FILED STATE OF FLORIDA AGENEY CLERK AGENCY FOR HEALTH CARE ADMINISTRATION <*>", 7 FEB a POR 27 at tap ‘ NORTHWEST MEDICAL CENTER, INC. d/b/a NORTHWEST MEDICAL CENTER, ost a Petitioner, ° oan AHCA No.: 2008011462 vs. DOAH No.: 08-5656 RENDITION NO.: AHCA-09- O5& -S-OLc STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Respondent. FINAL ORDER Having reviewed the Agency’s letter of October 8, 2008 denying Petitioner’s emergency service exemption, attached hereto and incorporated herein (Exhibit 1), and all other matters of record, the Agency for Health Care Administration (“Agency”) has entered into a Settlement Agreement (Exhibit 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. In accordance with the Agreement, the parties agree to the following: a. The Agency’s letter of October 8, 2008 denying Petitioner’s emergency service exemption to provide ophthalmology services 14 days per month is superseded. b. As of the date of this Final Order, the Petitioner’s request to provide emergency ophthalmology services 14 days per month is approved. If Petitioner’s current circumstances change regarding the provision of ophthalmology services, Petitioner shall immediately report to the Agency any change which led to the approval of the exemption. c. The approved emergency service exemption is 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 the expiration of the facility’s licensure. d. The Petitioner’s request for formal administrative proceeding is withdrawn. 3. Each party shall bear its own costs and attorney’s fees. 4. The above-styled case is hereby closed. DONE and ORDERED this 2 day of Afi , 2009, in Tallahassee, Leon County, Florida. CL ably, Holly Bensqn, Secretary 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. Lourdes A. Naranjo, Esq. Rutledge, Ecenia & Purnell 111 South Monroe Street Suite 300 Tallahassee, Florida 32302-0551 (U. S. Mail) d Assistant General Counsel Agency for Health Care Administration 8350 N. W. 52 Terrace ~ Suite 103 Miami, Florida 33166 (Iinteroffice Mail) Jan Mills Agency for Health Care Administration 2727 Mahan Drive, Bldg #3, MS #3 Tallahassee, Florida 32308 (Interoffice Mail) Elizabeth Dudek Deputy Secretary Agency for Health Care Administration 2727 Mahan Drive, Bldg #1, MS #9 Tallahassee, Florida 32308 (Interoffice Mail) Laura MacLafferty Unity Manager Hospital and Outpatient Services Unit 2727 Mahan Drive Tallahassee, Florida 32308 (Interoffice Mail) Stuart M Lerner Administrative Law Judge Division of Administrative Hearing 1230 Apalachee Parkway Tallahassee, Florida 32399 (U.S. 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 q day of Richard J. Shoop Agency Clerk Agency for Health Care Administration 2727 Mahan Drive, Building #3 Tallahassee, Florida 32308 (850) 922-5873 FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION CHARLIE CRIST HOLLY BENSON GOVERNOR : . ; SECRETARY CERTIFIED MAIL Certified Article Number | 27)b0 3901 9845 1189 4338 SENDERS RECORD October 8, 2008 Mr. Richard M. Ellis Rutledge, Ecenia & Purnell 215 South Monroe Street, Suite 420 Tallahassee, Florida 32301-1841 Re: Emergency Services Exemption Request for Ophthalmology Northwest Medical Center - #2008011462 Dear Mr. Ellis: This is in response to Northwest Medical Center’s emergency service exemption request, received on August 27, 2008, requesting a partial exemption from providing ophthalmology as a continuous emergency service. 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, AHCA Form 3000-1, 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. The information submitted with the application for the emergency. service exemption was considered when making this decision. Based on the information provided, a partial emergency service exemption has been granted in the area of ophthalmology. Under the partial emergency service exemption, Northwest Medical Center must provide an average of 20 days on call-coverage per month for ophthalmology services. Please note that any change in the conditions that led to the granting of this exemption must be immediately reported to the Agency. This emergency service exemption is valid through your current licensure period, ending August 31, 2010. In order to continue this service exemption beyond your current licensure period, an updated Application for Service Exemption, AHCA Form 3000-1, must be submitted at the time of license renewal, at least 60 days prior to the expiration of the facility’s license. EXHIBIT 2727 Mahan Drive, MS#31 Visit AHCA online at Tallahassee, Florida 32308 i t http://ahea.myflorida.com October 8, 2008 Mr. Richard M. Ellis © Rutledge, Ecenia & Purnell Page 2 Northwest Medical Center, Inc., d/b/a Northwest 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). In 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 ee 77 Mi Hospital and Outpatient Services Unit Bureau of Health Facility Regulation Attachment ce: Delray Beach Field Office Jan Mills, AHCA Office of the General Counsel Dianne Aleman, CEO, Northwest Medical Center STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION NORTHWEST MEDICAL CENTER, INC. d/b/a NORTHWEST MEDICAL CENTER, Petitioner, AHCA No.: 2008011462 DOAH No.: 08-5656 Vv. STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Respondent. / SETTLEMENT AGREEMENT Respondent, State of Florida, Agency for Health Care Administration (hereinafter the “Agency”), through its undersigned representatives, and Petitioner, Northwest Medical Center, Inc. d/b/a ‘Northwest Medical Center (hereinafter “Petitioner”), pursuant to Section 120.57(4), Florida Statutes, each individually, a “party,” collect ively 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 ophthalmology services pursuant to Chapter 395, Part I, Florida Statutes (2008), Section 20.42, Florida Statutes (2008), Chapter 408, a II, Florida Statutes (2008), and Chapter 59A-3, Florida Administrative Code; and EXHIBIT Ia WHEREAS, the Agency has jurisdiction by virtue of being the regulatory and licensing authority over licensure sought by Petitioner; and WHEREAS, by letter dated October 8, 2008, the Agency indicated its intent to require Petitioner to provide emergency ophthalmology services 20 days per month, and preliminarily denied Petitioner’s emergency service exemption request to provide emergency ophthalmology 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. Page 2 of 6 3. Upon full execution of this Agreement, Petitioner agrees to a withdrawal of its request for an administrative proceeding; 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), a formal proceeding under Subsection 120.57(1), appéals 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 letter of October 8, 2008 denying Petitioner’s emergency service exemption to provide ophthalmology services 14 days per month is deemed superseded by this Agreement. b. Upon full execution of this Agreement and its adoption in a Final Order, the Petitioner’s request to provide emergency ophthalmology services 14 days per month shall be deemed approved. If Petitioner’s current circumstances change regarding the provision of ophthalmology services, Petitioner Page 3 of 6 shall immediately report to the Agency any change which led to the approval of the exemption. | c. The approved emergency service exemption is 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 the expiration of the facility’s licensure. dad. The Petitioner’s request for formal administrative proceeding is withdrawn. 5. Venue for any action brought to interpret, challenge or enforce the terms of this Agreement or the Final Order entered pursuant hereto shall lie solely in the Circuit Court in Leon County, Florida. 6. Upon full execution of this Agreement, the Agency shall enter a Final Order adopting and incorporating the terms of this Agreement and closing the above-styled case. 7. Each party shall bear its own costs and attorney’s fees. 8. This Agreement shall become effective on the date upon which it is fully executed by all the parties. 9. 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 Page 4 of 6 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. 10. This Agreement is binding upon all parties herein and those identified in the aforementioned paragraph of this Agreement. 11. 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. This agreement does not prohibit the Agency from taking action regarding Petitioner’s Medicaid provider status, conditions, requirements or contract. 12. The undersigned have read and understand this Agreement and have authority to bind their respective principals to it. ) 13. This Agreement contains the entire understandings and agreements of the parties. 14. This Agreement supersedes any prior oral or written agreements between the parties. This Agreement may not be Page 5 of 6 amended except in writing. Any attempted assignment of this Agreement shall be void. 15. All parties agree that a facsimile signature suffices for an original signature. The following representatives hereby acknowledge that they are duly authorized to enter into this Agreement) Elizabeth Dudek Richard M. Ellis, Esq. Deputy cretary Rutledge, Ecenia & Purnell Divistén of Health Quality 111 South Monroe Street Assurance. Suite 300 Agency for Health Care Tallahassee, Florida 32302-0551 Administration 2727 Mahan Drive Tallahassee, Florida 32308 pated: _ 3 B/ 5009 pacea: (2s /roag LLM Le le fucee, Ue dear en JuStin M.@@enior, Esq. urdes A. Naranjo, Esq. Acting General Counsel Assistant General Counsel Agency for Health Care Agency for Health Care Administration Administration 2727 Mahan Drive 8350 N.W. 52 Terrace - #103 Tallahassee, Florida 32308 Miami, Florida 33166 Dated: 2f2/os Dated: Vy 2-270F Page 6 of 6

Docket for Case No: 08-005656