Aug 18 2009 15:26 AUG-18-2889 16:39 AGENCY HEALTH CARE ADMIN 856 921 4158 P1422 STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, vs. Case No. 2009004646 HEALTH MANAGEMENT ASSOCIATES, INC., d/b/a BARTOW REGIONAL MEDICAL CENTER, Respondent. ef ADMINISTRATIVE COMPLAINT COMES NOW the Agency For Health Care Administration (hereinafter Agency), by and through the undersigned counsel, and files this Administrative Complaint against HEALTH MANAGEMENT ASSOCIATES, INC., d/b/a BARTOW REGIONAL MEDICAL CENTER (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 an administrative fine in the amount of seventy thousand dollars ($70,000.00) pursuant to Sections 120.569, 120.57, 395.1055 and 395.1041, Florida Statutes (2008). JURISDICTION AND VENUE 1. The Agency has jurisdiction pursuant to Chapters 395, Part 1, and 408, Part II, Florida Statutes (2008). Aug 18 2009 15:26 AUG-18-2889 16:39 AGENCY HEALTH CARE ADMIN 856 921 4158 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 | and 408, Part II, Florida Statutes (2008), and Chapter 59A-3, Florida Administrative Code, respectively. 4, Respondent is a hospital located at 2200 Osprey Blvd., Bartow, Florida 33831, and is licensed under Chapters 395, Part I and 408, Part II, Florida Statutes (2008), and Chapter 59A-3, Florida Administrative Code, license number 4428. 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 rules, and statutes. COUNTI 6. The Agency re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 7. Pursuant to Florida law, every hospital providing emergency services shall ensure the provision of services within the service capability of the hospital, 24-hours per day, 7-days per week either directly or indirectly through an agreement with another hospital made prior to receipt of a patient in need of the service; or an agreement with one or more physicians made prior to receipt of a patient in need of the service; or any other arrangement made prior to receipt of a patient in need of the service. Rule 59A-3.255(4)(a)(1-3), Florida Administrative Code: §395.1041(3)(d)(1), Florida Statutes (2008). 8. Florida law provides that each hospital providing emergency services and care shall establish policies and procedures which incorporate the requirements of Chapter 395, F.S., relating to emergency services. The policies and procedures shall incorporate at a minimum: (a) P.15/22 Aug 18 2009 15:27 AUG-18-2889 16:39 AGENCY HEALTH CARE ADMIN 856 921 4158 Decision protocols identifying the emergency services personnel within the hospital responsible for the arrangement of outgoing and incoming transfers; (b) Decision protocols stating the conditions that must be met prior to the transfer of a patient to another hospital. These conditions are: 1. If a patient, or a person who is legally responsible for the patient and acting on the patient’s behalf, after being informed of the hospital’s obligation under Chapter 395, F.8., and of the risk of transfer, requests that the transfer be effected; or 2. If a physician has signed a certification that, based upon the reasonable risks and benefits to the patient, and based upon the information available at the time of transfer, the medical benefits reasonably expected from the provision of appropriate medical treatment at another hospital outweigh the increased risks to the individual’s medical condition from effecting the transfer; or 3. If a physician is not physically present in the emergency services area at the time an individual is transferred, a qualified medical person may sign a certification that a physician with staff privileges at the transferring hospital, in consultation with such personnel, has determined that the medical benefits reasonably expected from the provision of appropriate medical treatment at another medical facility outweigh the increased risks to the individual’s medical condition from effecting the transfer. The certification shall summarize the basis for such determination. The consulting physician must sign the certification within 72 hours of the transfer. (c) A provision providing that all medically necessary transfers shall be made to the geographically closest hospital with the service capability, unless another prior arrangement is in place or the geographically closest hospital is at service capacity as stated in Section 395.1041(3)(e), F.S. (d) Protocols for maintaining records of patient transfers made or received for a period of five years. Patient transfer information shall be incorporated separately in transfer logs and into the patient’s permanent medical record as stated in Section 395.1041(4)(a)1, F.S. (¢) Documentation of all current transfer arrangements that have been made with other hospitals and physicians. (f) A P. 16/22 Aug 18 2009 15:27 AUIG-18-2889 16:48 AGENCY HEALTH CARE ADMIN 856 921 @158 copy of Section 395.1041, F.S., Access to Emergency Services and Care, and a copy of these rules. (g) Provisions for informing hospital emergency services personnel and medical staff of the hospital’s emergency service policies and procedures, having at a minimum, the requirement to provide emergency services and care pursuant to §395.1041, Florida Statutes (2008); Rule 39A-3,.255(2), Florida Administrative Code, 9. Florida law further provides that the agency may deny, revoke, or suspend a license or impose an administrative fine, not to exceed $10,000 per violation, for the violation of any provision of this section or rules adopted under this section, § 395.1041(5)(a) Florida Statutes (2008). 10. On or about March 11, 2009, the Agency completed an emergency access complaint survey (CCR#20090029533), of the Respondent facility. 11. Based on document review, record review and staff interview, it was determined that the Respondent failed to ensure 24-hour per day, 7-day per week coverage of all specialties as required, resulting in the transfer of seven (7) of thirteen (13) sampled patients. 12. Respondent’s hospital license number 4428, as issued by the Agency, requires that Respondent provide specialty coverage for, inter alia, gastroenterology, orthopedics, general surgery, urology, ENT (ear, nose, throat), gynecology, vascular surgery, neurology, plastic surgery and ophthalmology, 24-hours per day, 7-days per week. (Copy attached). 13. The facility's transfer log for February and March was reviewed. It was noted that seven (7) patients were transferred to other acute care hospitals for services offered by the Respondent facility due to lack of on call coverage. Six (6) patients were transferred for general surgery consultation and one (1) for neurology. 14. The physician on call schedule for February and March was reviewed. It was noted that the specialties of gastroenterology, orthopedics, general surgery, urology, ENT (ear, nose, P.ivee2 Aug 18 2009 15:27 AUG-18-2889 16:48 AGENCY HEALTH CARE ADMIN 856 921 4158 throat), gynecology, vascular surgery, neurology, plastic surgery and ophthalmology were not covered 24-hours per day, 7-days per week, in the month of February. The specialties of gastroenterology, urology, ENT, vascular, neurology, plastic surgery and ophthalmology were not covered 24-hours per day, 7-days per week, in the month of March. 15. Respondent’s Risk Manager and Director of Performance Improvement were interviewed on March 11, 2009 at approximately 8:30 AM. The Risk Manager and Director of Performance Improvement stated that an attempt to obtain a specialty specific transfer agreement with a nearby acute care hospital had been unsuccessful and that only a general transfer agreement with that facility was in place. These individuals also confirmed that the Respondent facility had not yet submitted application for partial exemption for services not covered 24-hours per day, 7-days per week. | 16. The above reflects Respondent’s failure to ensure 24-hour per day, 7-day per week, care or coverage for all specialties for which Respondent is licensed from at least February 1, 2009 through March 11, 2009. 17. The Respondent was previously cited and sanctioned by the Agency for this deficiency based on a January 12, 2009 survey wherein it was determined that the Respondent facility failed to ensure 24-hour per day, 7-day per week coverage for the specialties of orthopedics, nephrology, general surgery and gynecology. Said failures on thc part of the Respondent led to four (4) patients being transferred to other hospitals to receive necessary care. 18, The deficiency cited herein subjects the Respondent facility to the imposition of an administrative fine, not to exceed $10,000 per violation. §395.1041(5)(a) Florida Statutes (2008). WHEREFORE, the Agency intends to impose an administrative fine in the amount of P.1a/22 Aug 18 2009 15:28 AUIG-18-2889 16:48 AGENCY HEALTH CARE ADMIN 856 921 @158 P.1i9-22 $70,000.00 against Respondent, a hospital in the State of Florida, pursuant to §395.1041(5)(a) Florida Statutes (2008). Xo n Respectfully submitted this 22 day of July, 2009. ie C. Ragano Fla. Bar. No. 45632 Counsel for Petitioner Agency for Health Care Administration 525 Mirror Lake Drive, Suite 330L St. Petersburg, FL 33701 727.552.1526 (office) 727.552.1440 (fax) Respondent is notified that it has a right to request an administrative hearing pursuant to Section 120.569, Florida Statutes. Respondent has the right to retain, and be represented by an attorney in this matter. 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 43,48 #3, Tallahassee, FL 32308;Telephone (850) 922-5873, RESPONDENT I5 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 comect copy of the foregoing has been served by US. Certified Mail, Retum Receipt No. 7004 2890 0000 5526 5373 to Bruce Gould, Registered Agent, 301 8, Bronough St., Suite 500, Tallahassee, FL 32301 and by U.S. Mail, to Michael J. Kosor, Si Bartow Regional Medical Center, 2200 Osprey Blvd., Bartow, Florida 33831 on July “2/009. ie C. Ragano Senior Attorney Aug 18 2009 15:28 AUIG-18-2889 16:41 AGENCY HEALTH CARE ADMIN 856 921 4158 P. 28-22 Copies furnished to: Bruce Gould, Registered Agent Michael J. Kosor, CEO 301 8. Bronough St., Suite 500 Bartow Regional Medical Center Tallahassee, FL 32301 2200 Osprey Blvd. (U.S, Certified Mail} Bartow, Florida 33831 8. Mail Patricia R. Caufman Amie C. Ragano, Esq. Field Office Manager Agency for Health Care Admin. 525 Mirror Lake Drive, 4" Floor 525 Mirror Lake Drive, 330L St. Petersburg, Florida 33701 St, Petersburg, Florida 33701 Aug 18 2009 15:28 P.2i/22 856 921 4158 AGENCY HEALTH CARE ADMIN 16:44 AUIG-18-2889 CERTIFICATE #: 4113 , LICENSE #: 4428 State of Florida AGENCY FOR HEALTH CARE ADMINISTRATION DIVISION OF HEALTH QUALITY ASSURANCE HOSPITAL Active Class | Hospital BARTOW REGIONAL MEDICAL Number of Licensed CENTER 2200 OSPREY BLVD BARTOW, FL 33831 TOTAL CAPACITY: 72 Dedicated Emergency Department Emergency Services: Anesthesia, Cardiology, Emergency Medicine, Family Medicine, Gastroenterology, General Surgery, Gynecology, Infectious Disease, Internal Medicine, Nephrology, Gncology, Orthopedics, Otolaryngology, Pediatrics, Plastic Surgery, Podiatry, Pulmonary Medicine, Radiology, Urology ; EFFECTIVE DATE; 04/01/2009 EXPIRATION DATE: 03/31/201 | Deputy Secre\ary, Division of Health Quality Assurance Aug 18 2009 15:29 AUG-18-2009 16:41 AGENCY HEALTH CARE ADMIN 858 921 G158 P. 22/22 USPS - Track & Confirm Pape ] ot | Ea UNITED STATES AL SERVICE Home | Helm | Santo | Tack &Confim = FACS Track & Contirm Search Results LabelReceipt Number: 7004 2800 0000 5826 5373 -—-—-_ Service(s): Cortified Mail™ Track & Confirm Status: Delivered Enter LabelVReculpt Number. Your item was delivered at :27 AM on July 24, 2009 in TALLAHASSEE, FL 323. Gor Detailed Results: * Delivered, Juty 24, 2009, 0:27 am, TALE AHASSEE, FL 32301 + Arrival et Unit, July 24, 2008, 6:40 am, TALLAHASSEE, FL 32304 Notification Options Track & Confirm by email Get current event information or updates for your item seni to you or others by email. (@e> ) Site Map Cugleren Series Forms Gavi Senices Carers Primacy Policy Tatms of Ue Bpainess Customer Gateway Copyright® 2008 USPS. Ali Rights Reserved. NoFEARAGLEEO Data FOIA @ own. ¥ wo http://trkenfrm 1 .smi.usps.com/PTSInternet Web/InterLabelInquiry.do 08/17/2009 TOTAL FP. 22

Docket for Case No: 09-004530