STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION 04-0102 STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, vs. Case No. 2008012658 TOWN & COUNTRY HOSPITAL, LP, d/b/a TOWN & COUNTRY HOSPITAL, Respondent. ADMINISTRATIVE COMPLAINT COMES NOW the Agency For Health Care Administration (hereinafter Agency), by and through the undersigned counsel, and files this Administrative Complaint against TOWN & COUNTRY HOSPITAL, LP, d/b/a TOWN & COUNTRY HOSPITAL (hereinafter Respondent), pursuant to Section 120.569, and 120.57, Florida Statutes, (2008), and alleges: NATURE OF THE ACTION This is an action to impose administrative fines in the amount of one thousand dollars ($1,000.00) pursuant to Sections 120.569, 120.57, 395.1055 and 395.1065, Fla. Stat. (2008). JURISDICTION AND VENUE 1. The Agency has jurisdiction pursuant to Chapters 395, Part I, and 408, Part II, Fla. Stat. (2008). 2. Venue lies pursuant to Section 120.57 Florida Statutes, and Chapter 28-106.207 Florida Administrative Code. PARTIES 3. The Agency is the regulatory authority with regard to hospital licensing and regulation pursuant to Chapters 395, Part I, and 408, Part II, Florida Statutes, and Chapter 59A-3, Florida Administrative Code, respectively. 4. Respondent is a hospital located at 6001 Webb Road, Tampa, Florida 33615, and is licensed under Chapter 395, Part I, Florida Statutes and Chapter 59A-3, Florida Administrative Code, license number 4043. 5. Respondent was at all times material hereto a licensed facility under the licensing authority of the Agency, and was required to comply with all applicable tules, and statutes. COUNT I 6. The Agency re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 7. That pursuant to Florida law, every hospital offering emergency services and care shall provide emergency care available 24 hours a day within the hospital to patients presenting to the hospital. At a minimum 1. Emergency services personnel shall be available to ensure that emergency services and care are provided in accordance with Section 395.002(10)[sic], F.S.; 2. At least one physician shall be available within 30 minutes through a medical staff call roster; initial consultation through two-way voice communication is acceptable for physician presence; 3. specialty consultation shall be available by request of the attending physician or by transfer to a designated hospital where definitive care can be provided. Rule 59A-3.255(6){a), Florida Administrative Code. 8. That pursuant to Florida law, "Emergency services and care" means medical screening, examination, and evaluation by a physician, or, to the extent permitted by applicable law, by other appropriate personnel under the supervision of a physician, to determine if an emergency medical condition exists and, if it does, the care, treatment, or surgery by a physician necessary to relieve or eliminate the emergency medical condition, within the service capability of the facility. Section 395.002(9), Florida Statutes (2008). 9. That on October 9, 2008, the Petitioner Agency conducted a complaint survey, complaint number 2008011288 of the Respondent facility. 10. That based upon the review of records and interview, Respondent failed to ensure that specialty consultations within the service capability of the Respondent were utilized to treat a patient's emergency medical conditions, prior to transferring a patient, the same being contrary to law. 11. That Petitioner’s representative reviewed Respondent’s records relating to patient number one (1) during the survey and noted as follows: a. The patient is a non-insured young individual that presented to the emergency room, (ER), with a gunshot to left arm; b. Emergency room records contained a physician's note dated September 23, 2008 at 7:32 PM which reads "Wound was irrigated with normal saline and a pressure dressing, in addition to a splint was applied. Spoke with [named physician], T&C orthopedics who felt that fracture could be seen as an outpatient. However, due to pulsating artery seen in the laceration, I felt that patient needed to be evaluated tonight by vascular surgery. Distal flow does not eliminate the possibility of partial arterial tear. [named local hospital] accepted transfer.” c. The patient’s medical record reflected that the orthopedics physician, after being called by the emergency room physician, did not see the patient in the emergency room, but instead stated that the orthopedic physician could see the patient as an outpatient; d. Absent from Respondent’s records was any indication that the vascular physician on-call was either called or that the vascular consult directed by the emergency room physician was requested by Respondent’s emergency room staff from staff within its service capability prior to the patient’s transfer to another hospital for possible vascular trauma. 12. _ That Petitioner’s representative reviewed Respondent’s Emergency Room On-Call Schedule for September 2008 during the survey and noted that both an orthopedic and a vascular physician was on call on the day of the emergency room treatment for patient number one (1), September 23, 2008. 13. That Petitioner’s representative interviewed Respondent’s Chief Nursing Officer during the survey who indicated as follows: a. That the Chief Nursing Officer was on administrative call on September 23, 2008 and gave the emergency room administrative approval for the transfer of patient number one (1); b. That the Chief Nursing Officer could not remember if a vascular consult of patient number one (1) was obtained by Respondent prior to the transfer of patient number one (1); c. That the Chief Nursing Officer had given approval for the transfer of patient number one (1), but the same was based on information provided by emergency room staff and not based upon a review of the patient’s chart. 14. _—_ That Petitioner’s representative interviewed Respondent’s Emergency Room Director during the survey who indicated that the Director remembered the case of patient number one (1), but could not recall if the vascular surgeon was called for a consultation. 15. That Petitioner’s representative interviewed Respondent’s Emergency Room Medical Director during the survey who indicated that the Medical Director had spoken to the emergency room physician after the transfer and was told that patient number one (1) was transferred because of possible trauma to the radial artery. 16. That Petitioner’s representative reviewed Respondent’s policy and procedure named “EMTALA-Transfer” and noted under procedure numbered three (3) “Each hospital must transfer the patient if it has exhausted all its capabilities in trying to stabilize the patient's emergency medical condition." 17. _ That the above reflects Respondent’s failure to provide emergency specialty consultation within Respondent’s service capability prior to transfer of a patient, the same being contrary to law. 18. That the failure to provide emergency specialty consultation within the Respondent’s service capability places patients at risk of not receiving prompt emergency medical care and services as defined by law and stabilization prior to transfer. 19. That these deficient practices do not ensure that patient goals are met. 20. That the Agency cited the Respondent facility for the above referenced deficiency. 21. That the above cited deficiency subjects the Respondent facility to the imposition of an administrative penalty in a sum not to exceed one thousand dollars ($1,000.00) per violation per day. § 395.1065 (2)(a) Fla. Stat. (2008). WHEREFORE, the Agency intends to impose an administrative fine in the amount of one thousand dollars ($1,000.00) against Respondent, a hospital in the State of Florida, pursuant to § 395.1065 (2)(a) Fla. Stat. (2006). Respectfully submitted this“ day of December, 2008. af a Thomas J? Walsh I Fla.Bar. No. 566365 Counsel for Petitioner Agency for Health Care Administration 525 Mirror Lake Drive, 330G St. Petersburg, FL 33701 727.552.1525 (office) Respondent is notified that it has a right to request an administrative hearing pursuant to Section 120.569, Florida Statutes. 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 Agency Clerk, Agency for Health Care Administration, 2727 Mahan Drive, Bldg #3,MS #3, Tallahassee, FL 32308;Telephone (850) 922-5873. RESPONDENT IS FURTHER NOTIFIED THAT THE FAILURE TO REQUEST A HEARING WITHIN 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. CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing has been sgrved by USS. Certified Mail, Return Receipt No. 7007 0220 0001 1589 3362 on December , 2008 to CT Corporation System, Registered Agent, 1200 South Pine Island Rd., Plantation, Florida 33324 and by U.S. Mail to Michael Landry, CEO, Town & Country Hospital, 6001 Webb Road, Tampa, Florida 33615. A / / 3 J as J. Walsh II, Esquire f Copies furnished to: CT Corporation System Michael Landry, CEO Registered Agent Town & Country Hospital 1200 S. Pine Island Rd. 6001 Webb Road Plantation, FL 33324 (US. Certified Mail) Tampa, Florida 33615 U.S. Mail Patricia R. Caufman Thomas J. Walsh, I, Esquire Field Office Manager Agency for Health Care Admin. 525 Mirror Lake Drive, 4" Floor 525 Mirror Lake Drive, 330G St. Petersburg, Florida 33701 St. Petersburg, Florida 33701 Interoffice) (nteroffice) , SENDER: COMPLETA * ™ Complete items.1, 2, and o. iso complete item 4 if Restricted Delivery is desired. ™ Print your name and address on the reverse so that we can return the card to you. @ Attach this card to the back of the mailpiece, or on the front if space permits. x ed B. Received by ( Printed Name) D. Is delivery address different from item 1? LI Yésh IFYES, enter delivery address below: [1 No ay, oy 1. Article Addressed to: CT Corporation System Registered Agent’ 1200 S. Pine Island Rd. 3. Service Type Plantation, FL 33324 tified Mail C1 Express Mail CRegistered St Return Recelpt for Merchandise O insured Mail = C.0.D. 4, Restricted Delivery? (Extra Fee) O Yes & 900? geen noon 159 ashe 7) ACOS OPC ——————— 2 PS Form 3811, February 2004 Domestic. Return Receipt 102595-02-M-1540

Docket for Case No: 09-000103