STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION, meitonen, (1-398 | vs, AHCA Na. 2007007050 PARK MEDICAL SURGERY CENTER, LLC, Respondent. / ADMINISTRATIVE COMPLAINT = \ COMES NOW the Petitioner, State of Florida, Agency for Health Care Administfation (hereinafter “the Agency”), by and through its undersigned counsel, and files this Administrative Complaint against the Respondent, Park Medical Surgery Center, L.L.C. (hereinafter “the Respondent”), pursuant to Sections 120,569 and 120,57, Florida Statutes (2006), and alleges: NATURE OF THE ACTION This is an action to revoke the licensé of an ambulatory surgical center pursuant to Subsections 40%.810(4)(a) and 408,815(1)(c), Florida Statutes (2006), Subsection 395,003(8)(a), Florida Statutes (2006), and Rules 59A-5,003(10), (16)-(17), Florida Administrative Code. ~ JURISDICTION AND VENUE 1. The Court has jurisdiction over the subject matter pursuant to Sections 120,569 and 120.57, Florida Statutes (2006). 2. The Agency has jurisdiction over the Respondent pursuant to Sections 20,42 and 120.60. Florida Statutes (2006), and Chapters 408, Part Tl, and 395. Part I, Florida Statutes (2006), and Chapter 59A-5, Florida Administrative Code, Td TES6L89 OL PeSSe9BLes = ALMAdaYe AI Deed HOH déeret = 2aae-2-9N 3, Venue lies pursuant to Rule 28-106.207, Florida Administrative Code. PARTIES 4, The Agency is the licensing and regulatory authority that oversees ambulatory: * surgical centers in Florida pursuant to Chapters 408, Part If, and 395, Part I, Florida Statutes (2006), and Chapter 594-5, Florida Administrative Code. The Agency may deny, modify, suspend or revoke the license of an ambulatory surgical center for violations of the Florida Health Care Licensing Procedures Act or the authorizing statutes or the applicable rules, §§ 395,003(8), 408.815(1), Fla. Stat. (2006); Fla, Admin. Code R, 59A-5.003(16). 5, The Respondent was issued a license by the Agency (License Number 1221) to operate an ambulatory surgical center located at 5000 Park Street North, St, Petersburg, Florida 33709, and was required to comply with the applicable federal and state regulations, statutes and rules. COUNT The Respondent Discontinued Its Ambulatory Surgical Center Operation ; And Failed To Surrender Its License To The Agency In Violation of F.S. 408.810(4)(a) and F.A.C. 59A-5.003(10), (16)-(17) 6. The Agency re-alleges and incorporates by reference paragraphs 1 through 5. 7, Under Florida law, “ambulatory surgical center” or “mobile surgical facility” means a facility the primary purpose of which is to provide elective surgical care, in which the patient is admitted-to and discharged from such facility within the same working day and is not permitted to stay overnight, and which is not part of a hospital. § 395.002(3), Fla. Stat. (2006). 8. Under Florida law, a person may not establish, conduct, or maintain a hospital, ambulatory surgical center, or mobile surgical facility in this state without first obtaining a license under this part, § 395.003(1)(a), Fla. Stat. (2006), 9, Under Florida law, whenever the Agency finds that there has been a substantial 2'd F9S6ER9 -OL bpSSLSAJAL ALUdHad SDC DUE SMOdA beet = daa@ad-2~-9nd failure to comply with the requirements established under Chapter 400, Part 1, Florida Statutes (2006), or in the rules, the Agency is authorized to deny, modify, suspend, or revoke a license. § 395,03(8)(a), Fla. Stat. (2006). 10, Under Florida law, each license shall be returned to the Agency immediately upon change in ownership or voluntary cessation of operations; or when the license is suspended or revoked, Fla. Admin, Code R. 59A-5.003(10). A licensee shall notify the Agency of impending closure of an ambulatory surgical center 30 days prior to such closure. The ambulatory surgical center shall be responsible for advising the Agency as to the disposition of medical records. Fla. Admin, Code R. 59A-5.003(17). A license issued to an ambulatory surgical center shall be revoked or denied by the agency in any case where the agency finds there has been substantial failure to comply with provisions of Chapter 395, F.8., Part I, or Chapter 59A-5, FLAC. Fla. Admin. Code R. 59A-5.003(16). 11, Under Florida law, in addition to the licensure requirements specified in Chapter 408, Part Il, Florida Statutes (2006), authorizing statutes, and applicable rules, each applicant and licensee must comply with the requirements of Section 408.810, Florida Statutes (2006), in order to obtain and maintain a license. § 408.810, Fla, Stat. (2006). Whenever a licensee discontinues operation of a provider, the licensee must inform the Agency not less than 30 days prior to the discontinuance of operation and inform clients of such discontinuance as required by anthorizine Statuts, luauedialely upon the discondauanee uf uperanon Ly a provider, tne licensee shuli surrender the license to the Agency and the license shall be canceled, § 408,810(4)(a), Fla. Stat. (2006). 42, Based upon a review of the Agency’s licensure records and other information, it was revealed that the Respondent was in violation of the above-referenced provisions, £'d peceseas :OL ppssloesed ALYAdDYd SW Id Wedd Woes dod:at 4@%e-4-gnv , 13. The Respondent filed a change of ownership application with the Agency with respect to this ambulatory surgical center. 14, In February 2007, the Agency issued the Respondent an ambulatory surgical center license to operate this ambulatory surgical center. 15. Since that time, however, the Respondent and its new owners have not provided any ambulatory surgical center services at this Facility. 16, The Respondent did not provide the Agency 30 days notice that it was not going to provide any ambulatory surgical center services ut the Facility. 17... After the discontinuance and/or voluntary cessation of its ambulatory surgical center services, the Respondent did not immediately return and surrender its ambulatory surgical center license to the Agency to be canceled. 18, The Respondent currently does not provide any ambulatory surgical services at this Facility, is closed for business and has locked the doors to the Facility. WHEREFORE, the Petitioner, State of Florida, Agency for Health Care Administration, respectfully requests the Court to revoke the Respondent’s license to operate this ambulatory surgical center, CLAIM TOR RELIEF WHEREFORE, the Petitioner, State of Florida, Agency for Health Care Administration, respectlully requests the Court to grant the tollowing relief, 1. Enter findings of fact and conclusions of law in favor of the Agency as set forth in the complaint. 2. Revoke and cancel the Respondent’s license to operate an ambulatory surgical center in Florida. be : d TSS6£89 :OL PSSLOBLL ALMSdOMe FOU Ie ed WOed d@siet = Lege-2- 9nd 3, Order the Respondent to immediately return its ambulatory surgical center license certificate to the Agency. 4, Order any other relief that the Court deems just and4py Respectfully submitted this 30th day of July, 2007. Florida Bar No. 70931 Agency for Health Care Administration Office of the General Counsel The Sebring Building, Suite 330D 525 Mirror Lake Drive North St. Petersburg, Florida 33701 Telephone: (727) 552-1439 Facsimile: (727) 552-1440 NOTICE The Respondent is notified that it has the right to request an administrative hearing pursuant to Sections 120.569 and 120,57, Florida Statutes. If the Respondent wants to hire an attorney, it/he/she has the right to be represented by an attorney in this matter. Specific options for administrative action are set out in the attached Election of Riglits form. The Respondent is further notified if the Election of Rights form is not receiyed by the Agency for Health Care Administration within twenty-one (21) days of the receipt of this Administrative Complaint, o final order will be entered. The Election of Rights form shall be made to the Agency for Health Care Administration and delivered to: Agency Clerk, Agency for Health Care Administration, 2727 Mahan Drive, Building 3, Mail Stop 3, Tallahassee, FL. 32308; Telephone (850) 9225873. CERTIFICATE OF SERVICE 1 HEREBY CERTIFY that a true and correct copy of the Administrative Complaint and Election or Rights form were served to: Kevin McCallum, Manager/Registered Agent, Park Medical Surgery Center, LLC, 5000 Park Street North, St. Petersburg, Florida 33709, by U.S Certified Mail, Retum Receipt No. 7007 0220 0001 1589 2549, and Charles J. Jacobson, Td TSS6ER9 *OL PbSSJOBLA =ALMADOMd SOO Dvd *HOes dee:et 208d-2-bN - Petersburg, Florida 33709, by U.S Certified Mail, Return Receipt No. 7007 0220 00Q 8 ¥4, on this 30th day of July, 2007. Thomas M. Hoeler Senior Attomey Florida Bar No. 709311 Agency for Health Care Administration Office of the General Counsel The Sebring Building, Suite 330D 525 Mirror Lake Drive North St. Petersburg, Florida 33701 Telephone: (727) 552-1439 Facsimile: (727) 552-1440 Copies Furnished to: Kevin McCallum Manager/Registered Agent Park Medical Surgery Center, LLC Thomas M. Hoeler, Senior Attorney Agency for Health Care Administration Office of the General Counsel 5000 Park Street North 525 Mirror Lake Drive North, Suite 330D St. Petersburg, Florida 33709 St. Petersburg, FL. 33701 ° .S. Certified Mail teroffice Mail Charles J. Jacobson . Patricia Caufman Administrator | Field Office Manager Park Medical Surgery Center, LLC Agency for Health Care Administration 5000 Park Street North 525 Mitror Lake Dr,, 4" Floor St. Petersburg, Florida 33709 St. Petersburg, FL, 33701 8. Certified Mail Interoffice Laura MacLafferty/Jack Plagge Hospital and Outpatient Unit Agency for Health Care Administration 2727 Manan Drive, M& 31 Tallahassee, Florida 32308 (Interoffice Mail) a'd TSSEERS ‘OL bESGIOBA ALMSdOMd SOU Id avd :WOM daeat 2eg2-2-eny

Docket for Case No: 07-003980