STATE OF FLORIDA . AGENCY FOR HEALTH CARE ADMINISTRATION ‘ a TENET ST. MARY’S INC., d/b/a ST. MARY’S MEDICAL CENTER, Petitioner, AHCA No: 2004002405 vs. DOAH No: 04-1395 AGENCY FOR HEALTH CARE ADMINISTRATION, cal Respondent. / il 9 a wl to a ee FINAL ORDER The Agency for Health Care Administration, having étitered into an re Joint Stipulation and Settlement Agreement with the parties to these proceedings, and being otherwise well advised in the premises, decides as follows: The attached Joint Stipulation and Settlement Agreement is approved and adopted as a part of this Final Order. The parties are directed to comply with the terms of the Joint Stipulation and Settlement Agreement, and both parties agree to dismiss the above styled case. THEREFORE, it is ORDERED and ADJUDGED that the parties hereto are directed to comply with the terms of the Joint Stipulation and Settlement Agreement. ORDERED: 1. A partial emergency services exemption for hyperbaric medicine is granted. DONE and ORDERED this 323 day of Cee gee t, 7 2005, in Tallahassee, Leon County, Florida. Alan Levine, Secretary Agency foy Health Care 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 AGENCY CLERK AND Copies furnished to: Nelson E. Rodney, Assistant General Counsel Agency for Health Care Administration Manchester Building, 1st Floor 8355 N.W. 53rd Street Miami, Florida 33166 (Interoffice mail) Elizabeth Dudek, Deputy Secretary Agency for Health Care Administration 2727 Mahan Drive, Mail Stop #9 Tallahassee, Florida 32308 (Interoffice mail) Michael J. Glazer, Esq. Ausiey & McMullen 227 South Caihoun Street Tallahassee, Florida 32301 (U.S. Certified Mail) Hon. Errol H. Powell Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 (U.S. Mail) Wendy Adams AHCA-Mail Stop #3 2727 Mahan Drive Tallahassee, Florida 32308 (Interoffice mail) CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true copy of the foregoing was furnished to the above-named addressees _ this 30 Gay of Ag, 2005. A Richard Shoop, y Clerk Agency for Health Care Administration 2727 Mahan Drive Building 3 Tallahassee, Florida 32308 (850) 922-5873 STATE OF FLORIDA DIVISION OF ADMINISTRATIVE HEARINGS TENET ST. MARY’S, INC., d/b/a ST. MARY'S MEDICAL CENTER, Petitioner, Vv. CASE NO. 04-1395 2004002405 AGENCY FOR HEALTH CARE ADMINISTRATION, Respondent. / STIPULATION AND SETTLEMENT AGREEMENT Petitioner, Tenet St. Mary's, Inc. d/b/a St. Mary’s Medical Center ("St. Mary’s”), and the State of Florida, Agency for Health Care Administration (“Agency”), through their undersigned representatives and pursuant to Section 120.57(4), Florida Statutes, hereby enter into this Stipulation and Settlement Agreement (“Agreement”) and agree as follows: WHEREAS, St. Mary’s is a licensed acute care hospital located in West Palm Beach, Florida that provides, among many other services, hyperbaric medical services; and WHEREAS, on or about December 29, 2003, St. Mary’s filed an application for an emergency services exemption relating to the provision of hyperbaric medicine because of its limited capacity to provide full time emergency coverage in that service; and WHEREAS, pursuant to a letter dated March 17, 2004, the Agency initially denied the emergency services exemption request; and WHEREAS, on April 9, 2004, St. Mary’s timely filed a Petition for Formal Administrative Hearing contesting said preliminary decision, which Petition was referred to the Division of Administrative Hearings and assigned DOAH Case No. 04-1395; and WHEREAS, the parties have engaged in subsequent discussions and §t. Mary's has provided additional information to the Agency regarding its request for said exemption; and WHEREAS, the Agency has determined that it should grant a partial emergency services exemption for hyperbaric medicine under the terms and conditions set forth herein. NOW, THEREFORE, in consideration of the mutual promises and covenants contained herein, the parties intending to be legally bound, agree as follows: 1. All recitals are true and correct and are expressly incorporated herein. 2. Effective November 1, 2004, St. Mary’s emergency services exemption relating to hyperbaric medicine is granted in part. St. Mary’s obligation to provide hyperbaric medicine emergency services coverage is limited to twenty (20) days each month. 3. The granting of this exemption does not otherwise limit St. Mary's ability to provide hyperbaric medicine services on either an inpatient or outpatient basis at any time. 4. The exemption granted herein will expire with the normal expiration of St. Mary's hospital license (June 30, 2005). However, upon a showing that the circumstances that resulted in the granting of this partial exemption remain essentially unchanged, and that the exemption application requirements are otherwise satisfied, AHCA will favorably consider and may grant a request for another similar partial exemption. 5. Upon full execution of this Agreement, St. Mary’s and AHCA will file a Joint Motion in DOAH Case No. 04-1395 seeking remand for entry of a Final Order by the Agency incorporating and adopting the terms of this Stipulation and Settlement Agreement. 6. Each party shall bear its own costs and attorneys’ fees. 7. This Agreement shall become effective on the date upon which it is fully executed by all the parties. 8. This Agreement is binding upon all parties herein. 9. The undersigned have read and understand this Agreement and have authority to bind their respective principles to it. 10. This Agreement contains and incorporates the entire understandings and agreements of the parties. 11. This Agreement supercedes any prior oral or written agreements between the parties. 12. This Agreement may not be amended except in writing by both parties hereto. Any attempt at assignment of this Agreement shall be void. DONE and ENTERED into as of the dates written below. TENET ST. MARY'S, INC. d/b/a AGENCY FOR HEALTH CARE ST. MARY'S MEDICAL CENTER ADMINISTRATION oN Chel 4 y JeclEL Michael Elizabeth Dudek Ausley & en Deputy Sefretary Post Office Box 391 Division/f Health Quality 227 S. Calhoun Street Assurance Tallahassee, Florida 32302 Agency for Health Care Administration 2727 Mahan Drive Tallahassee, Florida 32308 Date: Ceesgens.t PB POEL o Cake Cee GHEISTA CALAWAS Aeting General Counsel Agency for Health Care Administration 2727 Mahan Drive Tallahassee, Florida 32308 ATTORNEYS FOR TENET ST. MARY’S, INC. d/b/a ST. MARY’S MEDICAL CENTER Date: Lhe, BL Woes Date: 7 FIGRIOA AGENCY FOR HEALTH TARE ADMENSTRATION EB BUSH, GOVERNOR MARY PAT MOORE, INTERIM SECRETARY CERTIFIED MAIL IPT REQUESTED RE 7001 9360 0003 3829 2051 St. Mary’s Medi 901 45" Street West Palm Beach, Florida 33407 Re: Request for Emergency Service Exemption - Hyperbaric Medical Services (#200400240 5) Dear Ms. Goodwin: This is in response tO your recent application requesting a0 exemption from providing emergency hyperbaric medical services at St. Mary’s Medical Center. Section 395.1041(3), Florida Statutes, requires every hospital to ensure the provision of services within the service capability of the hospital at all times, unless an exemption has been granted by the Agency. Section V of the Application for Service Exemption corresponds to the above section of the Jaw and requires you to present the facts that would support your hospital has exhausted all reasonable efforts 10 ensure service capability through backup arrangements. This information was submitted with your request for this service exemption. Based on the information provided in your request for exemption, St. Mary’s Medical Center currently has two (2) physicians who provide yperbaric medical services. While supporting documentation submitted with your application indicates that St. Mary’s is the only facility between Orlando and Miami providing these services, YOU further indicate that the hospital can yeat 72003, thirty four (34) patients presented at St. Mary’s Medical Center and received hyperbaric medical services. While hyperbaric medical services are avery necessary service for our diving public and tourists, the need for this service is not a daily event or even a frequent event that would cause life style issues for taking call when it is shared by two people. Furthermore, the granting of this exemption request would create an increased risk to the public needing emergency care. The documentation you submitted does not demonstrate that Palmetto General Hospital Jacks the ability to ensure service capability jn the area of Hyperbaric medical services. Therefore, your request for exemption from the provision of Hyperbaric emergency medical services 1 denied. Exhibit "2" —_—— visit AHCA online a www. fdke state fl us TTTirnan Drive © Mail Stop #35 ___ re .» ~Ms. Debra Goodwin, RN, MSN. ; / . St. Mary’s Medical Center Page 2 Tenet St. Mary’s, Inc., d/b/a/ St. Mary’s Medical Center, has the right to seek administrative review of this decision pursuant to section ]20.569 and 120.57, Florida Statutes, (See Attached Forms). {n order to obtain a formal hearing before the Division of Administrative Hearings under section 120.57(1), Florida Statutes, your request for an administrative hearing must state the material facts disputed and must conform to the requirements in Section 28-106.201, Florida Administrative Code. Your petition must be filed within 21 days of your receipt of this letter. A copy of this letter and the attached form must be included with your petition. The petition should be sent to the Agency for Health Care Administration, Attention: Agency Clerk, 2727 Mahan Drive, Building 3, Mail Stop #3, Tallahassee, Florida 32308. If you have any questions, or would like to discuss this in greater detail, please feel free to contact Sonya Longfellow, at (850) 487-2717. : Sincerely, ta Laura MacLafferty, Unit Manager Hospital and Outpatient Services Unit Bureau of Health Facility Regulation Attachment ce: West Palm Beach Field Office Wendy Adams, AHCA Office of the General Counsel

Docket for Case No: 04-001395