STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, 5 a vs. AHCA NO.2005005023 Return Receipt Requested KENDALL HEALTHCARE GROUP, LTD, 7002 2410 0001 4234 5223 d/b/a KENDALL REGIONAL MEDICAL 7002 2410 0001 4234 5230 CENTER, 7002 2410 0001 4234 5247 Respondent. / ADMINISTRATIVE COMPLAINT COMES NOW the Agency for Health Care Administration (hereinafter “AHCA”), by and through the undersigned counsel, files this Administrative Complaint against Kendall Healthcare Group, LTD, d/b/a Kendall Regional Medical Center (hereinafter “Kendall Regional Medical Center”) pursuant to 28-106.111 Florida Administrative Code (2003) and Chapter 120, Florida Statutes (2004) hereinafter alleges: NATURE OF THE ACTION 1. This is an action to impose an administrative fine in the amount of three thousand ($3,000.00) dollars pursuant to Section 395.1065(2) (a) Florida Statutes. JURISDICTION AND VENUE 2. This court has jurisdiction pursuant to Section 120.569 and 120.57 Florida Statutes and Chapter 28-106 Florida Administrative Code. 3. Venue lies in Miami Dade County, pursuant to 120.57 Florida Statutes and Chapter 28, Florida Administrative Code. PARTIES 4. AHCA is the enforcing authority with regard to Hospital licensure law pursuant to Chapter 395, Part I, Florida Statutes and Rules 59A-3 Florida Administrative Code. 5. Kendall Regional Medical Center is a hospital facility located at 11750 Bird Road, Miami, Florida 33175 and is licensed under Chapter 395, Part I, Florida Statutes and Chapter 59A-3. Florida Administrative Code. COUNT I KENDALL REGIONAL MEDICAL CENTER FAILED TO APPROPRIATELY MONITOR PATIENTS WITH CHEST PAIN AND TO TAKE ALL REASONABLE STEPS TO ENSURE THAT AN OPTIMAL LEVEL OF NURSING CARE WAS PROVIDED FOR 3 OF 5 SAMPLED RESIDENTS 59A-3.2085(5) (a), FLORIDA ADMINISTRATIVE CODE (NURSING SERVICE) 6. ANCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 7. During the complaint investigation conducted on 05/26/2005 and based on clinical record review, policy review and interview it was determined that the facility failed to appropriately monitor patients with chest pain and to take all reasonable steps to ensure that an optimal level of nursing care was provided for 3 of 5 (#1, #2, #4) sampled ER patients. (a) Review of the clinical record of sample patient #1 revealed that the patient came to the ER by county fire rescue with chest pain to rule out myocardial infarction at 2:0C pm. In addition, the patient had rectal bleeding. The patient complained of pain in the mid-chest and difficulty breathing. The triage nurse took the patients vital signs and used the chest pain protocol: aspirin within 5 minutes and EKG within 10 minutes. The patient also had a chest x-ray and lab work. The ER physician saw the EKG, but the physician did not examine the patient until 7:30 pm. There was an order for nitro paste 1", cardiac diet and nothing by mouth after midnight, but the order had no time documented. The medication was given at 3 pm. There was no evidence in the record of reassessment every 2 hours, as noted by the ER Director. The patient was to be admitted to Telemetry at 8:30 pm. There were no beds available and the patient remained in the =R for the bed to become available. The admitting orders at 8:40 pm were for nitro past %" every 6 hours and clear liquid diet. The medication was given at 8:00 pm and there was no evidence that the medication was given again during the time the patient was in the facility. Vital signs were to be taken every 4 hours on the telemetry unit and a monitor strip was to be recorded every 8 hours. There was no evidence that after the initial vital signs and monitor strip any documentation was made in the record. (b) Review of the clinical record of sample patient #2 revealed that the patient came to the ER by county fire rescue with chest pain and difficulty breathing at 7:00 pm. The triage nurse took the patients vital signs anc used the chest pain protocol: aspirin within 5 minutes and EKG within 10 minutes. The physician examined the patient at 10:00 pm. The patient remained in the ER overnight. Laboratory tests and chest x-ray were done in the morning. There was no further evidence in the record of vital signs or nurse reassessment during the time that the patient was in the ER. (c) Review of the clinical record of sample patient #4 revealed that the patient came to the ER by car with chest pain and headache at 11:30 am. There was no evidence in the record of the patients stay in the ER. There was no triage record for the patient. There was no evidence of an EKG having been done or the chest pain protocol having been used. The patient was admitted to hospice, but remained in the ER unti_ the following day. For the date of the patients' admission to the ER, there was one temperature noted. A chest x-ray was done. There was no admission assessment in the record documenting the patient’s diabetes, cardiac problems or history. Review of the current facility policy for "Emergency Room Full Capacity Protocol" revealed that patients remaining the ER after admission status has been determined would be cared for based on the standards of practice of the assigned unit. Review of the current facility policy for "Telemetry Process Standards" revealed that vital signs are routinely taken every 4 hours in telemetry and cardiac rhythm strips are obtained every 8 hours. 8. Interview with the ER Director on 5-26-05 at 2 pm revealed that the patients who are admitted to a unit but remain in the ER because no bed is available, are treated by the ER staff according to the standards of the nursing unit the patient would be on. The ER staff follows the protocol. All patients in the ER are reassessed every 2 hours. The policy could not be produced, as it is being rewritten. Repeat Deficiency from the 9/22/2004 complaint investigation 9. Based on the foregoing, Kendall Regional Medical Center violated 59A-3.2085(5) (a), Florida Administrative Code, carrying in this case, an assessed fine of ($1,000.00 x 3 patients) =$3,000.00. CLAIM FOR RELIEF WHEREFORE, AHCA requests this Court to order the following relief: A. Make factual and legal findings in favor of the Agency on Count I. B. Assess a fine against the facility in the amount of Three Thousand Dollars ($3,000.00). The Respondent is notified that it has a right to request an administrative hearing pursuant to Section 120.569, Florida Statutes. Specific options for administrative action are set out in the attached Explanation of Rights (one page) and Election of Rights (one page). All requests for hearing shall be made to the Agency for Health Care Administration, attention Agency Clerk, 2727 Mahan Drive, Mail Stop #3, Tallahassee, Florida 32308, Telephone (850) 922-5873. RESPONDENT IS FURTHER NOTIFIED THAT FAILURE TO RECEIVE A REQUEST FOR 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. Respectfully submitted. Nelson E. R ey, Esquire AHCA - Senior Attorney Fla. Bar No. 178081 Spokane Bldg., Suite #103 8350 NW 52™° Terrace Miami, Florida 33166 (305) 470-6802 Copies furnished to: Diane Lopez Castillo Field Office Manager Agency for Health Care Administration 8355 NW 537° Street Miami, Florida 33166 (U.S. Mail Hospital Program Office Agency for Health Care Administration 2727 Mahan Drive, Mail Stop #31 Tallahassee, Florida 32308 (Interoffice mail) Jean Lombardi Agency for Health Care Administration Finance and Accounting 2727 Mahan Drive, Mail Stop #14 Tallahassee, Florida 32308 (Interoffice mail) CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true copy hereof was sent by U.S. Mail, Return Receipt Requested to Victor J. Maya, CEO, Kendall Regional Medical Center, 11750 Bird Road, Miami, Florida 33175,Kendall Healthcare Group, LTD, P.O. Box 750, Legal Department, Nashville, Tennessee 37202, and to CT Corporation System, 1200 South Pine Island Road, Plantation, Flcrida 33324 ons June 22, 2005. ~ Nelson E. Rodney, Es ! 7

Docket for Case No: 05-002626