STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION, D) Petitioner, O | ¢ vs. AHCA NO.2007001465 Return Receipt Requested JUPITER MEDICAL CENTER, INC. 7002 2410 0001 4235 5444 a/b/a JUPITER MEDICAL CENTER, 7002 2410 0001 4235 5451 Respondent. / ADMINISTRATIVE COMPLAINT COMES NOW the Agency for Health Care Administration (hereinafter “AHCA”), by and through the undersigned counsel, files this Administrative Complaint against Jupiter Medical Center, Inc. d/b/a. Jupiter Medical Center (hereinafter “Jupiter Hospital”) pursuant to 28-106.111 Florida Administrative Code (2006) and Chapter 120, Florida Statutes (2006) hereinafter alleges: NATURE OF THE ACTION 1. This is an action to impose an administrative fine in the amount of nine hundred ($900.00) dollars pursuant to Section 395.1041(5) (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 Palm Beach 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. Jupiter Medical Center is a hospital facility located at 1210 South Old Dixie Highway, Jupiter, Florida 33458 and is licensed under license #4072 with an expiration date of 6/30/07. COUNT I JUPITER MEDICAL CENTER FAILED TO ENSURE THE PROVISION OF SERVICES LICENSED TO BE WITHIN ITS CAPABILITY AT ALL TIMES. Section 395.1041(3) (d)1., Florida Statutes, and/or Rule 59A-3.255(4) (a) and Rule 59A-3.255(6) (e)2, Florida Administrative Code (EMERGENCY CARE) 6. AHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 7. During the visit of 01/03-04/07 and based upon interview and record review, the facility failed to ensure the provision of services licensed to be within its capability at all times either by an agreement with another hospital or an agreement with one or more physicians. This affected one of twenty-one sampled patients (#21). 8. A review of the clinical record for Patient #21 was conducted on 01/04/2007. The record revealed Patient #21 was transported to another hospital by Emergency Medical Services (EMS) on 09/16/2006, after being found sitting on the ground at work vomiting bright red blood. The EMS Report documents that the patient arrived at the other hospital at 15:29 on 09/16/2006. The Emergency Physician Medical Screening Examination (MSE) record from the other hospital, dated 09/16/2006 at 4:15 PM, lists a clinical impression of upper gastrointestinal (GI) bleeding and documents that Patient #21 was vomiting blood and had blood in the stool. 9. A review of the other hospital's Emergency Department Transfer Out Log showed that on 09/16/2006 at 20:47, the other hospital contacted Jupiter Medical Center regarding an emergency transfer of Patient #21 to the facility, and was told by a _ specifically identified representative of the facility that the facility had no Gastroenterology physician on call coverage. 10. During a tour of the Jupiter Medical Center Emergency Department on 01/03/2006 at 10:50 AM, it was noted that the posted license/inventory of services list includes the provision of Gastroenterology services. In addition, the facility's license, reviewed on 01/03/2006, lists Gastroenterology as being within the scope of services provided by the facility. 11. State regulations at 59A-3.255(4) (a), Florida Administrative Code and Section 395.1041(3) (d)1., Florida Statutes mandate the hospital to ensure the provision of services within the service capability of the hospital at all times; 24 hours per day, 7 days per week either directly by their staff or indirectly by an agreement with another hospital or physician(s). 12. A review of the specialty physician on-call schedule for Gastroenterology coverage for 09/16/2006 revealed the facility did not ensure/schedule physician coverage for Gastroenterology Service which they are required to do based on their license and State regulations identified above. 13. As a result of failing to ensure the provision of Gastroenterology Service 24 hours per day, 7 days per week as the hospital is licensed to do, patient #21 was not accepted and his/her transfer was denied. 14. A record review revealed patients #5 to 20 entered Jupiter Hospital’s Emergency Room with signs and symptoms of Gastrointestinal bleeding including vomiting blood and/or the presentation of blood in the stool. All were diagnosed with a gastrointestinal bleed, and all were admitted as in- patients, and all were treated at the facility. 15. Based on the foregoing, Jupiter Medical Center violated Section 395.1041(3) (d)1., Florida Statutes, and/or Rules 59A-3.255 (4) (a), and S9A-3.255(b) (e)2., Florida Administrative Code, carrying in this case, an assessed fine of $250.00. COUNT II JUPITER MEDICAL CENTER FAILED TO FOLLOW THEIR POLICIES AND PROCEDURES REGARDING INCOMING EMERGENCY TRANSFERS FOR ONE (1) PATIENT Rule 59A-3.255(2) (a), Florida Administrative Code (EMERGENCY CARE) 16. AHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 17. During the visit conducted on 01/03-04/07 and based upon interview and record review, the facility failed to follow their policy and procedures regarding incoming emergency transfers for 1 (Patient #21) of 21 sampled patients. 18. A review of the clinical record for Patient. #21 was conducted on 01/04/2007. The record revealed that Patient #21 was transported to another hospital by Emergency Medical Services (EMS) on 09/16/2006, after being found sitting on the ground at work vomiting bright red blood. 19. A review of the other hospital's Emergency Department Transfer out Log showed that on 09/16/2006 at 20:47, the other hospital contacted Jupiter Medical Center regarding an emergency transfer of Patient #21 to the facility, and was told by a = specifically identified representative of the facility that the facility had no Gastroenterology physician on call coverage. 20. According to the facility's policy on the transfer of patients to the facility, reviewed on 01/03/2006, Emergency Transfers are defined as requests for transfers from another facility due to lack of service at the transferring facility. The policy specifies the following: The Emergency Department physician will record the request, including disposition, on the Transfer-In Log. If service capability is not available as determined by the Nursing Supervisor or Administrator, the transferring hospital will be advised of the inability to accept the patient. The reason for declination will be recorded on the Transfer-In Log. 21. During an interview with the Risk Manager, the Clinical Manager of the Emergency Department and the Emergency Department Physician on 01/03/2006, at 10:55 AM, all three individuals confirmed that any call regarding a possible emergency transfer from another facility goes directly to the Emergency Department Physician who makes the decision to accept or decline the patient based upon service capability. All three individuals informed the surveyor that it is the responsibility of the Emergency Department Physician to record the request and the disposition of the request in the facility's Transfer-In Log. 22. A review of Jupiter Hospital’s Transfer-In Log, conducted on 01/03/2006, failed to reveal any mention of the 09/16/2006, request to transfer patient #21 as documented in the other hospital's Emergency Department Transfer-Out Log. 23. During an interview with the Clinical Manager of Jupiter Hospital’s Emergency Department (Clinical Manager) on 01/03/2006 at 1:35 PM, the Clinical Manager agreed that the request for transfer was not documented in the facility's Transfer-In Log. The Clinical Manager confirmed that the representative identified on the other hospital's Emergency Department Transfer-Out Log was an employee of Jupiter Hospital who worked on the night shift in registration in the Emergency Department. Staffing records confirm that this employee was working on 09/16/2006, during the time of the contact call. The Clinical Manager stated, "she (the identified employee) shouldn't be making transfer decisions." Based on the findings above it was determined that Jupiter Hospital did not ensure the consistent implementation of their emergency transfer policy. 24. Based on the foregoing, Jupiter Medical Center violated Rule 59A-3.255(2) (a), Florida Administrative Code, carrying in this case, an assessed fine of $250.00. COUNT IIIT JUPITER MEDICAL CENTER FAILED TO MAINTAIN AN EMERGENCY SERVICES TRANSFER MANUAL IN ACCORDANCE WITH THE LAW Rule 59A-3.255(6)(c) and (d), Florida Administrative Code (EMERGENCY CARE) 25. AHCA re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 26. During the visit of 01/03-04/07 and based upon interview and record review, the facility failed to maintain a transfer manual containing decision protocols for when to transfer a patient and a list of receiving hospitals with special care capabilities, including the telephone number of a contact person. 27. A review of the facility's Transfer Manual as presented to the surveyor was conducted on 01/03/2006. The manual contained a page entitled Transfer Log Instructions, a Transfer-Out Log Form, a listing of hospitals specifying mileage from Jupiter Hospital and directions from Jupiter Hospital to each listed hospital. The Transfer Log lists instructions only for transferring a patient to another facility and those instructions address only procedures for filing out forms. There are no protocols listed addressing decision protocols for when to transfer a patient. The manual also fails to list protocols addressing procedures that must be followed when a transfer request is received from another hospital. 28. Further review of the manual revealed that although the facility maintains a list of receiving hospitals, the list does not identify the special care receiving capabilities of each facility. The list only specifies, if a hospital provides trauma services or does not provide a service such as Psychiatry or Pediatrics. Although the list contains the name and phone number of each hospital, the list does not specify the name or title of a contact person at each facility. During an interview with the Clinical Manager of the Emergency Department on 01/03/2006 at 10:50, the Clinical Manager confirmed that the listing does not include the special care capabilities of each hospital and that the person attempting to secure transfer would have to call each hospital and ask. 29. During the visit of 1/03-04/07 and based upon interview and record review, Jupiter Hospital failed to maintain a transfer manual containing: decision protocols for receiving a call from a transferring hospital; requirements for specific information regarding the patient's problem; estimated time of patient arrival; specific medical requirements; a request to transfer the patient's medical record with the patient; the name of the transporting service; and the assignment of a _ specific person on each shift who shall have responsibility for being knowledgeable of the transfer manual and. maintaining it. 30. The surveyor reviewed the facility's transfer manual on 01/03/2006. The manual only lists instructions for transferring a patient to another facility and those instructions only address procedures for filing out forms. The manual fails to list protocols addressing procedures that must be followed when a transfer request is received from another hospital. The transfer manual also fails to address the assignment of a specific person on each shift who maintains responsibility for the manual. 31. A review of the facility's Transfer-In Log was conducted on 01/03/2006. While the Transfer-In Log does document date, time, name of the patient for whom transfer is requested, age, gender, diagnosis, whether the patient was accepted or not, physician name and physician signature, it fails to document the following: specific information regarding each patient's problem; estimated time of patient arrival; specific medical requirements; a request to transfer the patient's medical record with the patient; and the name of the transporting service. 32. During an interview with the Risk Manager on 01/03/2006 at 12:30 PM, the Risk Manager confirmed that the Transfer-In Log fails to document specific information regarding each patient's problem, the estimated time of patient arrival, the specific medical requirements of each patient for who transfer is requested, a request to transfer the patient's medical record with the patient, and the name of the transporting service. 33. Based on the foregoing, Jupiter Medical Center violated Rule 59A-3.255 (6) (c) and (d), ' Florida Administrative Code, carrying in this case, an assessed fine of $400.00. 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 Counts I through III. B. Assess a fine against the facility in the amount of nine hundred dollars ($900.00) . c. Grant such other relief as this Court deems is just and proper. 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. 11 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. IF YOU WANT TO HIRE AN ATTORNEY, YOU HAVE THE RIGHT TO / BE PRESENTED BY AN ATTORNEY IN mms warren. / Respegeeetay subicves oy ~ ria Lawton-Russell, Esquire AHCA - Senior Attorney Spokane Bldg., Suite #103 8350 NW 52™ Terrace Miami, Florida 33166 (305) 470-6805 Copies furnished to: Diane Reiland Field Office Manager Agency for Health Care Administration 5150 Linton Boulevard, Suite 500 Delray Beach, Florida 33484 (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 Paul Dell Uomo, Administrator, Jupiter Medical Center, 1210 South Old Dixie Highway, Jupiter, Florida 33458, and to Timothy E. Monaghan, Registered Agent, 54 N.E. 4° Avenue, Delray Beach, Florida ‘ +n 33483 on , 2007. / Tria Lawton-Russell, Esq.

Docket for Case No: 07-002304