STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION STATE OF FLORIDA, . AGENCY FOR HEALTH CARE ADMINISTRATION, a (YY {Sd Petitioner, vs. ACHA No.: 2007011109 KONRAD FILUTOWSKI d/b/a FILUTOWSKI EYE INSTITUTE, P.A., d/b/a SUNRISE SURGICAL CENTER, Respondent. / ADMINISTRATIVE COMPLAINT COMES NOW the Petitioner, State of Florida, Agency For Health Care Administration (hereinafter “the Agency”), by and through its undersigned counsel, and files this Administrative Complaint against the Respondent, Konrad Filutowski d/b/a Filutowski Eye Institute, P.A., d/b/a Sunrise Surgical Center (hereinafter “the Respondent”), pursuant to Sections 120.569 and 120.57, Florida Statutes (2007), and alleges as follows: NATURE OF THE ACTION 1. This is an action to impose an administrative fine against an ambulatory surgical center in the amount of three thousand dollars ($3000), pursuant to Section 395.1065(2)(a), Florida Statutes (2007), for. violations of Rules 59A-5.005(1), S9A-5.011(1), and 59A-5.016(1), Florida Administrative Code (2007). JURISDICTION AND VENUE 2. This Court has jurisdiction over the subject matter pursuant to Sections 120.569 and 120.57, Florida Statutes (2007). 4 3. The Agency has jurisdiction over the Respondent pursuant to Chapter 395, Part I Florida Statutes (2007), Chapter 59A-5, Florida Administrative Code (2007) and Chapter 408, Part II, Florida Statutes (2007). 4. Venue lies in Volusia County pursuant to Rule 28-106.207, Florida Administrative Code (2007). PARTIES 5. The Agency is the enforcing authority with regard to ambulatory surgical centers pursuant to Chapter 59A-5, Florida Administrative Code and Chapter 495, Part I, Florida Statutes (2007). The Agency is to impose an administrative fine for violations as provided for by Section 395.1065(2)(a), Florida Statutes (2007). 6. The Respondent is licensed to operate an ambulatory surgical center in Florida, License No. 766, and holds itself out to the public as operating a licensed ambulatory surgical center. Respondent is located at 110 Yorktowne Drive, Daytona Beach, FL 32119, and was at all material times required to comply with the applicable federal and state regulations, statutes and rules, COUNT I THE RESPONDENT FAILED TO ASSUME RESPONSIBILITY FOR DETERMINING, IMPLEMENTING AND MONITERING OPERATION POLICIES AND FAILED TO ENSURE THE PHYSICAL PLANT CONSTITUTED A SAFE AND SANITARY ENVIRONMENT IN VIOLATION OF RULE 59A-5.005(1), FLORIDA ADMINISTRATIVE CODE. 7. The Agency re-alleges paragraphs 1 through 6 as if fully set forth herein. 8. Rule 59A-5.005(1), Florida Administrative Code (2007), provides in relevant part: (1) The ambulatory surgical center organization shall have an effective governing authority responsible for the legal and ethical conduct of the ambulatory surgical center. The governing body in fulfilling its responsibility shall be organized under approved written bylaws, rules and regulations which shall: * * * (b) Provide for the designation of officers, their duties, and for the organization of the governing body into essential committees with the number and type consistent with the size and scope of the ambulatory surgical center’s activities. (c) Coordinate through an executive committee or the governing body as a whole, the policies and activities of the ambulatory surgical centers and special committees established by the governing body. ° * * * (e) Establish a position, the incumbent of which shall be responsible for operation and maintenance of the ambulatory surgical center as a functioning institution, and define the methods established by the governing body for holding such designated person responsible. 9. On or about September 20, 2007, the Agency conducted a complaint investigation of the Respondent. 10. At that time, the Respondent did not comply with the above provision of the Florida Administrative Code. 11. Based upon observation, interview and record review, the facility’s governing body failed to establish a program for ensuring that the physical plant and the facility’s environment remained safe and sanitary. The findings include: A. Evidence of water infiltration was seen in the two (2) surgical suites, common scrub area, storage area for sterile and bulk supplies, ladies dressing room, and in hallways leading to the surgical suites. Water was dripping from the ceiling into a wastebasket in one of the surgical suites. B. The water infiltration had caused ceiling tile damage, damage to walls, and caused tiles on the floors to buckle, C. The Assistant Director of Nursing during an interview on September 20, 2007 between 9:00 and 11:00 AM stated that surgery was performed on September 11 and 12, 2007 and the next scheduled surgery is scheduled for September 25 and 26, 2007. 12, The Agericy imposed an Emergency Order of Immediate Moratorium on Admissions 13. These above facts illustrate that the governing body failed to establish a position responsible for maintaining the safety and sanitation of the physical plant or that the person responsible failed to ensure the facility was operational. 14. The above constitutes a violation for which a fine of $1000.00 is statutorily authorized pursuant to Section 395.1065(2)(a), Florida Statutes. COUNT I THE RESPONDENT FAILED TO ESTABLISH A PROGRAM FOR IDENTIFYING AND PREVENTING INFECTIONS, MAINTAINING A SANITARY ENVIRONMENT, AND FAILED TO IDENTIFY AND ADDRESS THE EFFECTS OF WATER DAMAGE ON THE ENVIRONMENTAL SYSTEM IN VIOLATION OF RULE 59A-5.011(1), FLORIDA ADMINSITRATIVE CODE. 15, The Agency re-alleges paragraphs | through 6 as if fully set forth herein. 16. Rule 59A-5.011(1), Florida Administrative Code (2007), provides: (1) Each ambulatory surgical center shall establish an Infection Control Program involving members of the medical staff, nursing staff, other professional and administrative staff as appropriate. The program shall provide for: (a) The surveillance, prevention, and control of infection among patients and personnel; (b) The establishment of a system for identification, reporting, evaluating and maintaining records of infections; (c) Ongoing review and evaluation of aseptic, isolation and sanitation techniques employed by the center, and (d) Development and coordination of training programs in infection control for all center personnel. 17. On or about September 20, 2007, the Agency conducted a complaint investigation of the Respondent. 18. At that time, the Respondent did not comply with the above provision of the Florida Administrative Code. 19. Based upon observation, interview and record review, the facility failed to establish a program for identifying and preventing infections, maintaining a sanitary environment, and failed to address of water damage on the environmental system. The findings include: A. Evidence of water infiltration was seen in the two (2) surgical suites, common scrub area, storage area for sterile and bulk supplies, ladies dressing room, and in hallways leading to the surgical suites. Water was dripping from the ceiling into a wastebasket in one of the surgical suites. B. The water infiltration had caused ceiling tile damage, damage to walls, and caused tiles on the floors to buckle. C. No evidence was seen to indicate the facility addressed issues related to such conditions which create a fertile ground for the growth of potentially infectious or damaging particulates including mold and bacteria. D. The Assistant Director of Nursing during an interview on September 20, 2007 between 9:00 and 11:00 AM stated that surgery was last performed on September 11 and 12, 2007 and the next scheduled surgery is on September 25 and 26, 2007. 20, The Agency imposed an Emergency Order of Immediate Moratorium on Admissions. 21. The above facts show that the Respondent failed to implement a program for identifying and preventing infections, maintaining a sanitary environment, and failed to address of water damage on the environmental system. 22. The above constitutes a violation for which a fine of $1000.00 is statutonly authorized pursuant to Chapter 395.1065(2)(a), Florida Statutes (2007). COUNT It THE RESPONDENT FAILED TO MAINTAIN A SAFE AND SANITARY ENVIRONMENT TO PROTECT AND MAINTAIN THE HEALTH AND SAFETY OF PATIENTS IN VIOLATION OF RULE 59A-5.016(1), FLORIDA ADMINISTRATIVE CODE 23. The Agency re-alleges paragraphs 1 through 6 as if fully set forth herein. 24. Rule S9A-5.016(1), Florida Administrative Code (2007), provides: (1) Each ambulatory surgical center shall establish written policies and procedures designed to maintain the physical plant and overall ambulatory surgical center environment in such a manner that the safety and well-being of patients is assured. 25. On or about September 20, 2007, the Agency conducted a complaint investigation of the Respondent. 26. At that time, the Respondent did not comply with the above provisions of the Florida Administrative Code. 27. Based upon observation, interview and record review, the facility failed to maintain a safe and sanitary environment to protect the health and safety of its patients. The findings include: A. The common scrub area was observed with ceiling tile damage above the scrub sink and surrounding area. The ceiling tile damage was obviously caused by water infiltration. B. The surgical theater numbered one (1), to the left of the scrub area, was not noted to have any visible water damage to ceiling, walls, or floors. C. The surgical theater numbered two (2) is to the right of the scrub area. The tiles of the floor leading into this theater were buckling from the scrub area to the theater 's entranceway. The buckling floor tiles continued through the entry and into the theater for at least a four (4) foot square area. D. In the second surgical theater, water was dripping from the ceiling and being collected into a waste basket. The ceiling tiles in the theater were buckling downward from obvious water infiltration weight. This severe buckling of ceiling. tiles existed throughout a large portion of the ceiling area. E. The wall surrounding the doorway to this theater suffered from water permeation and appeared bloated. F. Down a hallway of the facility are two (2) storage rooms, identified as storage areas for sterile supplies in one, and bulk supplies in the other. G. Both storage areas were empty and had obviously experienced water damage to the ceilings and walls. H. A ladies dressing room for patient use was also observed and therein the majority of the ceiling tiles had been removed, exposing the crawl space with the environmental control systems open and exposed to the room. The flooring in this area was obviously damp from extended exposure to water. L. The Assistant Director of Nursing during an interview on September 20, 2007 between 9:00 and 11:00 AM stated that bulk and sterile supplies were relocated within the facility due to water infiltration into the storage areas for these supplies. All had been relocated within the premises prior to the September 20, 2007 visit. : 28. The Agency imposed an Emergency Order of Immediate Moratorium on Admission 29. The above facts show that the Respondent failed to ensure that the physical plant was maintained in such a manner as to ensure the health and safety of its patients. 30. The above constitutes a violation for which a fine of $1000.00 is statutorily authorized pursuant to Chapter 395.1065(2)(a), Florida Statutes (2007). CLAIM FOR RELIEF WHEREFORE, the Petitioner, State of Florida, Agency for Health Care Administration, respectfully requests that the Court order the following relief against Respondent: (A) — Make factual and legal findings in favor of the Agency as set forth in Count I. (B) Make factual and legal findings in favor of the Agency as set forth in Count I. (C) Make factual and legal findings in favor of the Agency as set forth in Count II. (D) Impose an administrative fine in the amount of three thousand dollars ($3000.00); and (E) Grant such other relief as the court deems is just and proper. NOTICE OF RIGHTS 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 form. 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. \f you want to hire an attorney, you have the right to be represented by an attorney in this matter. RESPONDENT JS FURTHER NOTIFIED THAT FAILURE TO RECEIVE OR REQUEST A HEARING WITHIN TWENTY-ONE (21) DAYS OF RECEIPT OF THIS COMPLAINT, PURSUANT TO THE ATTACHED ELECTION OF RIGHTS, WILL RESULT IN AN ADMISSION OF THE FACTS ALLEGED IN THE COMPLAINT AND THE ENTRY OF A FINAL ORDER BY THE AGENCY. 4 aX Respectfully submitted on this § day of October 2007. ZAYNAB SALMA! SQUIRE Florida Bar I.D. No. 0030942 Agency for Health Care Administration 2727 Mahan Drive, Mail Stop #3 Tallahassee, Florida 32308-5403 (850) 922-5873 / (850) 921-0158 Facsimile CERTIFICATE OF SERVICE J HEREBY CERTIFY that the Administrative Complaint and Election of Rights form has been served to: Administrator and Owner, Konrad W. Filutowski, Konrad Filutowski d/b/a Filutowski Eye Institute, P.A., d/b/a Sunrise Surgical Center, 1070 Greenwood Blvd Lake Mary, FL 32756, by U.S. Certified Mail, Return Receipt Requested 7000 0520 0024 8388 1648, and Konrad Filutowski d/b/a Filutowski Eye Institute, P.A., d/b/a Sunrise Surgical Center, 110 Yorktowne Drive, Daytona Beach, FL 32119, by US. Certified Mail, Return Receipt Requested 7000 0520 0024 8388 1631, on this Jor day of October 2007. (Wan Z AB SALMANSESQUIRE Florida Bar 1.D. No. 0030942 Agency for Health Care Administration 2727 Mahan Drive, Mail Stop. #3 Tallahassee, Florida 32308-5403 (850) 922-5873 / (850) 921-0158 Facsimile Copies furnished to: Administrator and Owner Sunrise Surgical Center 1070 Greenwood Blvd Lake Mary, FL 32756 (U.S. Certified Mail) Sunrise Surgical Center 110 Yorktowne Drive Daytona Beach, FL 32119 ZAYNAB SALMAN, ESQUIRE Agency for Health Care Administration 2727 Mahan Drive, Mail Stop #3 Tallahassee, Florida 32308-5403 (Interoffice Mail) Nancy Marsh Field Office Manager Agency for Health Care Administration 921N. Davis St. Building A, Suite 115 Jacksonville, FL 32209 U.S. Postal Service - CERTIFIED MAIL RECEIPT. (Domestic Mail Only; No. Insurance Coverage Provided) - Postage Cottified Fee Return Receipt Fee {Endorsement Requires) Restricted Delivery Fa (Endorsement Requires) Total Postage & Fees See Reverse for instr ctions Pa SENDER: COMPLETE THIS SECTION @ Complete items 1, 2, and 3. Also complete A. Received by (Please Print Clearly) | 8, Date of Délivery item 4 if Restricted Delivery is desired. ANG ® Print your name and address on the reverse $0 that we can return the card to you. @ Attach this card to the back of the mailpiece, Or on the front if space permits. LA. 0 Addressee : —— delivery address different from item 1? O Yes 1. Article Addressed to: - If YES, enter delivery address below: [1 No Konrok fi lv fovosks jo170 Gre 3. Service Type z O Certified Mail ) Express Mail Lake Mary 1 FL 32 156 oO Registered CO Return Receipt for Merchandise OQ tnsured Mail = G.0.D. 4, Restricted Delivery? (Extra Fee) DOD 6520 O24. 836 (64K PS Form 3811, July 1999 Domestic Return Receipt 102595-00-M-0952 RA U.S. Postal Service CERTIFIED MAIL RECEIPT {Domestic Mai} Only; No Insurance Coverage’ Provided) “B31 Certified Fee Return Receipt Fee (Endorsement Required) Restricted Delivery Fee (Endorsement Required) ‘Total Postage & Fees SENDER: COMPLETE THIS SECTION ’ Complete items 1, 2, and 3. Also complete Item 4 if Restricted Delivery is desired. ™ Print your name and address on the reverse So that we can return the'card to you. ®@ Attach this card to the back of the mailpiece, or on the front if space permits. 1. Article Addressed to: Konrad Filvtowski Sunrise 5 ial Comte llo Vek bunt Dewe Dy na Boul fu 32ll4 2. Article Number (Transfer fram service abe) WOD{) 0520 002 Domestic Retum Receipt PS Form 3811, August 2001 See Reverse for instructions ©. wei st te tA COMPLETE THIS SECTION ON DELIVERY ress different from item 1? 1 Yes If YES, enfer delivery address below: 1 No 3. Service Type Certified Mail 1 Express Mall OD Registered 0 Insured Mait Oc. 4. Restricted Delivery? (Extra Fee) OC Return Receipt for Merchandise ae 102595-02-M-1540 Sinan

Docket for Case No: 07-005386