STATE OF FLORIDA OT 18 a2 AGENCY FOR HEALTH CARE ADMINISTRATION STATE OF FLORIDA, AGENCY FOR - HEALTH CARE ADMINISTRATION, t Petitioner, SML cleaecA CASE NO. 02-2301 fu.) Of vs. AHCA No: 2001067571 SUNCOAST HOME CARE AND MEDICAL . ? SUPPLY SERVICES, INC., d/b/a “ & SUNCOAST HOME CARE AND MEDICAL SUPPLY SERVICES, INC., Respondent. FINAL ORDER Having reviewed the Administrative Complaint dated March 7, 2002 (Ex. 1), and all other matters of record, the Agency for Health Care Administration (“Agency”) finds and concludes as follows: FINDINGS OF FACT 1. The Agency issued an administrative complaint stating an intent to impose a fine against the Respondent, Suncoast Home Care and Medical Supply Services, Inc., d/b/a Suncoast Home Care and Medical Supply Services, Inc., a home health agency, for violations of Chapter 400, Part IV, Florida Statutes, and Chapter 59A-8, Florida Administrative Code. 2. The Respondent was served with the administrative complaint on March 8, 2002 by Airborne Express (attached hereto and incorporated herein) (Ex.2). The Respondent was advised of its right to request an administrative hearing, was provided with an Election of Rights form and an Explanation of Rights form (Ex. 3). The Respondent selected Option 3 within the Election of Rights, admitting the allegations of fact contained in the administrative complaint, but requesting to be afforded an informal proceeding, pursuant to 120.57(2), Florida Statutes. Subsequently, the Respondent withdrew its request for a hearing. 3. The facts as alleged and found, establish that: Respondent did not ensure that one of four non-licensed direct care personnel received the minimum 2 hours of initial training and 1 hour biennially of in-service training. This is a violation of Rule 59A -8.0185(2), Fl. Admin. Code, a Class III deficiency, and the fine imposed is $500. Respondent did not ensure that physician treatment orders in the plan of care were followed. This is a violation of 59A-8.0215(2), Fl. Admin. Code. a Class II deficiency, and the fine imposed is $3,000.00 Respondent did not ensure that some patients received services as ordered in their plan of care. This is a violation of 59A-8.020, FI. Adm. Code, a Class III deficiency, and the fine imposed is $2,000.00. CONCLUSIONS OF LAW 1. The Agency has jurisdiction over Respondent pursuant to the provisions of Chapter 400, Part IV,.and Sec. 120.569, Florida Statutes (2001). 2. As alleged in the administrative complaint, the Respondent is in violation of Chapter 400, Part IV, Florida Statutes (2001), and Chapter 59A-8, Florida Administrative Code. The violation consisted of one Class II and two Class III deficiencies. 3. The Respondent filed a Motion to Withdraw Request for Hearings on August 21, 2002 and consented to the entry of a Final Order, adopting the allegations and conclusions set forth in the administrative complaint and imposing the sanction sought. Based on the foregoing findings of fact and conclusions of law, it is ORDERED: 1. A fine of $5,500 is hereby imposed upon the Respondent. The fine is due and payable within thirty (30) days of the date of rendition of this Order. 2. Checks should be made payable to the “Agency for Health Care Administration.” The check, along with a reference to this Case number, should be sent directly to Gloria Collins Agency for Health Care Administration Office of Finance and Accounting 2727 Mahan Drive, Mail Stop Code # 14 Tallahassee, Fl. 32308. 3. Unpaid fines will be subject to statutory interest, and may be collected by all methods legally available. DONE and ORDERED this fk. of btihey) 2002 in Tallahassee, Leon County, Florida. tle M,. ce Ket! 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: Nelson E. Rodney, Esq. Assistant General Counsel Agency for Health Care Administration 8355 NW 53™ Street Miami, Florida 33166 (Interoffice Mail) Elizabeth Dudek Deputy Secretary Agency for Health Care Administration 2727 Mahan Drive Bldg #1 Mail Stop Code #9 Tallahassee, Florida 32308 (Interoffice Mail) Gloria Collins Stuart Leenee Finance & Accounting Agency for Health Care Administration Mht- DOAH 2727 Mahan Drive Mail Stop Code #14 1230 Aypatechas “Phwy Tallahassee, Florida 32308 “TLH AL AZ >AIQ - DOW (Interoffice Mail) Nelago Ashipala, R.N. Suncoast Home Care and Medical Supply Services 1194 Old Dixie Highway Lake Park, Florida 33409 (U.S. Certified Mail) Wendy Adams (Inter-office 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) by U.S. Mail, or the method J , designated, on il ) it Yor 1) , 2002. (Char len Weupey fLealand McCharen, Agency Clerk Agency for Health Care Administration 2727 Mahan Drive, Building #3 Tallahassee, Florida 32308-5403 (850) 922-5865 are STATE OF FLORIDA > : AGENCY FOR HEALTH CARE ADMINISTRATION < ley To, STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, AHCA No: 2001067571 AirBorne Express 1962376673 VS. SUNCOAST HOME CARE AND MEDICAL SUPPLY SERVICES, INC., d/b/a SUNCOAST HOME CARE AND MEDICAL SUPPLY SERVICES, INC. Respondent / AMENDED ADMINISTRATIVE COMPLAINT COMES NOW the Agency for Health Care Administration (hereinafter “AHCA”), by and through the undersigned counsel, and files this Administrative Complaint against Suncoast Home Care and Medical Supply Services, Inc., d/b/a Suncoast Home Care and Medical Supply Services, Inc., (hereinafter “Suncoast Home Care”) pursuant to 28-106.111, Florida Administration Code (2000) (F.A.C.), and Chapter 120, Florida Statutes (Fla. Stat.) hereinafter alleges: NATURE OF ACTION 1. This is an action to impose an administrative fine in the amount of $5,500 pursuant to Section 400.474, Fla. Stat. JURISDICTION AND VENUE 2. This court has jurisdiction pursuant to Section 120.569 and 120.57, Fla. Stat., and Chapter 28-106, F.A.C. EXHIBIT 1 3. Venue lies in Palm Beach County, pursuant to 120.57, Fla. Stat., and Chapter 28-106.207, F.A.C. PARTIES 4. AHCA is the enforcing authority with regard to home health agencies licensure law pursuant to Chapter 400, Part IV, Fla. Stat., and Rules 59A-8, F.A.C. 5. Suncoast Home Care is a home health agency located at 1194 Old Dixie Highway, Suite 9, Lake Park, Florida 33403, and is licensed under Chapter 400, Part IV, Fla. Stat., and Chapter 594-8, F.A.C. COUNTI SUNCOAST HOME CARE DID NOT ENSURE THAT ONE OF FOUR NON- LICENSED DIRECT CARE PERSONNEL RECEIVED THE MINIMUM 2 HOURS OF INITIAL TRAINING AND 1 HOUR BIENNIALLY OF IN-SERVICE TRAINING 59A-8.0185(2), F.A.C. (PERSONNEL POLICIES) CLASS I 6. AHCA realleges and incorporates (1) through (5) as if fully set forth herein. 7. During the visit conducted on 10/8-10/01 and based on review of personnel records, interview with the office manager, and interview with the Alternate Director of Nursing, the agency did not ensure that one of four non-licensed direct care personnel received the minimum 2 hours of initial training and ! hour biennially of inservice training in HIV and AIDS (Employee #1). Findings include: 8. Six personnel records were reviewed. Four of them were non-licensed direct care personnel. One (Employee #1) of four did not have proof of the required 2 hours of initial training and 1 hour biennially of in-service training in HIV and AIDS. 9. Based on the foregoing, Suncoast Home Care and Medical Supply Services, Inc. violated 59A-8.0185(2)(b), F.A.C., herein classified as a Class II deficiency, which carries in this case a $500 fine. This is a repeated deficiency from the annual survey of 8/28-3 1/00. COUNT II SUNCOAST HOME CARE DID NOT ENSURE THAT PHYSICIAN TREATMENT ORDERS IN THE PLAN OF CARE WERE FOLLOWED.. 59A-8.0215(2), F.A.C. (PHYSICIAN ORDERS) Class I 10. AHCA realleges and incorporates (1) through (5) as if fully set forth herein. 11. Onthe survey visit of 10/10/01 and based on clinical record review the agency did not ensure that the physician treatment orders that were contained in the plan of care were followed for five of ten active clinical records reviewed. ( Records # 2, 4, 7, 8, and 9) 12. Continued review of clinical record # 4 revealed that the agency nurses were not providing the accurate amount of saline in the vancomycin. The order on the plan of care reads Vancomycin 1 gram in 250 cc of normal saline to infuse over 2 hours every 12 hours. The nurses notes revealed that on 9-25-01 am visit, 9-25-01 pm visit and on 9-26-01 am visit, the nurse gave the vancomycin in 500 cc of normal saline over 2 hours, instead of following the order of 250cc of normal saline. On 9-26-01 during the am visit the patient’s blood pressure was recorded as 144/103. There is no evidence in the clinical record that the physician was notified of this elevated blood pressure. 13. There is a note from a nurse who did a visit on 10-2-0lat 8:00 pm. The nurse writes in her/his note "dressing changed”. There is no order on the plan of care for a dressing change. 14. Review of clinical record # 8, this patient was admitted to the agency with diagnosis of Insulin Dependent Diabetes Mellitus. The orders on the plan of care read: “ Novolin Insulin 70/30 35 units in the am and 15 units in the pm. If blood sugar under 100, hold insulin. If blood sugar under 80, call MD.” Review of the nurses’ notes revealed that the incorrect insulin dosage was given on 9-10- Ol, at 4:00 pm. The dosage ordered was 15 units. The dosage given by the nurse is recorded as 42 units. There is no evidence in the clinical record that the physician changed the dosage on this visit. Further review of this clinical record revealed that on 9- 12-0 lat 8:40 am the nurse records the blood sugar as 137, and writes, " insulin held ". The order reads to hold insulin if blood sugar under 100. The insulin was held in error by the nurse. On 9-24-01 am visit the nurse records the blood sugar as 119, insulin held. This was held in error. On 9-25-01 am visits the nurse records the blood sugar as 72. There is no evidence in the clinical record that the physician was notified of this low blood sugar. The order on the plan of care reads " Blood sugar below 80 notify MD." 15. Clinical record # 2, this patient was admitted to the agency with diagnosis of Insulin Dependent Diabetes Mellitus ( IDDM ). The nurse’s orders are to visit five times a week for accuchek and insulin coverage. The nurse made a visit on 9-12-01 and recorded the blood sugar as 202, and gave 8 units of Humulin R insulin. This was the incorrect dosage. The order on the plan of care reads, ..”for a blood sugar of 201 to 250 give 6 units of Humulin R.” The nurse made a visit on 9-17-01 and recorded the blood sugar as 244. The nurse gave 8 units of Humulin R Insulin. This was the incorrect dosage. The order on the plan of care reads: “for a blood sugar of 201 to 250 give Humulin R Insulin 6 units.” 16. Clinical record # 4 was reviewed. This patient was admitted to the agency with a MRSA infected wound to the left hand. There was an order on the plan of care for Vancomycin 1 gram in 250 cc of normal saline to infuse over 2 hours every 12 hours. This patient has a Hickman catheter. Nowhere on the plan of care does it give orders for this Hickman catheter. There are no specific orders for a dressing change to the Hickman catheter, There are no orders on the plan of care for flushing the Hickman catheter. The nurses are infusing the vancomycin, then flushing the line. The nurses never specify in their notes what they are flushing the line with. There are no orders to flush the line. 17, Review of clinical record # 7, this patient was admitted to the agency with the diagnosis of Insulin Dependent Diabetes Mellitus, orders on the plan of care for insulin reads: “Novolin 70/30 30 units every am.” Review of the nurses notes reveal that on 10-3-01, 10-4-01 and 10-5-01 the nurse gave 35 units of insulin instead of the 30 units that was ordered on the plan of care. There is no evidence in the clinical record that this insulin dosage was changed by the physician. 18. Review of clinical record # 9, revealed this patient was admitted to the agency with the diagnosis of Insulin Dependent Diabetes Mellitus and Manic Depression. Orders on the plan of care for nursing are for three times a day. The orders on the plan of care for insulin are as follows,: “Check accucheck each visit. Give insulin Humulin N 80 units in the am with Humulin R 40 units in the am. Give Insulin Humulin N 90 units in the pm with Humulin R 40 units in the pm. Mid-day sliding scale coverage only.” : 19. On 9-21-01 at 12:00 pm the nurse makes a visit and records the blood sugar as 283. The nurse gave 90 units of Humulin N and 40 units of Humulin R. This was the incorrect dosage. The insulin dosage for the noon visit is sliding scale coverage. The plan of care states for a blood sugar of 251 to 300, the patient should receive 8 units of Humulin Insulin R. 20. Based on the foregoing, Suncoast Home Care and Medical Supply, Inc. violated 59A-8.0215(2), F.A.C., herein classified as a Class II violation, which carries, in this case, an assessed fine of $3,000. COUNT Hi SUNCOAST HOME CARE AND MEDICAL SUPPLY DID NOT ENSURE THAT SOME PATIENTS RECEIVED SERVICES AS ORDERED IN THEIR PLAN OF CARE. 59A-8.020, F.A.C. (ACCEPTANCE OF PATIENTS OR CLIENTS) CLASS HI 21. ACHA realleges and incorporates (1) through (5) as if fully set forth herein. 22. During a survey conducted on 6/28/01 and based on record review and interview with the director of Nursing, the agency did not administer drugs and treatments as ordered by the physician for three of six clinical records reviewed, (records # 2,3, and 5). This is an uncorrected citation. Findings include: 23. Record review # 2, patient was admitted to the agency on January 28, 1998, with the diagnosis of Diabetes and Manic depression. On the plan of care under medications it states "make sure patient takes Glucophage with breakfast and dinner", there is no order on the plan of care from the physician to give Glucophage. There is no order in the clinical record to give Glucophage. 24. Record review # 3, this patient was admitted to the agency on March 3, 2001, with diagnosis of Diabetes, Hypertension, and Neuropathy. The orders are for nursing two times a day for insulin administration. On May 15, 2001, there was only one nursing visit. On May 19, 2001, and May 20, 2001, a weekend there was no visits made. On May 29, 2001, there was only one visit made. On June 5, 2001, there was only one visit made. On June 16, 2001, there was only one visit made. There was no notation in the clinical record as to why these visits were missed. There was no notation in the clinical record that the physician was notified of these missed visits. 25. Record review # 5, this patient was admitted to the agency on February 1, 2001, with diagnosis of Diabetes and Hypertension. The orders are for a nurse to administer insulin two times a day five times a week Monday through Friday. On May 1, 2001, and May 2, 2001, there were no nursing visits made. On May 3, 2001, and May 4, 2001, there was only one nursing visit made. On May 7, 2001 there were no nursing visits made. There was no notation in the clinical record as to why these visits were not made, and no evidence that the physician was notified. . 26. During the follow up conducted on 10/10/01 and based on clinical record review the agency did not ensure that four of ten active patients or clients received services as ordered in a specific plan of care, including all assigned visits, (patients # 3,4,7, and 9). Findings include: 27. Clinical record #3 was reviewed; this patient was admitted to the agency with diagnosis of Diabetes Mellitus. The orders on the plan of care read for a nurse to visit two times a day and a home health aide to visit daily. Review of the clinical record revealed that the certified nurse assistant only visited five times a week, Monday through Friday. There were no visits on the weekend. The order is for the home health aide to visit one time daily. The agency is not following the physician’s plan of care. 28. Clinical record #4 was reviewed; this patient was admitted to the agency with the diagnosis of wound left hand. The orders on the plan of care are for a nurse to visit two times a day to administer Intravenous antibiotics. On 9-27-01, 9-28-01, 9-29-01 and 9-30-01 the nurse only made one visit. Then starting on 10-1-01 the nurse started visiting two times a day again. The agency did not follow the physician’s plan of care. 29. Clinical record # 7 was reviewed; this patient was admitted to the agency with diagnosis of Diabetes Mellitus. The plan of care has orders for a home health aide to visit three times a week to assist with personal care. There are no home health aide notes in the clinical record. This patient’s certification period started on 9-1-01. There is no evidence that this patient ever received any home health aide visits since the start of care on 2-1-01. The office manager was asked if there were any home health notes on this patient. She/he was unable to produce any notes. 30. Clinical record # 9 was reviewed; this patient was admitted to the agency with diagnosis of Diabetes. The plan of care has orders for a nurse three times a day for accucheks and administration of insulin. Review of the clinical record revealed that the nurse missed four scheduled visits since 9-17-01. The missed visits were on 9-29-01 the am visit and-noon visit was missed. On 9-30-01 the am visit was missed. On 10-2-01 the pm visit was missed. There is no indication in the clinical record as to why these visits were missed. There are no missed visit notations in the clinical record. 31. Based on the foregoing, Suncoast Home Care and Medical Supply, Inc. violated 59A-8.020, F.A.C., herein classified as a Class III violation, which carries, in this case, an assessed fine of $2,000. This is an uncorrected deficiency. PRAYER FOR RELIEF 10. WHEREFORE, the Petitioner, State of Florida Agency for Health Care Administration requests the Court to order the following relief: A. Enter a recommended order in favor of the Agency for Health Care Administration against Suncoast Home Care and Medical Supply, Inc., on Counts I through III. B. Assess against Suncoast Home Care Medical Supply, Inc. an administrative fine for $5,500.00, in accordance with §400.484(2)(b) and (c), Fla. Stat. C. Award the Agency for Health Care Administration reasonable attorney’s fees, expenses, and costs. D. Grant such other relief as the court deems is just and proper. Respondent is notified that it has a right to request an administrative hearing pursuant to Sections 120.569 and 120.57, Florida Statutes (2001). Specific options for administrative action are set out in the attached Election of Rights and explained in the attached Explanation of Rights. All requests for hearing shall be made to the Agency for Health Care Administration, and delivered to the Agency for Health Care Administration, Manchester Building, First Floor, 8355 NW 537 Street, Miami, Florida 33166; Lourdes F. Roberts, Assistant General Counsel. RESPONDENT IS FURTHER NOTIFIED THAT FAILURE TO REQUEST A HEARING WITHIN TWENTY-ONE (21) DAYS OF RECEIPT OF THIS COMPLAINT, PURSUANT TO THE ATTACHED ELECTION OF RIGHTS, WILL RESULT EN AN ADMISSION OF THE FACTS ALLEGED IN THE COMPLAINT AND THE ENTRY OF A FINAL ORDER BY THE AGENCY. CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing has been furnished by Air Borne Express, to Nelago Ashipala, RN, Suncoast Home Care and Medical Supply, Inc. 1194 Old Dixie Highway, Suite #9, Lake Park, Florida 33403, on March 7, 2002. ‘ourde$ F. Robér#s, Assistant General for Health Care Administration NW 53% Street, First Floor Miami, Florida 33166 (305) 499-2165 Copy to: Lourdes F. Roberts, Assistant General Counsel Agency for Health Care Administration Manchester Building 8355 NW 53” Street Miami, Florida 33166 Elizabeth Dudek, Deputy Secretary Agency for Health Care Administration 2727 Mahan Drive, MS#9 Tallahassee, Florida Diane Reiland, Field Office Manger 1710 East Tiffany Drive West Palm Beach, Florida 33407 Airborne Express - Tracking Det?‘t Results Page 1 of 1 PHOKURS TRANSIT TIMES LEXCATIONS Q AIRBORNE . BY TRACKING NUvdAZES | BY REFERENCE | SYOEM AL TRACKING RESULTS: DETAILED VIEW 40; Tracking Number: 1962376673 Shipment Summary: Current Status: Delivered. Delivered on: Mar 8 2002 12:39 pm Delivered to: Left with Receptionist P MAJOR Signed for by: Shipment History: Date Time* Activity Location** Mar 8 2002 12:39 pm Delivered. Picked up by Airborne. * status times reflect the time zone where the update took place, ** cities reflect the Airborne terminal servicing the area. Shipper: Receiver: AGENCY FOR HEALTH CARE SUNCOAST HOMECARE & MAMI, PL 33166 LAKE PARK, FL 33403 Shipment Detail: Service: Next Afternoon Ship Type: ‘ Package Weight: 5 Description: Piaces: 1 Shippers Reference: Special: If you have any further questions, please contact Customer Service at 1-800-AIRBORNE 2676) or email us at customerservice@airborne.com Tracking request generated on 3/22/02 at 9:19:40 AM. © Airborne Express | Privacy Policy | Contact Us | Site Map . EXHIBIT | 1 2 http://track.airborne.com/atrknav.asp 3/22/2002 =~ @ y) STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION | RE: CASE NAME: Suncoast Home Care and Medical Supply. CASE No. 2001067571. ELECTION OF RIGHTS PLEASE SELECT ONLY 1 OF THE 3 OPTIONS An Explanation of Rights is attached. OPTION ONE (1) 1 do not dispute the allegations of fact contained in the Administrativers Somplaint a and waive my right to object or to be heard. | understand that by waiving my rights, a finaorder. will issued that adopts the Administrative Complaint and imposes the sanctions sought. ors m OPTION TWO (2) 8 { do not dispute and | admit the allegations of fact in the Administrative | Complaint, but do wish to be afforded an informal proceeding, pursuant to Section 120-87(2), Floritta _ ; Statutes, at which time | will be permitted to submit oral and/or written evidence to the Agency in mitigation of the penalty imposed. uh 2 REPTION THREE (3) xX 1 do dispute the allegations of fact contained in the Administrative Complaint and request a formal hearing, pursuant to Section 120.57(1), Florida Statutes, before an Administrative Law Judge appointed by the Division of Administrative Hearings. \f you choose OPTION THREE (3), in order to obtain a formal proceeding before the Division of Administrative Hearings under Section 120.57(1), F.S., your request for an administrative hearing must conform to the requirements in Section 28-106.201, Florida Administrative Code (F.A.C), and must state the material facts you dispute. In order to preserve your right to any hearing, your Election of Rights in this matter must be directed to the Agency by filing within twenty-one (21) days from the date you receive the Administrative Complaint. If you do not respond at all within twenty-one (21) days from receipt of the Administrative Complaint, a final order will be issued finding you guilty of the violations charged and imposing the penalty sought in the Complaint. \f you have elected either OPTION TWO (2) oF THREE (3) above and you are interested in discussing a settlement of this matter with the Agency, please also mark this block. @ Mediation under Section 420.573, Florida Statutes, is not available in this matter. SEND NO PAYMENT NOW — REGARDLESS OF THE OPTION SELECTED, PLEASE WAIT UNTIL YOU RECEIVE A COPY OF A FINAL ORDER FOR INSTRUCTIONS ON PAYMENT OF ANY FINES. (Please sign and fill in your current address.) License. No. and facility type: PLEASE RETURN YOUR COMPLETED FORM TO: Agency for Health Care Administration, Lourde Fernandez Roberts JAssistant_General Co S. Street, Miami, Florida 33166 Telephone Nuppep 0s 799.2165. ; FAX [305) 499-2195 ; TOD EXHIBIT 3 unsel, 8355_NW 53° 4-800-955-8771. _FROM : SUNCOAST " : SL S Fax NO. : 8409917 Aug. 21 2082 @3:21Am Pa Aa-13-28a2 16415 GRC? LEGAL DEPARTMENT * Bane STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, Case No. 023-2301 vs. SUNCOAST HOME CARE AND MEDICAL SUPPLY SERVICES, INC., d/b/a SUNCOAST HOMECARE AND MEDICAL SUPPLY SERVICES, INC. Respondent. MOTION TO WITHDRAW REQUEST FOR BEARING Respondent, SUNCOAST HOME CARE AND MEDICAL SUPPLY SERVICES, INC., d/b/a SUNCOAST HOMECARE AND MEDICAL SUPPLY SERVICES, INC., (Hereinafter SUNCOAST) requests that the formal hearing set for August 29 and August 30 be cancelled and as reasons will state: 1) SUNCOAST wishes to withdraw the election of tights form filed March 11, 2002 in which a formal hearing pursuant to Section 120.57(1) was requested. 2) SUNCOAST does not want to pursue a formal heanng and instead would elect Option 1. 3) SUNCOAST does not believe any benefit would be served by proceeding to formal hearing. Respectfully submited for SUNCOAST by: Nelago Aad RN. 1194 Old Dixie Hway, Suite 9 Lake Park, Florida 33409 EXHIBIT i 4 . FROM : SUNCOAST FAX NO. : gBagagi7 Gug. 21 2002 @3:226m PL AUG-19-2082 16:15 AHCA LEGA. DEPARTMENT areas (Cate Ht CERTIFICATE OF SERVICE O1-23 of WE CERTIFY thar a true copy of this Motion to Withdraw Request for Hearing was faxed to Judge Stuart M. Lemer, Division of Admintstrative Hearings, and Nelson E. Rodacy, Assistant General Counsel, Agency for Health Care Administration, this) day of y 2002 C Lielape Tat, Nelago Ashypala, R.N. yale TOTAL P.@5 STATE OF FLORIDA DIVISION OF ADMINISTRATIVE HEARINGS AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, vs. Case No. 02-2301 SUNCOAST HOME CARE AND MEDICAL SUPPLY SERVICES, INC., d/b/a SUNCOAST HOME CARE AND MEDICAL SUPPLY SERVICES, INC., Respondent. ORDER CLOSING FILE This cause having come before the undersigned on the Respondent's Motion to Withdraw Request for Hearing, filed August 21, 2002, and the undersigned being fully advised, it is, therefore, ORDERED that: 1. The final hearing in this cause scheduled for August 28 and 29, 2002, is hereby cancelled. 2. The file of the Division of Administrative Hearings in the above-captioned matter is hereby closed. EXHIBIT i os

Docket for Case No: 02-002301