LA ~ IIIS RECEIVED JUL 3 1 2002 STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, AHCA No.: 2001068581 Return Receipt Requested: Nea v. 7000 1670 0011 4845 8974 oO Karl HCA HEALTH SERVICES OF FLORIDA, INC. d/b/a SAINT LUCIE MEDICAL CENTER, Respondent. / eI ADMINISTRATIVE COMPLAINT COMES NOW the Agency for Health Care Administration (“AHCA”), by and through the undersigned counsel, and files this Administrative Complaint against HCA Health Services of Florida, Inc. d/b/a Saint Lucie Medical Center (hereinafter “Saint Lucie Medical Center”), pursuant to Chapter 395, Part I, and Chapter 59A-3, Florida Administrative Code and alleges: NATURE OF THE ACTION 1. This is an action to impose an administrative fine of $800.00 pursuant to Section 395.1065(2) (a) Florida Statutes (2001), for the protection of the public health, safety and welfare. + 7 : : EXHIBIT , & JURISDICTION AND_VENUE 2. This Court has jurisdiction pursuant to Sections 120.969 and 120.57 Fla. Stat., Chapter 28-106, Florida Administrative Code. 3. Venue lies in St. Lucie County, pursuant to Section 120.57 Fla. Stat, Rule 28-106.207, Florida Administrative Code. PARTIES 4. AHCA is the regulatory authority responsible for licensure and enforcement of all applicable statutes and rules governing adult living facilities, pursuant to Chapter 395, Part I, Florida Statutes (2001), and Chapter 59A-3 Florida Administrative Code. 5. Saint Lucie Medical Center operates a 194-bed hospital located at 1800 S. E. Tiffany Avenue, Port Saint Lucie, Florida 34952. Saint Lucie Medical Center is licensed as a hospital, license number 4193. Saint Lucie Medical Center was at all times material hereto a licensed facility under the licensing authority of AHCA and was required to comply with all applicable rules and statutes. COUNT I SAINT LUCIE MEDICAL CENTER FAILED TO ENSURE THAT STANDARDS OF NURSING CARE WERE FOLLOWED BY THE NURSING STAFF RULE 59A-3.2085(5) (e) 1-3 (NURSING SERVICES) 6. BHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 7. Saint Lucie Medical Center was cited with one (1) deficiency pursuant to a survey conducted on September 27, 2001. 1 8. Based on survey conducted on April 9, 2007 and based on record review and interview, the facility did not have interventions documented for each hospitalized patient, and did not follow physician's orders for 2 of the. 4 clinical records reviewed. Findings include the following. 9. Patient #1, who was two years old, was admitted on 03/30/01, with a diagnosis of seizure, pharyngitis and rule out sepsis, and was discharged on 04/01/01. The patient was examined in the emergency room, and had a temperature of 104.1 degrees Fahrenheit (F.). An intravenous (IV) line was started in the emergency room, which became infiltrated, sO was removed and not reinserted. The physician's admitting orders, dated 03/30/01, at 5:45 p.m., included "vital signs every four 3 hours". Review of the clinical record revealed that there were "gaps" from 5 to 8 hours when the child's temperature was not taken during the hospital stay. 10. Further review revealed that the child had medication ordered for the fever. The admitting order, dated 03/30/01, stated: "Motrin 100 mg orally every 6 hours around the clock". On 03/31/01, at 1:55 p.m., an additional doctor's order stated: "please alternate with Tylenol 3/4 teaspoon every four hours if temperature greater than 10LF." Review of the medication administration record (MAR) revealed that it was not always given, and that "mom giving the patient meds". There were no times recorded when these medications were given by the parent, and no way to track how much or how often the mother gave the medications. There was no documentation in the nurses notes regarding the mother giving the child medication, or if the staff educated the parent regarding this. Further review of the MAR revealed that on 03/31, at 4 p.m., the patient was given Tylenol. The temperature documented on 03/31, for 1 p.m., was 100.6F, and was not documented as taken again until 6:34 p.m. There was no documentation of a temperature greater than 1O01F, for administering Tylenol at 4 p.m. This was not following the physician's order. "Rondex infant drops 1& 1/2 dropper four times a day” was ordered on 03/31 4 at 8:45 p.m. The MAR reveals that it was given at 9:00 a.m.; fifteen minutes before it was ordered by the physician. 11. Still, further review of the record revealed that the patient was admitted at 5:50 p.m. on 03/30/01. Review of the physician orders, during the course of hospitalization, revealed that there was no order for a diet for this patient. The unit manager was able to locate in the computer record that on 03/31/01 at 6:30 p.m., @ pediatric diet was requested for the patient. This was not written as a physician's order on the doctor's order sheet, and it was 24 hours after the patient was admitted. There was no documentation of the patient's intake, or whether the child was given anything to eat or drink during the first 24 hours of being in the hospital. The dietary assessment for this 2 year old, dated 03/31/01 included the patient's height (37 inches), weight (27 pounds), diagnosis of sepsis, medication and food allergies (none), and Level II. Review of the facility standard/policy for "Level II" revealed that the patient was of moderate risk, and "are further reassessed within 72 hours of admission by the diet technician...” There were no dietary recommendations for a pediatric or special diet for this patient. 12. Interview with staff and management personnel revealed that they were unable to locate the above documentation either. 13. Patient #3 was admitted on 01/25/01 with a diagnosis of gastroenteritis and hypovolemia. He/she was discharged on 01/28/01. Review of the physician's orders for this 3 year old, revealed an order for "vital signs every four hours". Review of the vital sign record revealed that there were periods of 6 or more hours, and on the patient's last day in the hospital, there was no vital signs documented from 4 a.m. to when the patient was transferred to another hospital later in the afternoon. The physician's orders were not followed. The designated correction date was May 10, 2001. 14. Based on the survey conducted on September 27, 2001 and based on record review for three of six patients (#1, #3 & #6) admitted to the cardiac catheterization department for surgical invasive procedure, the nursing process of assessment, planning, intervention, and evaluation was not documented for two of the three regarding the placement of central venous’ catheters (Quinton Catheters for Dialysis). In two of the three, the nurse did not complete the chart checklist for Quinton Catheter to ensure all required documentation was completed. The nursing staff did not follow hospital policy Assessment/Reassessment Plan Vol. II 4.1 date 4/2001. The findings include the following. 15. Standard of care for nursing process of assessment, planning, intervention and evaluation for placement of central venous catheters in the Illustrated Manual of Nursing Practice, Second Edition, SPRINGHOUSE 1994 includes the following nursing measures on pages 128 and 129: a. Ensure patients immobilization during insertion procedure. Assess for signs and symptoms of complications during and after insertion. Complications can include: lung puncture, puncture of large blood vessel with bleeding inside or outside the lung, puncture of lymph nodes with leakage of lymph fluid, intake of air into catheter during insertion, thrombus formation, perforation of the heart wall by the catheter, infection. 16. Standard of care for nursing SPRINGHOUSE Handbook of Clinical Skills SPRINGHOUSE 1997 Page 183 and 184 lists documentation to be completed by the nurse. They are as follows: a. Record the time date of insertion, the length and location of the catheter, the solution infused, the doctor's name, and the patient's response. Document the 7 time of the X-ray study performed to confirm placement, the result of the x-ray and the notification of the doctor. 17. The Hospital Administrative Policy "Assessment/ Reassessment Plan Vol. II 4.1 dated 4/2001 documents that the Registered Nurse is responsible for the assessment and reassessment of the patient before and after invasive vascular procedures. Hospital requirements in the policy are as follows: a. Assessment to include chief complaint, baseline status and vital signs. Patient status and vital signs are continually monitored during the procedure. The R.N. will monitor and the Pre-op checklist. The R.N. will ensure that a nursing history and physical is completed. Reassessment of post-invasive vascular procedures will be done every 15 minutes X and every 30 minutes X4 then every hour Xl and will include: 1. site inspection 2. pulse checks distal to puncture site 3. extremity color and temperature 4. vital signs. b. Prior to discharge from the Cath Lab the patient must meet the following criteria: 1) responsive to name and stimuli 2) respiratory status at baseline 3) hemodynamic status stabilized (vital signs, site, circulation and I.V. site) 18. The above nursing standards of care and hospital policy was not followed and the findings are as follows: a. Patient #1 was scheduled for the operative invasive procedure, placement of a central venous catheter Quinton Catheter on 06/15/01. The chart contained no documentation of any pre-procedure assessment to include chief complaint, baseline status and vital signs. The patient's status and vital signs were not continually monitored during the procedure. There was no Pre-op checklist. There was no R.N. (Registered Nurse) nursing history and physical completed. b. The record contained no documentation of reassessment post invasive vascular procedures Quinton Catheter Placement. The record contained no documentation that the following was done. Vital signs were not done every 15 minutes X 4 and every 30 minutes X 4 then every hour X 1 and will include: 1) site inspection 2) pulse checks distal to puncture site 3) extremity color and temperature 4) vital signs. c. There was no documentation prior to discharge that the patient met discharge criteria of: 1) responsive to name and stimuli 2) respiratory status at baseline 3) hemodynamic status stabilized (vital signs, site, circulation and I.v. site) 9 d. The only nursing documentation on the record by the R.N. was a note dated 6/15/0l(no time), which read " Arrived to CCH via wheelchair assisted to stretcher. Quinton catheter inserted R side of neck by Doctor (name) tolerated well. Lines flushed illegible flushed with saline with 10 (illegible) Heparin instilled to lines. Catheter secured with Tegaderm. Returned to wheelchair taken to OP." The chart contained no Physician's order for the lines to be flushed with any medication or solution. 19. The Risk Manager confirmed the content of this record and lack of documentation of nursing care during the site visit on 09/27/01. 20. In July 2001 the Risk Manager stated a new pre- operative checklist for Quinton Catheter was implemented for the Cardiac Catheterization department. This was to be completed by the R.N. Patient #3, admitted 8/16/01 and #6, admitted 9/5/01, did not have documentation of the checklist being completed preoperatively by the R.N. 21. Patient #3 was admitted 8/16/01 for invasive surgical procedure central line placement of a Quinton Catheter. The clinical record was reviewed for pre, intra and post-operative nursing care. There was no documentation of any nursing care on the record. The record contained no 10 assessment to include chief complaint, baseline status and vital signs. The record had no documentation that the patient's status and vital signs were continually monitored during the procedure. The R.N. did not monitor and complete the Pre-op checklist (new one developed in July for Quinton Catheter placement). The R.N. did not complete the nursing history and physical. 22. There was no documentation of reassessment of post invasive vascular procedures being done every 15 minutes X 4 and every 30 minutes X 4 then every hour X 1 and will include 1 site inspection 2) pulse checks distal to puncture site 3) extremity color and temperature 4) vital signs. 23. Prior to discharge from the Cath Lab there was no documentation the patient met the discharge criteria: 1) responsive to name and stimuli 2) respiratory status at baseline 3) hemodynamic status stabilized (vital signs, site, circulation and I.V. site) This record was reviewed with the Risk Manager during the site visit on 09/27/01. 24. Based on the foregoing, Saint Lucie Medical Center violated Rule 59A-3.2085(5) (e) 1-3 Florida Administrative Code which carries in this instance an assessed fine of $800.00. CLAIM FOR RELIEF WHEREFORE, the Agency requests the Court to order the following relief: 1. Enter a judgment in favor of the Agency for Health Care Administration against Saint Lucie Medical Center on Count I. 2. Assess an administrative fine of $800.00 against Saint Lucie Medical Center on Count I for violation of Rule 59A-3.2085(5) (e) 1-3, Florida Administrative Code. 3. Assess costs related to the investigation and prosecution of this matter, if the Court finds costs applicable. 4. Grant such other relief as this 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 N. W. 53rd Street, Miami, Florida, 33166; Attn: Alba M. Rodriguez. 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. ¢ Qbba) mM. Aacturcst, — Alda M. Rodtigtez Assistant General Counsel Agency for Health Care Administration 8355 N. W. 53 Street Miami, Florida 33166 Copies furnished to: Diane Reiland Field Office Manager Agency for Health Care Administration 1710 E. Tiffany Drive West Palm Beach, Florida 33407 (U. S. Mail) Gloria Collins Finance and Accounting Agency for Health Care Administration 2727 Mahan Drive Tallahassee, Florida 32308 (Interoffice Mail) 13 Hospital Unit Program Agency for Health Care Administration 2727 Mahan Drive Tallahassee, Florida 32308 (Interoffice Mail) CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing has been furnished by U.S. Certified Mail, Return Receipt Requested to Gary Cantrell, Administrator, Saint Lucie Medical Center, 1800 $s. E. Tiffany Avenue, Port Saint Lucie, Florida 34952; HCA Health Services of Florida, Inc., One Park Plaza, Nashville, TN 37202; cT Corporation System, 1200 South Pine Island Road, Plantation, Florida 33324 on this 29°" day of July, 2002. sé M. mee A a y 14

Docket for Case No: 02-003953