STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION p — 7 "Oy wn O1-U554 se. STATE OF FLORIDA, AGENCY FOR avg Ve HEALTH CARE ADMINISTRATION, AHCA No.: 2007005025 Petitioner, Return Receipt Requested: 7002 2410 0001 4232 2156 v. 7002 2410 0001 4232 2163 7002 2410 0001 4232 2170 NORTH BROWARD HOSPITAL DISTRICT d/b/a CORAL SPRINGS MEDICAL CENTER , Respondent. ADMINISTRATIVE COMPLAINT COMES NOW the State of Florida, Agency for Health Care Administration (hereinafter “AHCA”), by and through the undersigned counsel, files this administrative complaint against North Broward Hospital District d/b/a Coral Springs Medical Center (hereinafter “Coral Springs Medical Center”) 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 of $4,000.00 pursuant to Section 395.1065(2) (a) 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 Broward 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 hospitals pursuant to Chapter 395, Part I, Florida Statutes (2006), and Chapter 59A-3 Florida Administrative Code (2006). ) 5. Coral Springs Medical Center operates a 200-bed hospital facility located at 3000 Coral Hills Drive, Coral Springs, Florida 33065. Coral Springs Medical Center is licensed as a hospital facility under license number 3954. Coral Springs 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 TI CORAL SPRINGS MEDICAL CENTER FAILED TO FOLLOW EMERGENCY TRANSFER PROTOCOL. SECTION 395, FLORIDA STATUTES RULE 59A-3.255(2), FLORIDA ADMINISTRATIVE CODE (EMERGENCY CARE) 6. AHCA re-alleges and incorporates paragraphs. (1) through (5) as if fully set forth herein. 7. Coral Springs Medical Center was cited with four (4) deficiencies due to a complaint investigation survey that was conducted on March 28, 2007. 8. A complaint investigation was conducted on March 28, ‘2007. Based on clinical record reviews and staff interview, it was determined the facility's Emergency Department personnel failed to follow the facility’s own Emergency Transfer protocols. This affected 1 of 20 sampled patients (Patient #20). The findings include the following. a. Review of the clinical record for patient #20 from the transferring facility revealed the patient presented to the Emergency Department on 11/14/06 and was provided a Medical Screening Exam by the ED Physician at 7:50 PM. It was determined the patient was not in labor at the time. b. The Medical Screening Exam revealed the patient was 29 weeks pregnant, without prenatal care, and had been sent by the Health Department to be evaluated for high blood pressure, Results of an ultrasound documented the fetus at approximately 4 pounds, and patient 31 weeks pregnant. The Physician diagnosed the patient with pregnancy induced high blood pressure, preeclampsia, and Hypokalemia, and ordered the patient transferred to a facility with the specialty of Obstetrics for further monitoring. A Form titled "EMTALA Memorandum of Transfer", documents the arrangement and preparation for transfer of the patient to have started on 11/14/06 at 2330 hours (11:30 PM). ‘The reason for transfer is documented as "obstetrics high risk; High risk pregnancy". c. Interview on 3/29/07 with the Obstetrician who was on call on 11/15/06 at Coral Springs Medical Center, revealed the emergency department physician ‘from the transferring hospital called him/her directly, and said the facility wanted to transfer a pregnant patient who was "less than 30 weeks pregnant". d. The Obstetrician further stated that he/she told the transferring hospital's Physician that if the patient delivered the baby, the nursery at Coral Springs Medical Center could not handle the baby, if the pregnancy was under 30 weeks. The Emergency Department Physician from the transferring hospital reportedly hung up the phone. e. The patient was transferred to another local hospital for "maternal fetal monitoring and further management". This hospital provided the specialty service the patient required. 9. Review of Coral Springs Medical Center's Transfer protocol/policy revealed that if an outside facility requests the transfer-in of a patient with an emergent medical condition, in order to access specialized services of the receiving hospital, the facility is obligated to accept the transfer unless it doesn't have the capacity or capability to treat the patient. 10. Review of the decision protocols for transfer of a patient to another facility revealed the calls are to be directed to the Nursing Supervisor, Administrator on-call, or their designee. 11. During an interview with the Nursing Supervisor on 3/29/07, at 1:30 PM, upon inquiry he/she said the Nursing Supervisor had no knowledge about the attempted transfer on 11/15/06. During an interview with the Risk Manager on 3/29/07 at approximately 11:00 AM, the Risk Manager stated that they found out about the request for a transfer-in of the patient for the specialty of obstetrics, which they provide, the next day when the transferring facility's Risk Manager called and informed them. 12. Review of the physician specialty on-call schedule for 11/15/06 revealed Coral Springs Medical Center had an Obstetrician physician on-call 11/15/06, within whose scope there is defined capability to have provided the “service required by the patient. 13. The facility's Emergency Department personnel did not follow their own decision protocol for transfers. The request ‘made on behalf of the patient for emergency obstetrical services to further evaluate and treat patient's emergent medical condition was denied instead of being passed on to the Nursing Supervisor or an Administrator as per the facility's transfer protocol. Thus Coral Springs Medical Center failed to accept the incoming transfer of the patient for a higher level of care. 14. Based on the foregoing facts, Coral Springs Medical Center violated Section 395, Florida Statutes and Rule 59:A- 3.255(2), Florida Administrative Code (2006), which warrants an assessed fine of $1,000.00. COUNT II CORAL SPRINGS MEDICAL CENTER FAILED TO MAINTAIN A COMPLETE RECORD OF ALL PATIENTS ON WHOSE BEHALF EMERGENCY CARE AND SERVICES ARE REQUESTED. SECTION 395.1041(4) (a)2, FLORIDA STATUTES (EMERGENCY CARE) 15. AHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. | 16. A complaint investigation survey was conducted on March 28, 2007. Based on clinical record review and staff interview, it was determined the facility failed to maintain a complete record of all patients on whose behalf emergency care and services are requested. The facility was unable to provide records maintained that documents incoming transfer requests for emergency services. This affected all attempted transfers *“ for the last six months. The findings include the following. 17. Review of the clinical record for patient #20 from the transferring hospital revealed that on 11/15/06, a request was made to Coral Springs Medical Center to accept the patient into the facility to provide evaluation and treatment from an Obstetrician. 18. Review of the Transfer Log provided to the surveyor revealed the Log was silent regarding the request placed to the facility to accept patient #20 for higher level of care which was in the facility's capability. 19. The Transfer Log for the last six months for the Emergency Department was reviewed. It was discovered during the review of the Transfer Log, the facility only documents information for patients who were accepted and transferred into the facility. Their Transfer Log was found to contain only one documented transfer not accepted by the facility during the time frame for review. It was also discovered, there is no documentation regarding the facility's attempts to transfer patients out for further emergency treatment/services who were refused by other facilities. 20. Review of the Emergency Department Transfer protocol revealed that all calls for a transfer from another facility would be routed to the hospital's Nursing Supervisor, Administrator on call, or their designee. 21. The Administrative Supervisor would thereby obtain and document the pertinent medical information on the Emergency Department transfer request form. If the Administrative/Supervisor determined the facility had the 7 capability and capacity, the transfer would be accepted and the ED would be notified. 22. If the facility was not able to take the transfer, the other facility would ‘be notified immediately. The reason for the denial of transfer would be documented on the ER transfer request form, and entered in the regional hospital's Transfer Log. 23. During an interview with the Nursing Supervisor on 3/29/07, at approximately 1:30 PM, the supervisor stated that the request for transfer form is completed when a call comes in., The form then goes either to the registrar in the Emergency Department, or the Administrator. The Nursing Supervisor, upon inquiry, stated that he/she does not recall any actual "Transfer book" to document the information in. 24. During an interview with the Chief Nursing Officer on 3/29/07, at approximately 11:00 AM, the Nursing Officer stated that the facility does not always document when Patients are not accepted, or when they make a call out placing a request to transfer a patient for higher level of care, which is not accepted. 25. The facility failed to document and retain all records for incoming and outgoing patient transfers in, from the Emergency Department. 26. Based on the foregoing facts, Coral Springs Medical Center violated Section 395.1041(4)(a)2, Florida Statutes, which warrants an assessed fine of $1,000.00. COUNT III CORAL SPRINGS MEDICAL CENTER FAILED TO MAINTAIN A TRANSFER MANUAL AND FAILED TO IMPLEMENT REQUIREMENTS THAT INDIVIDUAL IDENTIFIED AS RESPONSIBLE FOR THE ARRANGEMENTS AND COORDINATION OF INCOMING AND OUTGOING TRANSFERS IS KNOWLEDGEABLE OF REGULATORY’ REQUIREMENTS. RULE 59A~3.255(6) (c)3,4 a-e and (d), FLORIDA ADMINISTRATIVE CODE : (NURSING SERVICE) 27. AHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. . 28. A complaint investigation survey was conducted on March 28, 2007. Based on clinical record reviews and staff interview, it was determined that the facility failed to maintain a transfer manual and that the individual identified as responsible for the arrangements and coordination of incoming and outgoing transfer is knowledgeable of regulatory requirements, ensure the manual contains the decision protocols and a list of receiving hospitals and the hospitals capabilities. This affected 1 of 20 sampled patients (Patient #20). The findings include the following. 29. Review of the clinical record for patient #20 from the transferring facility revealed the patient presented to that. facility's Emergency Department on 11/14/06. The patient was not in labor at that time. The Medical Screening Exam (MSE) is documented to have been performed by the ED Physician at the transferring hospital at 7:50 PM, and lab work and ultrasound were ordered. 30. Based on the timing of the ED notes, it appears upon presentation the patient was immediately given a Medical Screening Exam. The triage nurse note dated 11/14/06 at 8:05 PM. document that the patient was 29 weeks pregnant, without prenatal care, and had been sent by the Health Department to be evaluated for high blood pressure. 31. The patient was not in labor at that time. Results of an ultrasound performed on the patient document the fetus was approximately 4 pounds, and the patient was 31 weeks pregnant. The Physician diagnosed the patient with pregnancy induced high blood pressure, preeclampsia, and Hypokalemia, and ordered the patient transferred to a facility with the specialty of Obstetrics for further monitoring. A Form titled "EMTALA Memorandum O€£ Transfer" documents the arrangement and preparation for transfer of the patient to have started on 11/14/06 at 2330 hours (11:30 PM). The reason for transfer is documented as "obstetrics high risk; High risk pregnancy". 32. Review of Coral Springs Medical Center's Transfer protocol/policy revealed documented, if an outside facility 10 requests the transfer in of a patient with an emergent medical condition, in order to access specialized services of the receiving hospital, the facility is obligated to accept the transfer unless it doesn't have the capacity or capability to treat the patient. 33. Review of the decision protocols for transfer of a patient to another facility revealed documented, the calls are to be directed to the Nursing Supervisor, Administrator on- call, or their designee. 34. During an interview with the Nursing Supervisor on 3/29/07, at 1:30 PM, upon inquiry the Nursing Supervisor stated that he/she had no knowledge about the attempted transfer on 11/15/06. During an interview with the Risk Manager on 3/29/07 at ‘approximately 11:00 AM, the Risk Manager stated that they found out about the request for the patient to be transferred in for the specialty of obstetrics, “which they provide, the next day when the transferring facility's Risk Manager called and informed them. 35. Review of the Emergency Department Transfer protocol revealed documented, all calls for a transfer from another facility should be routed to the hospital's Nursing Supervisor, Administrator on call, or their designee. The Administrative Supervisor would thereby obtain and document the pertinent 11 Medical information on the Emergency Department transfer request form. 36. I£ the Administrative/Supervisor determines the facility has the capability and capacity, the transfer would be accepted and the Emergency Department would be notified. If the facility cannot take the transfer, the other facility would be notified immediately. The reason for denying the transfer is to be documented. on the ER transfer request form, and is be entered in the regional hospital's transfer log. 37. During an interview with the Nursing Supervisor on 3/29/07, at approximately 1:30 PM, the Nursing’ supervisor said the, request. for transfer Form is filled out when a call comes in. The Form then goes either to the registrar in the ED, or the. Administrator. The Nursing Supervisor, upon inquiry, stated that he/she does not recall any actual "Transfer book" to document the information in. 38. During an interview with the Chief Nursing Officer on 3/29/07, at approximately 11:00 AM, the chief Nursing Officer said the facility does not always document when patients are not accepted, or when they make a call out placing a request to transfer a patient for higher level of care, which is not accepted. 39. The facility does not. maintain and document information regarding all incoming and outgoing requests for 12 patient transfers. Even though the facility has identified the Nursing Supervisor or Administrator on-call as being responsible for the documentation in a Transfer Manual and maintaining a Transfer Manual, it was found the responsibilities of these individuals relating to the Transfer Manual were not implemented. 40. Based on the foregoing facts, Coral Springs Medical Center violated Rule 59A-3.255(6) (c)3,4, a-e(d), Florida Administrative Code which warrants an assessed fine of $1,000.00. COUNT IV CORAL SPRINGS MEDICAL CENTER FAILED TO OFFER SPECIALTY SERVICES OF OBSTETRICS, 24 HOURS A DAY, SEVEN DAYS A WEEK. SECTION 395.1041(3) (d) (1), FLORIDA STATUTES RULE 59A-3.255(4), FLORIDA ADMINISTRATIVE CODE (EMERGENCY CARE) “41. AHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 42. A complaint investigation survey was conducted on March 28, 2007. Based on clinical record review and staff interview, it was determined that the facility failed to offer the specialty services of Obstetrics, 24 hours a day, seven days a week. This affected 1 of 20 sampled patients (Resident #20). The findings include the following. 13 43. Review of the facility's State of Florida license, revealed Obstetrics is listed on the inventory of services provided (within the capabilities) by the hospital. State regulation at 59A-3.255(4), F.A.C. requires, every hospital providing emergency services to ensure the provision of services within the service capability of the hospital at all times, 24 hours per day, 7 days per week either directly or indirectly through an agreement with another hospital or an agreement with one or more physicians. 44. During an interview with the Risk Manager on 3/29/07 at approximately 2:00 PM, the risk manager stated that the facility has not applied for an exemption for Obstetric service. The facility's on call list for the past six months was reviewed, and it was found the facility has an Obstetrician on call every day. 45. Review of the clinical record for patient #20 from the transferring facility revealed the following: a. Review of the clinical record for patient #20 from the transferring facility revealed patient presented to the Emergency Department on 11/14/06 and was provided a Medical Screening Exam by the ED Physician at 7:50 PM. It was determined the patient was not in labor at the time. b. The Medical Screéning Exam revealed the patient was 29 weeks pregnant, without prenatal care, and had been sent by the health department to be evaluated for high blood pressure. Results of an ultrasound documented the fetus at approximately 4 pounds, and patient 31 weeks pregnant. The Physician diagnosed the patient with ‘pregnancy induced high blood pressure, preeclampsia, and Hypokalemia, and ordered the 14 patient transferred to a facility with the specialty of Obstetrics for further monitoring. A Form titled "EMTALA Memorandum Of Transfer", documents the arrangement and preparation for. transfer of tthe patient to have started on 11/14/06 at 2330 hours (11:30 PM). The reason for transfer is documented as “obstetrics high risk; High risk pregnancy". a. Interview on 3/29/07 with Obstetrician who was on call on 11/15/06, revealed the emergency department physician from the’ transferring hospital called him/her directly, and said the facility wanted to transfer a pregnant patient who was "less than 30 weeks pregnant". d. The Obstetrician further stated that he/she told the transferring hospital's Physician that if the patient delivered the baby, the nursery at Coral Springs could not handle the baby, if the pregnancy was under 30 weeks. The Emergency Department Physician from the transferring hospital reportedly hung up the phone. e. The patient was transferred to another local hospital for "maternal fetal monitoring and further management". This hospital provided the specialty service the patient required. 46. Coral Spring Medical Center had the capacity and the capability to handle the patient who required the specialty service of Obstetrics, but the request to accept the patient for further obstetrical evaluation and treatment was not granted by the Obstetrician on call. The facility failed to provide the specialty service of Obstetrics 24 hours a day, seven days a week, as licensed by the State of Florida. 47. Based on the foregoing. facts, Coral Springs Medical Center violated Section 395.1041(3) (d) (1), Florida Statutes, and Rule 59A-3.222(4), Florida Administrative Code, which warrants an assessed fine of $1,000.00. 15 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 Coral Springs Medical Center on Counts I through IV. 2. Assess an administrative fine of $4,000.00 against Coral Springs Medical Center on Counts I through IV for the violations 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 16 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 Qua) 47. Alba M. Rodriguez, Esq. Fla. Bar No.: 0880175 Assistant General Counsel Agency for Health Care Administration 8350 N.W. 52 Terrace - #103 Miami, Florida 33166 Copies furnished to: Diane Reiland Field Office Manager Agency for Health Care Administration 5150 Linton Blvd. - Suite 500 Delray Beach, Florida 33484 (U.S. Mail) Karen Davis Agency for Health Care Administration Finance and Accounting , 2727 Mahan Drive, Mail Stop #14 Tallahassee, Florida 32308 (Interoffice mail) 17 Hospital Program Office Agency for Health Care Administration 2727 Mahan Drive, Mail Stop #31 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: Chief Executive Officer, Coral Springs Medical Center, 3000 Coral Hills Drive, Coral Springs, Florida 33065; North Broward Hospital District, 303 ‘S.B. 17m Street, Fort Lauderdale, Florida 33301; Barbara C. Rubin, Registered Agent, 633 South Federal Highway, Ft. Lauderdale, Florida 33301 on this QY**day of august 2007. : / AY]. Alba M. Rodriguez, Es 18 U.S. Postal Servicer Cone 2, and’: item 4 if Restricted. Daliver fa CERTIFIED MAIL. RE @ Print your name and address 8 (Domestic Mail Only; No Insurance so that wa c an r= . nu "| tu { tu + gq, Certtied Fes o o (Endorastnent Heeuoe} Paik . ! TJ Restricted Dellvery Foo 3, Service Type > (endersenen: Feaited O Gertited Mall, .. C'Exprase Mail [ TU ata! Postage & Fees Or Registered fet n Recat for Merchandise nm 7 Oinsured Mal §=1 G0, a . ies ne bore é 2002) 24D pony. ase: “BUS 20 SE [Fd Fitts dine don, Restricted Dallvery Fea (Endorsement Required) Atius ‘Total Postage & Faos 3. Service Typa O Certified Mah = Express Mail m fa rt ms mu 4 nt ™ Attach this card r or onthe front a tw Article Addressed to: H 5 | a sent DsetwZind bt end am eR eR — Neth ! | ar mu ru o oOo tm O Registered © Retum Recelpt for Merchandise Crinsured Mail ~= CO cop, 7002 2449 0002 W232 Ere (Transfer trom service label) i : [ PS Form 3800, June 2002 ree. i ii : iH PS Form-3811, August 2001 Domestic Retum Rosai 2AGPRI-03-2-0985 Go Min Com AN .

Docket for Case No: 07-004559