ren a , STATE OF FLORIDA rdi.i 9) _ AGENCY FOR HEALTH CARE ADMINISTRATION o4 Jah -5 PH 3:51 STATE OF FLORIDA reps AGENCY FOR HEALTH CARE Dish ce ADMINISTRATION, Petitioner, vs. AHCA No: 2003008031 Return Receipt Requested CEDARS HEALTHCARE GROUP, LTD, 7002 2410 0001 4236 9656 d/b/a CEDARS MEDICAL CENTER, 7002 2410 0001 4236 9663 7002 2410 0001 4236 9670 Respondent. / oe ADMINISTRATIVE COMPLAINT COMES NOW the Agency for Health Care Administration (hereinafter “AHCA”), by and through the undersigned counsel, files this Administrative Complaint against Cedars Healthcare Group, LTD, d/b/a Cedars Medical Center (hereinafter “Cedars Medical Center”) pursuant to 28- 106.111 Florida Administrative Code (2002) (F.A.C.) and Chapter 120, Florida Statutes ("Fla. Stat.") hereinafter alleges: NATURE OF THE ACTION 1. This is an action to impose an administrative fine in the amount of one thousand ($1,000.00) dollars pursuant to Section 395.1065(2) (a) Fla. Stat. 04¢-lke- 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. 3. Venue lies in Miami-Dade County, pursuant to 120.57 Fla. Stat. and Chapter 28, F.A.C. PARTIES 4, AHCA is the enforcing authority with regard to Hospital licensure law pursuant to Chapter 395, Part I, Fla. Stat. and Rules 59A-3 F.A.C. 5. Cedars Medical Center is a hospital facility located at 1400 N.W. 12°* Avenue, Miami, Florida 33136 and is licensed under Chapter 395, Part I, Fla. Stat. and Chapter 59A-3. F.A.C. COUNT I CEDARS MEDICAL CENTER FAILED TO FOLLOW ITS POLICY FOR THE INVESTIGATION AND RESOLUTION OF PATIENT GRIEVANCES/COMPLAINTS FOR ALL PATIENTS. 59A-3.254, F.A.C. (PATIENT RIGHTS AND CARE) 6. AHCA re-alleges and incorporates (1) through (5) as if fully set forth herein. 7. During a complaint investigation conducted on July 10, 2003 and based on record review and interview, the facility did not follow its policy for the investigation and resolution of patient grievances/complaints for 1 sampled patient (#1). 8. Review on July 10, 2003 of the facility policy for grievance resolution revealed, "Grievances are to be handled by the grievance committee made up of the facility's Chief Executive Officer, Chief Operations Officer, Chief Nursing Officer, Chief Financial Officer, Director of Human Resources, and other hospital members as appropriate to the matter.” According to policy, "grievances are reviewed, investigated and resolved within a reasonable amount of time, depending on the nature of the grievance... All grievances will be responded to in a timely manner dependent on their complexity and impact on the patient's well being, not to exceed 10 (ten) days." 9. Review of the grievances made available for examination, showed that grievances were made by patient #2, both verbally and written to the hospital administration on April 18, June 18, 25, and another with date unknown. Interview with patient #2 on July 10, 2003 at 11:00 a.m. revealed that there were at least 15 to 20 grievances that he/she sent via e-mails to the grievance committee. The review of the facility's complaint/grievance log revealed that at least 11 to 16 of patient #2's complaint/grievances had not been entered into the log. Review of the grievances that were made available by the patient dated April 18, June 18, 25 and another with date unknown, revealed that the hospital attorney responded in writing to the grievances as a whole not individually, 13 (thirteen) days after its receipt. There was no evidence in this log that the grievances were discussed with the patient, or resolved. 10. Interview with the Regulatory Officer on July 10, 2003 confirmed the delay of resolving the patient's grievances was due to a "backlog of patient grievances not yet entered into the facility grievance/complaint log system." 11. Based on observation, record review and interview the facility failed to protect the right to personal privacy and confidentiality of personal health information during the process of delivering personal and/or medical care for 1 of 5 sampled pts (#2). 12. Observation on July 10, 2003 at 11:00 a.m. of patient #2's room confirmed the door was open with patient #2 in full view of anyone in the hallways on the floor. The security guard was observed at the open door of the patient's room. Nursing staff was observed entering the room of patient #2 to provide care and take vital signs. The security guard entered the room of patient #2 with the nursing staff. 13. Interview was conducted with patient #2 on July 10, 2003 at 11:00am about the presence of the security guard at his/her door and in his/her room. It revealed that he/she resented this security guard presence intervention and stated it violated his/her rights to confidentiality and privacy. The patient #2 stated that the door to his/her room is always open and the security guard watches his/her personal hygiene care, including baths and the cleaning of his/her colostomy device. The patient further stated that he/she had filed grievances that identified the violation of his/her rights, but the facility responded by serving him/her with a legal court injunction to cease stalking and harassing the staff. 14. Record review on July 10, 2003 of the facility's response to patient #2's grievance regarding the violation of his/her rights, revealed that the facility was protecting the safety of the staff with the presence of the security guard secondary to patient #2's verbal threats and physical violence to the staff. 15. Interview with the Captain of Security at 12:30 p.m. on July 10, 2003 confirmed the placement of the security guard near and/or in the patient room for "staff safety" on July 1, 2003. Additional interview with the Regulatory compliance officer and the Nurse manager on July 10, 2003 at 12:30 pm confirmed the guard had been posted since July 1, 2003 and was instructed to accompany all staff into the room and to remain while personal or medical care was being delivered. 16. A repeat deficiency was found during another complaint investigation conducted on 9/09/03 and based on record review and interview the facility failed to provide a process to report and resolve patient and/or family grievances regarding lack of communication and loss of patient property for 1 of seven sample records reviewed. 17. Review of the facility policy for patient complaints revealed that when an employee receives the complaint, the employee would attempt to resolve the complaint and relay the complaint to the supervisor. The supervisor will provide the patient and/or family member with a status report and/or resolution of the complaint as soon as possible, but no later than 24 hours after the complaint was received. 18. Interview with the Associate Vice President of Nursing on 9-9-03 revealed that if no one on the team speaks the language of the patient, any team member could call the consumer relationship line and have a translation. Also, the patients are assigned an “advocate” that visits them and resolves issues. Any supervisor can access a translator. There is a telephone service by AT & T that interprets for the facility. 19. The complainant was the family member of the patient. The patient spoke no English and the hospital did not volunteer a translator and as a result, the patient lost his/her teeth. The patient was unable to tell the staff that the teeth were under the pillow and they were discarded with the linen change. The complainant spoke several times with the supervisory staff at the facility. The complainant spoke with the patient representative of the facility. No grievances were ever resolved to the patients or the complainant’s satisfaction. 20. Review of the resolution of the documented complaints revealed that for the complaint regarding the language barrier and the loss of property, the complaint was not resolved to the patients or the complainant’s satisfaction. The staff did not use any of the resources available to them to communicate with the patient. The complainant spoke several times with the supervisory staff at the facility. The complainant spoke with the patient representative of the facility. No grievances were ever resolved to the patients or the complainant’s satisfaction. There was an additional complaint in the log from the patient but the complaint was not properly documented and there were no details noted in the printout, so there was no investigation or resolution. 21. Based on the foregoing, Cedars Medical Center violated 59A-3.254, F.A.C., carrying in this case, an assessed fine of $1,000.00. PRAYER FOR RELIEF WHEREFORE, AHCA intends to: A, Assess against Cedars Medical Center Hospital an administrative fine of $1,000.00 for the violations described in Count I in accordance with Section 395.1065(2) (a) Fla. Stat. B. Award the Agency for Health Care Administration reasonable attorney’s fees, expenses, and costs. Respondent is notified that it has a right to request an administrative hearing pursuant to Sections 120.569 and 120.57, Florida Statues (2002). 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 Agency for Health Care Administration, Lealand McCharen, Agency Clerk, 2727 Mahan Drive, Mail Stop #3, Tallahassee, Florida 32308, Telephone NO. (850) 922-5873. RESPONDENT IS FURTHER NOTIFIED THAT FAILURE TO RECEIVE REQUEST FOR A HEARING WITHIN TWENTY-ONE (21) DAYS OF RECEIPT OF THIS COMPLAINT, PURSUANT TO THE ATTACHED ELECTION OF RIGHTS, WILL RESULT IN AN ADMISSION OF THE FACTS ALLEGED IN THE COMPLAINT AND THE ENTRY OF A FINAL ORDER BY THE AGENCY. Respectfully submitted. a elson E. Rodney Counsel for Petitioner Agency for Health Care Administration 8355 NW 53™ Street Miami, Florida 33166 (305) 499-2165 Dated overlitr Uf , 2003 Copies furnished to: Diane Lopez-Castillo Field Office Manager Agency for Health Care Administration 8355 NW 53° Street Miami, Florida 33166 Elizabeth Dudek Deputy Secretary Agency for Health Care Administration 2727 Mahan Drive Tallahassee, Florida 32308 Jean Lombardi Finance and Accounting Agency for Health Care Administration 2727 Mahan Drive Tallahassee, Florida 32308 CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing complaint and election of rights was sent by U.S. Certified Mail, Return Receipt Requested to the Administrator, Cedars Medical Center, 1400 N.w. 12* Avenue, Miami, Florida 33136; Cedars Healthcare Group, LTD, One Park Plaza, P.O. Box 750, Legal Department, Nashville, TN 37202, and to C.T. Corporation System, 1200 S. Pine Island Road, Plantation, Florida 33324 on November + , 2003. Nélson E. Rodney

Docket for Case No: 04-000022