 17, 2007, the Agency indicated its intent to require Petitioner to provide emergency plastic surgery services 20 days per month, and preliminarily denied Petitioner’s request to provide emergency plastic surgery services 14 days per month; and WHEREAS, the Petitioner requested a formal administrative hearing by filing an election of rights form or by petition; and WHEREAS, the parties have agreed that a fair, efficient, and cost effective resolution of this dispute would avoid the expenditure of substantial sums to litigate the dispute; and WHEREAS, the parties stipulate to the adequacy of considerations exchanged; and WHEREAS, the parties have negotiated in good faith and agreed that the best interest of all the parties will be served by a settlement of this proceeding; and NOW THEREFORE, in consideration of the mutual promises and recitals herein, the parties intending to be legally bound, agree as follows: 1. All recitals are true and correct and are expressly incorporated herein. 2. Both parties agree that the “whereas” clauses incorporated herein are binding findings of the parties. py-11-2007 15:89 From-RUTLEOGE ECENIA at a! 9506816516 T-287 P04 F-952 3. Upon full execution of this Agreement and its adoption in 3 Final Order, Petitioner agrees to waive any and all proceedings and appeals to which it may be entitled including, but not limited to, an informal proceeding under Subsection 120.57(2), @ formal proceeding under Subsection 120.57(1), appeals under Section 120.68, Florida Statutes; and declaratory and all writs of relief in any court or quasi- court (DOAH) of competent jurisdiction, and further agrees to waive compliance with the form of the Final Order (findings of fact and conclusions of law) to which it may be entitled. Provided, however, that no agreement herein, shall be deemed a waiver by either party of its right to judicial enforcement of this Agreement. 4. Upon full execution of this Agreement, the parties agree to the following: a. The Agency’s July 17, 2007 letter preliminarily denying Petitioner’s request to provide emergency plastic surgery services 14 days per month is deemed superseded by this Agreement. Upon full execution of this Agreement and its adoption in a Final Order, the Petitioner’s request to provide emergency plastic surgery services 14 days per month shall be deemed approved. If Petitioner’s current circumstances change regarding the 21-11-2007 16:00 From-RUTLEDGE ECENIA at a _— 8506816516 7-287 P.008 F-952 provision of plastic surgery services, Petitioner shall immediately report to the Agency any change which led to the approval of the exemption. b. The approved exemption will be valid through Petitioner’s current licensure period. In order to continue the exemption beyond the current licensure period, Petitioner is required to submit an updated Application for Service Exemption at the time of license renewal, at least 60 days prior to expiration of the facility’s license. c. Upon the full execution of this Agreement, the Petitioner shall file a motion in DOAH Case No. 07- 3770 to relinquish jurisdiction to the Agency for entry of a Final Order adopting this Agreement. In the event that the AHCA Secretary declines to accept this Agreement, the parties agree to remand this case to DOAH for a formal administrative hearing. 5. Venue for any action brought to interpret, challenge or enforce the terms of this Agreement or the Final Order entered pursuant hereto shail lie solely in the Circuit Court in Leon County, Florida. 7. Each party shall bear its own costs and attorney’s fees. * a-t1-2007 16:00 From-RUTLEDGE ECENIA et al 8506816516 1-287 F006 F952 6. This Agreement shall become effective on the date upon which it is fully executed by all the parties. 7. The Petitioner for itself and for its related or resulting organizations, its successors or transferees, attorneys, heirs, and executors or administrators, does hereby discharge the Agency and its agents, representatives, and attorneys of all claims, demands, actions, causes of action, suits, damages, losses, and expenses, of any and every nature whatsoever, arising out of or in any way related to this matter and the Agency's actions, including, but not limited to, any claims that were or may be asserted in any federal or state court or administrative forum, including any claims arising out of this Agreement, by or on behalf of the Petitioner or related or resulting organizations. 8. | This Agreement is binding upon all parties herein and those identified in the aforementioned paragraph of this Agreement. 9. In the event that Petitioner is or was a Medicaid provider, this settlement does not prevent the Agency from seeking Medicaid overpayments or from imposing any sanctions pursuant to Rule 59G- 9.070, Florida Administrative Code. 10. The undersigned have read and understand this Agreement and have authority to bind their respective principals to it. 21-11-2007 16:00 From-RUTLEDGE ECENIA at ai QS0GR16516 T-287 P07 P-952 11. This Agreement contains the entire understandings and agreements of the parties. 12. This Agreement supersedes any prior oral or written agreements between the parties. This Agreement may not be amended except in writing. Any attempted assignment of this Agreement shall be void. 13. All parties agree that a facsimile signature suffices for an original signature. 14. The following representatives hereby acknowledge that they are duly authorized to enter into this ae iat Regge i Elizabeth Dude Richard M. Ellis, Esq. HQA, Deputy Secretary Agency for Health Care Administration 2727 Mahan Drive, Bldg #1 Tallahassee, Florida 32308 DATED: LY ¥/O7 Florida Bar No. 96598 Agency for Health Care Administration 2727 Mahan Drive, Mail Stop #3 Tallahassee, Florida 32308 DATED: afafen Attorney for Petitioner Rutledge, Ecenia, Purnell & Hoffman, P.A. Post Office Box 551 Tallahassee, Florida 32302 DATED: 7“ f2// O72 AW. elsor’E, Rodney Assistant General Counsel Agency for Health Care Administration 8350 NW 52" Terrace, S-103 Miami, Florida 33166 pated: I//26 /2e7

Docket for Case No: 07-003770