STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION STATE | OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, 00 -/005 * : - | CASE NO.: 67-00-00S “HasP Petitioner BRANDON REGIONAL HOSPITAL, Respondent. ADMINISTRATIVE COMPLAINT Petitioner, STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION (‘Agency’) by and through the undersigned hereby issues this Administrative Complaint against Respondent, BRANDON REGIONAL HOSPITAL (‘BRH’), for violation of state hospital licensure law, and i imposes administrative fines | in the amount of $25, 000. As grounds for the imposition of . such administrative fines, the Agency States. 1. . The Agenoy has iu jurisdiction over BRH and the enforcement of hospital licensure law and risk management law pursuant to Chapter 395, Florida 7 Statutes, and Rules 59A3 and 59A- 10, Florida Administrative Code. 2 BRHi isa hospital within the meaning of Section 395. 002(18),F Florida rene bain san : sede See Es Statutes, and Rule 5OA-10. .002(2), Florida Administrative C Code. : 3 - The, ‘Agency conducted a site ° suTvey of BRH on or about uly 26- 28, Se een rw . mo oY requirements and is subject to fines, pursuant to Section 395.01 97(12), Florida Statutes, as follows: | . a.) Hospital risk management violations 4. Hospitals are required to report specified adverse incidents to the Agency within fifteen fa 5) days (‘Code 45 Report”) of occurrence. Section /395.0197(8), Fla.Stat. (Supp.1998); Rule 59A-10.0065, Fla. Admin.Code isupp.1909) co eteenintiatne 5. The Agency finds that a death occurring on or about 7/30/98 at BRH which meets the criteria of a Code 15 Report, has not been reported. Therefore, BRH has violated Section 395.0197(8), Florida Statutes, and Rule 59A-10.0065, Florida Administrative Code. 6. Hospital risk managers are required to submit to the Agency a written justification for failure to file a timely Code 15 Report. Rule 59A-10.0065, supra. 7. The Agency finds that BRH failed to submit a written justification of its failure to timely file a Code 15 Report Therefore, BRH has violated Rule 59A- 10. 006s, Florida Administrative Code. . 1@ Agency notified BRH i in nits Statement of Deficiencies sent to the a Ww an 10. The Agency finds that BRH failed to disclose on the facility's annual report the aforementioned adverse incident, a death, on or about 7/30/98. Therefore, BRH has violated Section 395.0197(6), Florida Statutes. 11. The Agency notified BRH in its Statement of Deficiencies sent to the hospital on August 25, 1999 of the reportability of this incident and of the Hospital’ s failure to report this incident. BRH, in its Plan of Correction dated September 10, 1999 did not act t to remedy its failure. b.) Fines for violation of Hospital risk management law 12. The Agency hereby assesses an administrative fine against BRH of $25,000 pursuant to Section 395.01 97(12), Florida Statutes for: a). willful and intentional failure to submit a Code 15 Report regarding < an adverse incident occurring on or about 7130/98 in violation of Section 395.01 97(8), Florida Statutes and Rule 59A-10. 008s, Florida Administrative Code: b). willful and intentional failure to submit a written justification of its neglect to timely file a Code 15 Report i in violation of Rule 59A-10. 0065, Florida Administrative Code; _and, c). willful and intentional failure to include on the annual report ¢ an | adverse -- incident that occurred on or about 7130/98 i in n violation « of f Section 395. 6.019716), . Florida Statutes, soe &) Rights to A Hearing : . 13. BRH has a right t to request an n administrative hearing pursuant to” _ -- 18] requested. ‘In order fo obtain a formal | proceeding under Section 120. 1), st : Agency. Wo a Florida Statutes, BRH’s request for a formal hearing must set forth with specificity disputed issues of material fact. Failure to so set forth such disputed issues of material fact may be treated by the Agency as an election of an informal proceeding pursuant to Section 120.57(2), Florida Statutes. A request for hearing shall be filed with: Agency for Health Care Administration, 2727 Mahan Drive, Building #83, Tallahassee, Florida 32308-5403, Attention: Sam Powers, Agency Clerk, General Counsel’ 's Office, with a copy to Anna Polk, Agency for Health Care Administration, 2727 Mahan Drive, Building #1, Tallahassee, Florida 32308-5403. BRH should include a copy of this administrative complaint with any request for hearing. 14. If BRH does not contest the matters asserted in this administrative complaint, the amount of the total fine should be remitted by check or money order payable to: Agency for Health Care Administration, 2727 Mahan Drive, Building #1, Tallahassee, Florida 32308-5403, Attention: Anna Polk. 15, Failure to pay the fine or request an informal or formal hearing within twenty one (21) days of receipt of this s complaint w will result tinan a admission of the facts alleged herein and an entry ofa final order based upon such facts by the STREET RR TTT RE RE PTI RE RRR ROR Hae ay ” Ww 4 ISSUED this 225% day of January, 2000. ‘AGENCY FOR HEALTH CARE y State of Florida Agency for Health Care Administration 2727 Mahan Drive Ft. Knox Executive Center Ill Tallahassee, Florida 32308-5403 CERTIFICATE OF SERVICE | hereby certify that this Administrative Complaint was sent by U.S. Certified Mail Return Receipt Requested to: Administrator Brandon Regional Hospital 119 Oakfield Drive Brandon, Fiorida 33511 Be Fekrvary this F day of January, 2000. __ Mark S. Thomas, Esquire ce

Docket for Case No: 00-001005