> if Up é & ’ STATE OF FLORIDA : ADSL / fy “ AGENCY FOR HEALTH CARE ADMINISTRATION uy So, PR, LMG hey 49 SATA Qe STATE OF FLORIDA, AGENCY FOR HEALTH Wyre yy CARE ADMINISTRATION, oe Petitioner, ve AMEDISYS SOUTH FLORIDA, L.L.C. d/b/a AMEDISYS HOME HEALTH OF MIAMI-DADE, Respondent. AHCA No.: 2007001660 Return Receipt Requested: 7002 2410 0001 4235 2405 7002 2410 0001 4235 2412 7002 2410 0001 4235 2429 Of-14G2 ADMINISTRATIVE COMPLAINT COMES NOW the State of Florida, Administration (“AHCA” or undersigned counsel, and files against Amedisys South Florida, Health of Miami-Dade (hereinafter Miami-Dade”), “Agency” ) , this L.L.C. pursuant to Chapter 400, Agency for Health Care by and through the administrative complaint d/b/a Amedisys Home “Amedisys Home Health of Part III, and Section 120.60, Florida Statutes (2006), and herein alleges: NATURE OF THE ACTION 1. This is an action to impose an administrative fine of $10,000.00 pursuant to Section 400.484, Florida Statutes (2006), for the protection of public health, safety and welfare. 2. A re-licensure survey was conducted at the home health care agency from November 27 through November 30, 2006, in which AHCA found numerous deficiencies. As a result of the findings of the survey, an Amended Emergency Order of Immediate Moratorium on Admissions was imposed on the facility on December 6, 2006. [AHCA No.: 2006006963] JURISDICTION AND VENUE 3. AHCA has jurisdiction pursuant to Chapter 400, Part III, Florida Statutes (2006). 4. Venue lies in Miami-Dade County pursuant to Rule 28.106.207, Florida Administrative Code. PARTIES 5. AHCA is the regulatory authority responsible for licensure and enforcement of all applicable statutes and rules governing home health agencies, pursuant to Chapter 400, Part Iii, Florida Statutes (2006), and Chapter 59A-8 Florida Administrative Code. 6. Amedisys Home Health of Miami-Dade operates a home health agency located at 8181 N. w. isa4th Street, Miami Lakes, Florida 33016-5861. Amedisys Home Health of Miami-Dade is licensed as a home health agency under license number 209820951. w Amedisys Home Health of Miami-Dade 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 AMEDISYS HOME HEALTH OF MIAMI-DADE FAILED TO COORDINATE PATIENT CARE SERVICES PROVIDED BY THE REGISTERED NURSE, PHYSICAL THERAPIST, OCCUPATIONAL THERAPIST, AND SOCIAL WORKER. RULE 59A-8.0095(2) (b), FLORIDA ADMINISTRATIVE CODE. (PERSONNEL - DIRECTOR OF NURSING) 7. AHCA re-alleges and incorporates paragraphs (1) through (6) as if fully set forth herein. 8. Amedisys Home Health of Miami-Dade was cited with two (2) Class I deficiencies due to a re-licensure survey conducted from November 27, 2006 through November 30, 2006. 9. A re-licensure survey was conducted from November 27, 2006 through November 30, 2006. Based on observation, record review and interview, it was determined that the agency failed to ensure that the Administrator (who is a Registered Nurse), coordinated patient care services provided by the registered nurse, physical therapist, occupational therapist and social worker for 5 of 15 (#1,#4, #10, #14, #15) sampled clinical records reviewed. The findings include the following. 10. Review of the clinical record of sample patient 1, start of care 9/19/06, revealed that the patient had a sacral decubitus ulcer and was bed bound, requiring help with all activities of daily living. Observation of the patient during the home visit on 11/27/06 at. 4 pm revealed a semi-comatose, emaciated patient who had not eaten in 12 hours, lying in a small amount of yellowish fluid. ) 11. The living environment was extremely cluttered and dirty, and the patient's adult child had made a pathway through the house so the surveyors. could reach the patient. The record revealed that the patient was seen by the registered nurse twice daily for assessment and wound care. 12. The physician was not notified of the change in the patient's status: semi-comatose, emaciated patient being unable to eat or drink for 12 hours. On 10/18/06, the agency's social worker visited the patient and family. It was documented by the social worker that the patient was emaciated with poor food intake, and the social worker had documented the suggested assistance with homemaking, but the suggestion was not ‘reported to the agency and the service was never provided by the agency. | 13. The registered nurse documented wound care but did not inform the agency DON or Administrator or the patient's physician of the change in the patient’s condition. There was no evidence of documentation in the record that case management conferences were conducted for the purpose of coordination of care and services. The administrator was present at the home’ visit to confirm the findings. 14. ‘Review of the clinical record of sample patient #4, start of care 10/28/06, revealed that the patient had a diagnosis of abnormality of gait, joint pain and Diabetes. The patient was ordered nursing services, physical therapy and an evaluation by the social worker. 15. There was no evidence in the clinical record that the social worker conducted an evaluation of the patient. There was no evidence of documentation in the record that case management conferences were conducted for the purpose of coordination of care and services. 16. Review of the clinical record of sample patient #10, start of care 9/29/06, revealed a patient with urinary incontinence. Per plan of care, the patient was being treated for diabetes, Foley maintenance, and would be monitored by the skilled nurse and modified as needed by the physician. Documentation in the record identified that on 10/11/06, the Foley was not draining any urine, and the patient was wet with urine. 17. The information was not reported to the agency or the physician. The nurse's note of 10-11-06 stated that the Foley would be replaced on Monday, November 13th, 2006. There was no documentation in the record for 11-13-06 to support that the Foley was changed. There was no evidence of documentation in the record that case management conferences were conducted for the purpose of coordination of care and services. 18. Record review of clinical record #14 (start of care 10-30-06) revealed a patient with a primary diagnosis of Physical therapy, and Type i Insulin dependant, uncontrolled Diabetes. 19. The patient was ordered Novolin Insulin 70/30, 40 units, twice daily. The patient was seen by the registered nurse 2 times a week for 2 weeks, 1 time per week for 3 weeks, and once every other week for 4 weeks. Physical therapy was ordered 2 times per week for 5 weeks. The Initial Oasis assessment on 10/3/06 revealed that the patient was not able to give him/herself the Insulin injections. 20. The skilled nurse reported in the notes that the patient was non compliant with the insulin injections, medications, had elevated blood sugars. There was documentation in the record that the patient had no physician. The orders came from the hospital based physician. The nurse reported the information to the Director of Nurses on 10-9-06. There was no evidence of documentation in the record that case Management conferences were conducted for the purpose of coordination of care and services. 21. Record review of clinical record #15 (start of care 2- 10-06) revealed a patient with a Diabetes/Copp (chronic obstructive pulmonary disease) who was ordered to have physical therapy and occupational therapy. The physical therapy was given, but the patient was never evaluated for occupational therapy. There was no evidence in the record that the agency followed up on the evaluations. There was no evidence of documentation in the record that case Management conferences were conducted for the purpose of coordination of care and services. 22. Review of the current policy for Coordination of Care and Services revealed that each discipline's role is clearly defined in the provisions of each patients care. Case conferences and verbal communication between or among disciplines is documented in the clinical record. The agency provides information in a timely manner to physicians and includes as appropriate the patients’ current condition, changes in condition, patients’ response to treatment, outcomes of treatment. 23. Based on the foregoing facts, Amedisys Home Health of Miami-Dade violated Rule 59A-8.0095(2) (b), Florida Administrative Code, herein classified as a Class I violation, which warrants an assessed fine of $5,000.00. COUNT IT AMEDISYS HOME HEALTH OF MIAMI-DADE FAILED TO PROVIDE ADEQUATE CARE TO A PATIENT AND REPORT CHANGE IN CONDITION TO PHYSICIAN. RULE 59A~-8.0095(3) (a), FLORIDA ADMINISTRATIVE CODE. (PERSONNEL ~ REGISTERED NURSE) CLASS I 24, AHCA re-alleges and incorporates paragraphs (1) through (6) as if fully set forth herein. 25. A licensure annual survey was conducted from November 27, 2006 through November 30, 2006. Based on record review and interview, it was determined that the agency registered nurse failed to provide adequate care to the patient and report to the physician the change in condition as evidenced by the decline of sample patient #14 resulting in immediate jeopardy and 2 subsequent admissions to the hospital. The findings include the following. 26. Review of the clinical record of sample patient #14, start of care 10/3/06, revealed a patient with a diagnosis of Type 1 insulin dependant uncontrolled Diabetes. 27. The patient was ordered Novolin Insulin 70/30, 40 units, twice daily by the physician. The patient was seen by the registered nurse 2 times a week for 2 weeks, 1 time per week for 3 weeks, and once every other week for 4 weeks. Physical therapy was ordered 2 times per week for 5 weeks. The patient was unable to self inject and should have been seen by the registered nurse BID (twice daily) for administration of Insulin, blood sugar checks, and general Diabetic teaching. The initial orders were sent to the agency by a hospital based physician. 28. The Initial Oasis assessment on 10/3/06 revealed that the patient was not able to give him/herself the insulin injections. The first skilled nurses visit after the initial assessment was on 10/6/06 which revealed from the skilled nurse note that the patient was non-compliant with medicine and Insulin as ordered. "Don't take medicine and insulin as ordered." 29. There was no evidence in the record that the initial assessment or the patient’s ability to inject insulin was taken into consideration when providing the nursing care to the patient. The blood sugar testing was consistently not documented in the visit records by the nurse. The skilled nurse gave morning Insulin dose at 12:45 PM. The pM dosage of Novolin Insulin was prepared, and the syringe was pre-filled for the patient. There was no evidence in the record that pre-filled syringes were to be prepared and left for the patient, who was unable to self inject the medication. 30. The patient should have had complete Diabetic instructions on administration of Insulin, storage, and proper care of a Diabetic patient; foot care, daily exercises, prevention of infections and there was no evidence of this in the record. There was no indication that the nurse instructed the patient in the procedure for giving insulin or if there was a return demonstration by the patient. 31. The nurse visited the patient 2 times a week, so the insulin may not have been given at all by the patient contributing to the decline of the patient. 32. The next skilled visit was on 10/9/06 revealed that the blood sugar was 485 (norm 60-100). The skilled nurse noted that the patient had no primary care physician (PCP) at the time to report the very high blood sugar. This was reported to the Director of Nursing at the agency. 33. Insulin was given, but the dosage was not specified. The PM dosage of Insulin was prepared; the syringe pre-filled for the patient to administer later in the day. The patient had no current physician and the agency staff failed to notify the hospital based physician and let him/her refer the patient to a PCP. 34. The registered nurse visited the patient on 10/11/06. No evidence of any vital signs (blood pressure, pulse, temperature, and respirations) was documented. The blood sugar testing was not documented in the visit record by the nurse. The nurse stated that the patient was non-complaint with medication regimen. 10 35. The skilled nurse noted +4 edema and cyanotic feet. It was also documented that there was no PCP to report the blood glucose level. There was no documentation that the Insulin was given. 36. On 10/17/06 the skilled nurse visited the patient. The blood sugar was 380, and again the skilled nurse documented that there was no PCP to give the blood sugar results to. There was no documentation that Insulin was given. 37. On 10/24/06, 7 days later, the skilled nurse documented that Insulin was given by the patient, and the blood sugar was tested which was 438. The registered nurse documented that there was a new onset of wound; blisters on the left hand, with green tissue at the wound bed, and no drainage. The feet were cyanotic. It was documented that the patient had no PCP. It was documented that the agency would send a Doctor to see the patient, but there was no documentation to show that a physician saw the patient. 38. The record revealed that the patient was hospitalized from 10/26/06 through 11/8/06. Consultation done by a physician on 10/27/06 stated that the "wound on the left middle finger, most likely secondary to peripheral vascular disease, is associated with his diabetes." Resumption of care started on 11/9/06. 39. The patient was discharged home with a VAC wound dressing to be changed every Monday, Wednesday, and Friday. The patient went to the wound care clinic every Monday, and the agency was to provide care to the wound every Wednesday and Friday. It was noted on the Oasis assessment done on 11/9/06, that the patient has MRSA, which is a bacteria that is resistant to many antibiotics. 40. The next visiting nurse note was dated 11/15/06, 6 days later, on Wednesday, and the blood sugar was noted to be 263. Wound care was given, but no mention of the Insulin dosage was documented. The blood pressure was documented as 102/60, pulse was 76. No further Diabetic care or instructions was given at this time. 41. On 11/17/06, 2 days later, on Friday, the registered nurse saw the patient. The blood sugar was documented as 275. There was no documentation of Insulin given at this time. Wound care was given appropriately, but no mention of proper bio- hazardous waste management and the patient had MRSA. 42. Five days later, on 11/22/06, Wednesday, the fasting blood sugar was 289. Blood pressure was documented as 92/60 and a regular pulse.of 92. The Insulin dosage was not documented, and there were no further Diabetic instructions or education was given at this time. 43. Two days later, on 11/24/06, on Friday, the fasting blood sugar was 428. There was no documentation of the Insulin given. The blood pressure was documented as 50/40, pulse 100 and regular. The skilled nurse called 911 and the patient was transported to the hospital. 44. The patient had been diagnosed with MRSA (methcillin resistant staphylococcus aureus) and there was no evidence in the home visit notes that included biohazard management of the soiled dressings or aseptic technique used during the treatment and the wound care. 45. Review of the current agency policy for Patient Assessment and Reassessment revealed that additional assessments will be conducted as frequently as the patient condition warrants. 46. Review of the current policy for Coordination of Care and Services revealed that each discipline's role is clearly defined in the provisions of each patients care. Case conferences and verbal communication between or among disciplines is documented in the clinical record. The agency provides information in a timely manner to physicians and includes as appropriate the patients’ current condition, changes in condition, patients’ response to treatment, outcomes of treatment. 13 47. Interview with Director of Nurses, Administrator, and Clinical Manager on 11-30-06 at 4:00 pm confirmed the findings. The Administrator revealed that if he/she had known that the patient could not inject him/herself, they would have sent a nurse out 2 times day. 48. Based on the foregoing facts, Amedisys Home Health of Miami-Dade violated Rule 59A-8.0095(3) (a), Florida Administrative Code, herein classified as a Class I deficiency, which warrants an assessed fine of $5,000.00. 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 Amedisys Home Health of Miami-Dade on Counts I and II. 2. Assess against Amedisys Home Health of Miami-Dade an administrative fine of $10,000.00 on Counts I and II for violations cited above. This re-licensure survey also resulted in an imposition of an Amended Emergency Order of Immediate Moratorium on Admission [AHCA No.: 2006006963]. 3. Assess costs related to the investigation and prosecution of this matter, if applicable. 4. Grant such other relief as the court deems is just and 14 proper on Counts I and II. Respondent is notified that it has a right to request an administrative hearing pursuant to Sections 120.569 and 120.57, Florida Statutes. 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 THIS COMPLAINT WILL RESULT IN AN ADMISSION OF THE FACTS ALLEGED IN THE COMPLAINT AND THE ENTRY OF A FINAL ORDER BY THE AGENCY. IF YOU WANT TO HIRE AN ATTORNEY, YOU HAVE THE RIGHT TO BE REPRESENTED BY AN ATTORNEY IN THIS MATTER Aes be Uilearen, rdes A. Naranjo, aa a. Bar No.: 997315 Assistant General Counsel Agency for Health Care Administration 8350 N.W. 52 Terrace - #103 Miami, Florida 33166 15 Copies furnished to: Harold Williams Field Office Manager Agency for Health Care Administration 8355 N. W. 53 Street Miami, Florida 33166 (U.S. Mail) ‘Jean Lombardi Finance and Accounting Agency for Health Care Administration 2727 Mahan Drive Tallahassee, Florida 32308 (Interoffice Mail) Home Health Agency 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 Olga Cotera, Administrator, Amedisys Home Health of Miami-Dade, Inc., 8181 N. W. 154™ Street, Miami Lakes, Florida 33016-5861; Amedisys South Florida, L.L.c., 5959 8S. Sherwood Forest Boulevard, Baton Rouge, Louisiana 70816; CT Corporation System, 1200 South Pine Island Road, Plantation, Florida 33324 on this 20% day of FA pecwey-to07. Mire, U4, Caacuse: urdes A. Naranjo, SENDER: COMPLETE THIS SECTION m Complete items-1, 2, and 3. Also complete item 4 If Restricted Delivery Is desired. @ Print your name and address on the reverse U'S. Postal Servicen so that we'can retum the card to you. . CERTIFIED MAIL., RE geet ae ees Ail (Domestic Mail Only; No Insurance rt Return Reclapt Fe (Endorsement Required) Rastrictad Dativery Ft (Endorsement Requlrad) aus D. Is delivery address differant from tem 1? ‘C1 Yés if YES, entar delivery addréss below: “FPN | POFETODE . : ¢ x Flmca AL E854 S:Skenuend four || 219, Service Type |. (1) Certified Mail (J Express Mall ; CT Registered {1 Return Receipt for Merchandise | Cltnsiired Mail 1. C.0.D. 4 "——ticted Dallvery? (Extra Fee) Postage Gernlified Fae estic Return Recelpt 1 7002 2420 OOOL 42395 2412 1 PS Form-3811, August 2001 eC ans 2ACPRINS-2-0885 a ene PS Form 3800, June 2002 CE; Postal Service, * SENDER: COMPLETE THIS SECTION RTIFIED WPAN =) wt Complete items 1, 2, and 3. Also complete Se A eee: tom 4 If Restricted Dalivery Is desired. ™ Print your name and address on the reverse so that we can return the card to you. L ™ Attach this card to the back of the mailpiece, 4 aron the front if space permits. ! 4, Article Addressed to: or gnature: c— ~ D. Is dalivery acidress different fromitem 1? 11 Yes IfYES, enter delivery address below: £1 No 2 ar isit our website FFICS 4235 2 g . = ' T on Aaxt wm cenaorsemaneint Fes : ci Ce vp quires 1 Cogent oen rs 1200 Smuth Pnedalamdl ‘orsement Flequired) . { a f 0. mbakts We uy LL. mu Total Postage & Fa: P e ‘ du. 3. Service Type mu 2 39914 CO Certifed-Mail (1 Express Mail tq [Sentto 0 Registered C1 Return Receipt for Merchandise = ne wt Olinsured Mail 16.0.0. Weal, Apt No" ew. smene ewe .4. Rastrictad Delivery? (Extra Fee) O Yes 7002 2410 0002 4235 2429 | SFO BexHe.” | 0 Sinath Pons t ? ACL AT Ry PS Form 3811, August 2001 ) Domestic Return Recelpt 2ACPRIO3-Z-0985 A» aes { Wut

Docket for Case No: 07-001662