Petitioner: AGENCY FOR HEALTH CARE ADMINISTRATION
Respondent: ALL AMERICA ACLF, D/B/A ALL AMERICA ACLF
Judges: FLORENCE SNYDER RIVAS
Agency: Agency for Health Care Administration
Locations: Miami, Florida
Filed: May 17, 2006
Status: Closed
Settled and/or Dismissed prior to entry of RO/FO on Monday, July 31, 2006.
Latest Update: Dec. 26, 2024
STATE OF FLORIDA, AGENCY FOR HEALTH
CARE ADMINISTRATION,
Vv.
STATE OF FLORIDA
AGENCY FOR HEALTH CARE ADMINISTRATION
Petitioner, AHCA No.: 2006001880
Return Receipt Requested:
7002 2410 0001 4237 5527
7002 2410 0001 4237 5534
ALL AMERICA A.C.L.F. d/b/a ALL
AMERICA A.C.L.F.,
Respondent. / Ole _ | KU
ADMINISTRATIVE COMPLAINT
COMES NOW State of Florida, Agency for Health Care
Administration (“AHCA”), by and through the undersigned counsel,
and files this administrative complaint against All America
A.C.L.P.
A.C.L.F.
120.60,
1.
$13,000.
400.414
d/b/a All America A.C.U.F (hereinafter “All America
“), pursuant to Chapter 400, Part III, and Section
Florida Statutes, (2005), and alleges:
NATURE OF THE ACTION
This is an action to impose an administrative fine of
00 and a survey fee of $500.00 pursuant to Sections
and 400.419, Florida Statutes (2005) for the protection
of public health, safety and welfare.
JURISDICTION AND VENUE
2. This Court has jurisdiction pursuant to Sections
120.569 and 120.57, Florida Statutes (2005) and Chapter 28-106,
Florida Administrative Code (2005).
3. Venue lies in Miami-Dade County pursuant to Section
120.57, Florida Statutes (2005) and Rule 28-106.207, Florida
Administrative Code (2005).
PARTIES
4. AHCA is the regulatory authority responsible for
licensure and enforcement of all applicable statutes and rules
governing assisted living facilities pursuant to Chapter 400,
Part III, ‘Florida Statutes (2005) and Chapter 58A-5 Florida
Administrative Code (2005). |
5. All America A.C.L.F. operates a 100-bed assisted
living facility located at 808 W. 15* Avenue, Hialeah, Florida
33010. All America A.C.L.F. is licensed as an assisted living
facility under license number 7890. All America A.C.L.F. 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.
6. A complaint investigation survey was conducted at the
facility from February 24, 2006 through February 27, 2006. As a
result of the findings of the complaint investigation survey, an
Emergency Order of Immediate Moratorium was imposed on the
facility on March 1, 2006. The moratorium was lifted effective
March 23, 2006.
7. As a result of the complaint investigation survey
conducted from February 24 - 27, 2006, the facility was cited
with two (2) Class I deficiencies and three (3) Class II
deficiencies as set forth in this administrative complaint.
COUNT I
ALL AMERICA A.C.L.F. FAILED TO ENSURE THAT THE MINIMUM STAFFING
HOURS WERE MET.
RULE 58A-5.019(4) (a)1, FLORIDA ADMINISTRATIVE CODE
(STAFFING STANDARDS)
CLASS II VIOLATION
8. AHCA re-alleges and incorporates paragraphs (1)
through (7) as if fully set forth herein.
9. A complaint investigation survey was conducted from
February 24, 2006 through February 27, 2006. Based on review of
the staffing it was determined that the Administrator failed to
ensure that the minimum staffing hours were met. The findings
include the following.
10. The documented staffing hours which was not met: for
' the time period February 1, 2006 to February 7", 2006 with a
resident census of 68 residents. The documented staffing was 440
hours and. the required staffing was 457 hours weekly.
11. The documented staffing hours were not met for the
time period February 8, 2006 to February 14, 2006. ‘The
documented staffing was 442 hours and the required staffing was
457 hours for a census of 68 residents.
12. The documented staffing hours were not met for the
time period February 15, 2006 to February 21, 2006. The
documented staffing was 440 hours and the required staffing was
457 hours for a census of 68 residents.
13. The projected staffing for February 22, 2006 through
February 28, 2006 does not meet the required staffing of 457
hours. The projected staffing is 408 hours.
14. Based on the foregoing facts, All America A.C.L.F.
violated Rule 58A-5.019(4)(a)1, Florida Administrative Code,
herein classified as a Class II violation, which warrants an
assessed fine of $1,000.00.
COUNT IL
ALL AMERICA A.C.L.F. FAILED TO ENSURE THAT THERE WAS SUFFICIENT
QUALIFIED STAFF TO PROVIDE RESIDENT SUPERVISION TO ASSURE SAFETY
FOR ALL FACILITY RESIDENTS.
RULE 58A-5.019(4) (b), FLORIDA ADMINISTRATIVE CODE
(STAFFING STANDARDS)
CLASS I VIOLATION
15. AHCA re-alleges and incorporates paragraphs (1)
through (7) as if fully set forth herein.
16. A complaint investigation survey was conducted from
February 24, 2006 through February 27, 2006. Based on
observations, interviews and record review it was determined
that there was insufficient qualified staff to provide resident
supervision to assure safety for all facility residents.
Moreover, a staff member failed to have a FDLE Level 1
background screening even though she had been employed at the
facility for over eight (8) months. This lack of qualified staff
resulted in the hospitalization of one sampled resident (#2) and
the unwanted sexual advances towards others residents (#9, 10 &
12). The findings include the following.
17. Resident #2, diagnosed with schizophrenia, was
transferred to the hospital on 02/21/06 after sustaining second
degree burns to the buttocks, hands and forearms. Four staff
members (the owner, nursing assistant, housekeeper and
consultant) stated on interview on 02/24/06 at 2:15pm that the
5
resident was found on 02/21/06 at approximately 1:45pm in the
bathroom of room 10 seated on the side of the bathtub without
any clothing on with the hot water running from the faucet. All
staff members stated that the resident had burns to the
buttocks, hands and arms. According to all staff members the
nursing assistant had just showered and dressed the resident and
then left momentarily to the laundry room. At the same time the
police were in the facility processing an ex parte order for
resident #8 who had become violent. The documented Baker Act
occurred at 1:00pm on 02/21/06. According to the staff
interviewed all of the staff was assisting the police with
resident #8. The nursing assistant stated that he/she returned
to resident #2's room within 5 minutes of leaving for the
laundry and heard resident #2 yelling help me and then found the
resident burned as stated previously. Staff members indicated
that 911 was immediately called upon discovery of the incident
involving resident #2. on 2/25/06 at 3:10pm the nursing
assistant who found resident #2 demonstrated the position in the
bathtub that resident #2 was found which confirmed the verbal
accounts of the staff members. The documented progress note
confirmed the verbal accounts. The actual time of this incident
is not documented on the incident and accident report. There is
no documentation by the facility staff that there were
implemented measures taken to prevent another incident of this
type. There is no documentation of staff training and or
measurements of water temperatures post incident. The consultant
stated on interview that water temperatures in resident rooms
were taken by a friend of but there is no documentation
attesting to this.
18. Resident #9 diagnosed schizophrenic, bipolar and
asthma stated on interview at 7:45am on 02/26/06 that "men come
into my room all of the time and have touched my breasts and
genital areas." The resident indicated that this act is non-
consensual. The resident further stated, "I want out of here."
19. Resident #10 diagnosed schizophrenic stated on
02/26/06 at 8:25am that he/she was unable to sleep due to a man
coming into the room. The resident stated that the male resident
tried to take off his/her clothing which was non consensual. The
resident stated that the male resident climbed into the bed with
him/her and touched his/her breast. The resident told the male
resident to go away but he kept returning. Resident #10 stated
that the staff member on duty was told of this incident but did
nothing. The resident was upset as the lock on the door to the
residents room is broken and can not be locked which was checked
by the surveyor and verified. Resident #11 who is the roommate
of resident #10 stated that there was a man in the room during
the night but the staff member told the male resident to leave.
According to resident #10 the male resident spent the night in
the room. The resident asked the surveyor repeatedly to be
transferred out of the facility.
20. Resident #12 stated on 02/26/06 at 7:50am that "Men
enter my room all of the time. I don't have sex; one male
resident constantly tries to sexually aggress me demanding oral
Sex.
21. The staffing was not met for the time period of
February 1 - February 21, 2006 as fully set out in Count I.
22. Based on observation, interview and record review, the
facility failed to provide evidence of FDLE Level 1 background
screening for staff #1 (hired 5/2005). Record review by
surveyors on 2/24/06 at 2:45 pm revealed that there was no
satisfactory information on file for FDLE Level 1 background
screening for staff #1. There was a report on file that did not
include any results in terms of the staff's previous criminal
history, and therefore the report was inconclusive. Interview
with the facility’s consultant that took place on 2/24/2006 at
2:55 PM revealed that all the employees had their FDLE
background screening done, but she failed to provide appropriate
documentation for staff #1. On the evening of 2/24/2006, the
surveyors notified the facility’s staff that staff #1 did not
have a Level 1 background screening as required by Florida Law,
Section 400.4174, Florida Statutes (2005). Upon arrival at the
facility on 2/25/2006 at 1:00 PM, the surveyors observed staff
#1 working. Interview with staff #1 on.this date, at 2:40 pm
revealed that her/his job tasks include the following: assist
resident with medications, dining, grooming and bathing. The
facility continued to allow staff #1 to work even after being
notified that she/he should not be working.
23. Based upon review of the facility’s incident report
and staffing schedule, staff #1 was working on 2/21/2006 when
resident #2 suffered serious injury from burns. Four staff
members (the owner, nursing assistant, housekeeper, and
consultant) stated on interview on 2/24/2006 at 2:15 pm that the
resident was found on 2/21/2006 at approximately 1:45 pm in the
bathtub of room 10 seated on the side of the bathtub without any
clothing on with the hot water running from the faucet. All
staff members stated that the resident had burns to the
buttocks, hands and arms. Review of the hospital admission
records indicate that resident #2 was admitted at as an
intensive care unit (ICU) patient (pt) at a local hospital. The
resident experienced second degree burns in 16% of this body,
lower hands and lower gluteus area. Review of the hospital
social work and discharge planning note dated 2/24/2006 revealed
the following statement, “Pt’s burn patterns as per medical team
does not match how pt. got burned.” It is of extreme concern
that staff #1 was working at the time that Resident #2 was
burned and that his/her burn patterns were inconsistent with the
history given by the facility, and that the facility allowed
staff #1 to continue to work even after being notified by the
Surveyors that she/he was not appropriate to work at the
facility.
24. The resident complaints about male residents sexually
aggressing them was addressed with the owner on 02/26/06 at
10:30am. The Owner stated that resident #10 invites men into the
room all of the time.
25. Interview with the facility's consultant on 2/27/06 at
9:25 AM revealed that there is only one staff member who works
the overnight (11 PM to 7 AM shift). Review of the facility
schedule for the month of February 2006 verified this.
26. Based on the foregoing facts, All America A.C.L.F.
violated Rule 5BA-5.019(4) (b), Florida Administrative Code,
herein classified as a Class [I violation, which warrants an
assessed fine of $5,000.00.
COUNT III
ALL AMERICA A.C.L.F. STAFF FAILED TO EXERCISE THEIR
RESPONSIBILITIES TO OBSERVE RESIDENTS, TO DOCUMENT OBSERVATION
ON THE APPROPRIATE RESIDENT’S RECORDS AND TO REPORT THE
OBSERVATION TO THE RESIDENT'S HEALTH CARE PROVIDER.
SECTION 400.4255 (1) (a), FLORIDA STATUTES
RULE 58A-5.019(2) (b), FLORIDA ADMINISTRATIVE CODE
(STAFFING STANDARDS)
CLASS II VIOLATION
10
27. AHCA re-alleges and incorporates paragraphs (1)
through (7) as if fully set forth herein.
28. A complaint investigation survey was conducted from
February 24, 2006 and February 27, 2006. Based on interview the
facility's staff did not exercise their responsibilities, to
observe residents, to document observations on the appropriate
resident's record and to report the observations to the
resident's health care provider. The findings include the
following.
29. Interview with staff #2 took place on 2/24/2006 at
4:00 PM and revealed that resident #2 was given a bath by staff
#2 on 2/21/2006, at about 10:25 AM.
30. According to staff #2's statement, the resident
suffered Erom diarrhea on 2/21/06, but there was no
documentation on the resident's record indicating that the
resident was sick. Between 1:00 to 1:30 PM, resident #2 soiled
himself and went to the bathroom to clean himself. According to
his/her statement, staff #2 found resident #2 naked, sitting on
the edge of the bath tab, and his lower hands and the lower
gluteus area were irritated. Staff #2 said thatthe hot water
was running in the tab when she/he found the resident, so he/she
assumed that the resident tried to clean himself and got burned.
11
31. Staff #2 then notified the facility's administrator of
the incident and an ambulance was called and resident #2 was
taken to the hospital. .
32. Facility's record review that took place on 2/24/2006
at 2:30 PM revealed that the facility failed to fill out and
send the 1 day report to the Agency for Health Care
Administration.
33. Interview with the facility's consultant that took
place in 2/24/2006, at 2:45 PM, revealed that the facility's
administrator send the appropriate form to the main office, but
failed to provide proof that the form was indeed submitted in to
the office.
' 34. Based on the foregoing facts, All America A.C.L.F.
violated Section 400.4255(1) (a), Plorida Statutes (2005) and
Rule 58A-5.019(2) (b), Florida Administrative Code, herein
classified as a Class II violation, which warrants an assessed
fine of $1,000.00.
12
COUNT IV
ALL AMERICA A.C.L.F. FAILED TO OFFER PERSONAL SUPERVISION AS
APPROPRIATE. ADDITIONALLY, STAFF REVEALED RESIDENTS SMOKE IN
THEIR BEDROOMS, POTENTIALLY POSING A HAZARD TO ALL FACILITY
RESIDENTS .
RULE 58A-5.0182(1), FLORIDA ADMINISTRATIVE CODE
(RESIDENT CARE STANDARDS)
CLASS I VIOLATION
35. AHCA re-alleges and incorporates paragraphs (1)
through (7) as if fully set forth herein.
36. A complaint investigation survey was conducted from
February 24, 2006 through February 27, 2006. Based on interview
and record review, the facility’s staff did not offer personal
supervision, as appropriate for one of the sampled residents
(#2). In addition, staff interview revealed residents smoke in
their bedrooms, potentially posing a hazard to all facility
residents. The findings include the following.
37. Interview with staff #2 that took place on 2/24/2006
at 4:00 PM revealed that resident #2 received a bath by staff #2
on 2/21/2006, at about 10:25 AM. According to staff #2's
statement, the resident suffered from diarrhea that day, but
there was no documentation on resident's record indicating that
the resident was sick. According to staff member, at about 1:00
to 1:30 PM, resident #2 soiled himself and went to the bathroom
to clean himself. According to his/her statement, staff #2 found
13
resident #2 naked, sitting on the edge of the bath tub, and his
lower hands and the lower gluteus area were irritated. Staff #2
said that the hot water was running in the tub when she found
the resident, so the staff assumed that the resident tried to
clean himself and got burned. Staff #2 then notified the
facility’s administrator of the incident and an ambulance was
called. Review of the hospital admission records indicate that
as a result of the incident resident #2 was admitted at as an
intensive care unit (ICU) patient (pt) at a local hospital. The
resident experienced second degree burns in 16% of his body,
lower hands and lower gluteus area. Review of the hospital
social work and discharge planning note dated 2/24/06 revealed
the following statement, “Pt’s burn patterns as per medical team
does not match how pt. got burned.”
38. When the surveyors asked staff #2, where she was at
the time of the incident, the staff said that another resident
in the facility was Baker acted at the same time, and therefore
the staff was unable to attend to the residents’ needs
appropriately.
39. The surveyor visited the resident in a local hospital
on 2/27/2006. The resident was not responsive and in a stage of
delirium. The surveyor could not interview the resident. The
surveyor discussed the resident’s current condition with the
physician in charge at the time of the visits.
14
40. Interview with the physician in charge at the time of
the visit, that took place on 2/27/2006 at 10:15 AM, revealed
that the resident suffered 27? degree burns and was expected to
stay in ICU for somé time. The physician was unable to provide
the surveyor with a prognosis of the resident's condition due to
the fact that it was too soon after the incident and also due to
the fact that the resident was not responsive at all. Interview
with the resident’s RN that took place at 2/27/2006 at 10:30 AM,
revealed that there was no apparent bruising at the time of
admission to the hospital.
41. Interviews with facility consultant on 2/24/06 at 2:30
PM revealed the facility had no method of monitoring of hot
water temperatures within the facility prior to the incident
resulting in the resident's hospitalization and that they had
not implemented such a system post-incident.
42. There was no documentation of staff training and or
measurements of water temperatures post incident. The consultant
stated on interview that water temperatures in resident rooms -
were taken by a friend but there is no documentation confirming
this.
43. Interview with the facility’s consultant on 2/27/06 at
9:25 AM revealed that residents smoke in their bedrooms. She
stated that it is difficult to keep them from doing so, although
they are not supposed to smoke, for safety reasons.
15
44. Based on the foregoing facts, All America A.C.L.F.
violated Rule 58A-5.0182(1), Florida Administrative Code, herein
_ Classified as a Class I violation, which warrants an assessed
fine of $5,000.00.
COUNT V
ALL AMERICA A.C.L.F. FAILED TO PROVIDE ADEQUATE SUPERVISION ‘T0
MAINTAIN AN AWARENESS OF RESIDENTS WHEREABOUTS, HAVING THE
POTENTIAL TO IMPACT ALL FACILITY RESIDENTS.
RULE 58A-5.0182(1)(c), FLORIDA ADMINISTRATIVE CODE
(RESIDENT CARE STANDARDS)
CLASS II VIOLATION
45. AHCA re-alleges and incorporates paragraphs (a)
through (7) as if fully set forth herein.
46. A complaint investigation survey was conducted from
February 24, 2006 through February 27, 2006. Based on
observation and resident /staff interviews, it was determined
that the facility does not provide adequate supervision to
Maintain an awareness of residents whereabouts, having the
potential to impact all facility residents. The findings include
the following.
47. During an interview with the acting manager, one
caregiver and the consultant for the facility on 2/27/06 at 1:30
p.m., staff stated the facility had no mechanism to record and
know when residents leave the facility or return. As the
residents are free to come and go without signing out or
16
notifying staff of where they are going and expected return
time, the only way to know who is present is to go check each
room individually. Staff verified that a resident has to be
missing for more that 24 hours before it is reported to police.
Staff stated that they can't require that residents sign in or
out or tell someone what they are going as residents won't
cooperate, and will have to be Baker Acted. When asked for a
census list, the facility originally had 60 residents, then 59
residents finally 63 were identified.
48. Interviews with residents #10 & #11 (who are
roommates) on 2/27/06 at revealed that sometime during the
evening/night of 2/26/06 a man entered their bedroom. Resident
#10 stated this man made unwanted sexual advances towards her.
Resident #11 stated she asked staff to get the man out of
his/her room.. Both residents stated that the lock on their room
(which opens to the outside) did not work. Surveyor observation
of the lock at 9:05 AM on that date verified the lock to the
room was not functional.
49. Based on the foregoing facts, All America A.C.L.F.
violated Rule 58A-5.0182(1)(c), Florida Administrative Code,
herein classified as a Class II violation, which warrants an
assessed fine of $1,000.00.
17
SURVEY FEE
Pursuant to Section 400.419(10), Florida Statutes (2005),
AHCA may assess a survey fee of $500.00 to cover the cost of
monitoring visits. A survey fee of $500.00 has been assessed in
this case.
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 All America A.C.L.F. on Counts I
through Count V.
2. Assess an administrative fine of $13,000.00 against
All America A.C.L.F. on Counts I through V for the violations
cited above. This complaint investigation survey also resulted
in an imposition of an Immediate Order of Moratorium.
3. Assess a survey fee of $500.00 against All America
A.C.L.F. pursuant to Section 400.419(10), Florida Statutes.
4. Assess costs related to the investigation and
prosecution of this matter, if the Court finds costs applicable.
5. Grant such other relief as this Court deems is just
and proper.
18
Respondent is notified that it has a right to request an
administrative hearing pursuant to Sections 120.569 and 120.57,
Florida Statutes (2005). Specific options for administrative
action are set out in the attached Election of Rights. All
requests for hearing shall be made to the Agency for Health Care
Administration, and delivered to the Agency Clerk, Agency for
Health Care Administration, 2727 Mahan Drive, MS #3,
Tallahassee, Florida 32308.
RESPONDENT IS FURTHER NOTIFIED THAT THE FAILURE TO RECEIVE A
REQUEST FOR A HEARING WITHIN TWENTY-ONE (21) DAYS OF RECEIPT OF
q
THIS COMPLAINT WILL RESULT IN AN ADMISSION OF THE FACTS ALLEGED
IN THE COMPLAINT AND THE ENTRY OF A FINAL ORDER BY THE AGENCY.
Lourdes A. Naranjo, Esq.
Assistant General Counsel
Agency for Health Care
Administration
8350 N.W. 52 Terrace - #103
Miami, Florida 33166
Copies furnished to:
Harold Williams
Field Office Manager
Agency for Health Care Administration
8355 N. W. 53 Street
(Interoffice Mail)
19
Jean Lombardi
Finance and Accounting
Agency for Health Care Administration
2727 Mahan Drive
Tallahassee, Florida 32308
(Interoffice Mail)
Assisted Living Facility 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 Rosa M. Guzman, Administrator, All America
A.C.L.F., 808 W. 1° Avenue, Hialeah, Florida 33010; Teresita M.
7
Feal, 41S. W. 27™ Road, Miami, Florida 33129 on this 2 day
"naa eae
rdes A. Naranjo, Esq.
of
20
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2ACPRI-03-Z-0905 |
Docket for Case No: 06-001846
Issue Date |
Proceedings |
Jan. 04, 2007 |
Final Order filed.
|
Jul. 31, 2006 |
Order Closing File. CASE CLOSED.
|
Jul. 28, 2006 |
Joint Motion to Relinquish Jurisdiction filed.
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Jul. 25, 2006 |
Corrected Due to Scrivenor`s Error Order Denying Motion to Stay Discovery Pending Mediation or in the Alternative for Extension of Time.
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Jul. 24, 2006 |
Order Denying Motion to State Discovery Pending Mediation or in the Alternative for Extension of Time.
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Jul. 10, 2006 |
Notice of Telephonic Motion Hearing (motion hearing set for July 24, 2006; 10:00 a.m.).
|
Jul. 07, 2006 |
Motion to Stay Discovery Pending Mediation or in the Alternative for Extension of Time filed.
|
Jun. 05, 2006 |
Notice of Service of Petitioner`s First Set of Request for Admissions, Interrogatories, and Request for Production of Documents filed.
|
Jun. 02, 2006 |
Order of Pre-hearing Instructions.
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Jun. 02, 2006 |
Notice of Hearing by Video Teleconference (video hearing set for August 18, 2006; 9:00 a.m.; Miami and Tallahassee, FL).
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May 30, 2006 |
Joint Response to Initial Order filed.
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May 18, 2006 |
Initial Order.
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May 17, 2006 |
Administrative Complaint filed.
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May 17, 2006 |
Answer to Administrative Complaint, Affirmative Defenses, and Request for Administrative Hearing filed.
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May 17, 2006 |
Notice (of Agency referral) filed.
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