a ing if STATE OF FLORIDA OB py, So & AGENCY FOR HEALTH CARE ADMINISTRATION “4? Fp on © Gis, 4 4; STATE OF FLORIDA, “Oil! Siog Ny AGENCY FOR HEALTH CARE 0 y- / } ih 1 Kel S rp Op ADMINISTRATION, “RS ae Petitioner, vs. Case No. 2008000348 ST. ANTHONY’S HOSPITAL, INC., d/b/a SAINT ANTHONY’S HOSPITAL, Respondent. / ADMINISTRATIVE COMPLAINT COMES NOW the Petitioner, State of Florida, Agency For Health Care Administration . (‘the Agency”), by and through its undersigned counsel, and files this Administrative Complaint against the Respondent, St. Anthony’s Hospital, Inc., d/b/a Saint Anthony’s Hospital (the “Respondent” or “Respondent Facility”), pursuant to Sections 120.569 and 120.57, Florida Statutes (2007), and alleges as follows: NATURE OF THE ACTION This is an action to impose an administrative fine against a hospital in the amount of one thousand dollars ($1,000.00) pursuant to Section 395.1065, Florida Statutes (2007). JURISDICTION AND VENUE 1, The Court has jurisdiction over the subject matter pursuant to Sections 120.569 and 120.57, Florida Statutes (2007). 2. The Agency has jurisdiction over the Respondent pursuant to Sections 20.42 and 120.60, Florida Statutes (2007), Chapters 408, Part II, and 395, Part I, Florida Statutes (2007), and Chapter 59A-3, Florida Administrative Code (2007). 3. Venue lies pursuant to Rule 28-106.207, Florida Administrative Code. PARTIES 4. The Agency is the licensing and regulatory authority that oversees hospitals in Florida and enforces the applicable federal and state regulations, statutes and rules governing hospitals pursuant to Chapter 408, Part II, Florida Statutes (2007), Chapter 395, Part I, Florida Statutes (2007), and Chapter 59A-3, Florida Administrative Code. The Agency may deny, revoke, suspend a license, or impose an administrative fine against a hospital, for the violation of any provision of Chapter 395, Part I, Florida Statutes, or any rule adopted under that chapter. 5. The Respondent was issued a license by the Agency to operate a 395-bed hospital (License No. 4215) located at 1200 — 7 Avenue North, St. Petersburg, Florida 33705, and was at all times material to the allegations of this complaint required to comply with the applicable federal and state regulations and statutes. COUNTI 6. The Agency re-alleges and incorporates by reference paragraphs | through 5. 7. Under Florida law, each hospital shall develop and implement policies and procedures on discharge planning. Specifically, Sections 59A-3.254(2)(a)-(d), Florida Administrative Code, require: (2) Coordination of Care. Each hospital shall develop and implement policies and procedures on discharge planning which address: (a) Identification of patients requiring discharge planning; (b) Initiation of discharge planning on a timely basis; (c) The role of the physician, other health care givers, the patient, and the patient’s family in the discharge planning process; and (d) Documentation of the discharge plan in the patient’s medical record including an assessment of the availability of appropriate services to meet identified needs following hospitalization. 8. On December 7, 2007, the Agency conducted a complaint survey, CCR#2007012988, of the Respondent Facility. 9. Based on interview and review of clinical records it was determined that the facility did not assess a patient’s discharge needs for availability of appropriate continued care for one (#3) of three records reviewed. This practice may cause a patient's post-discharge goals not to be met. 10. Patient #3's History and Physical dated 11/9/07 revealed that Patient #3 was admitted through the Emergency Department on 11/9/07 with left forearm wounds and a history of psychiatric problems. 11. Review of admission paperwork revealed that Patient #3 resided in an Adult Living Facility (ALF). 12. Review of the nursing admission database dated 11/9/07 at 11:40 a.m. revealed that Patient #3's primary contact was a case management company for psychiatric patients. 13. | Nursing documentation dated 11/9/07 at 1:30 p.m. revealed that Patient #3 refused nasal medication and refused to have an intravenous line started, indicating “the germs had been swallowed with lunch.” 14. Physician progress notes, dated 11/11/07, revealed a discharge plan placing Patient #3 on daily oral antibiotics and twice-daily wound care in 1-2 days. 15, Psychiatric progress notes, dated 11/11/07, further revealed that Patient #3 needed to be kept in the hospital for treatment, and that the patient had a history of poor judgment for self-care. 16. Physician orders, dated 11/13/07, but without indicating a time, ordered that the hospital was to discharge Patient #3 and to consult the home health agency. 17. Facility Case Management documentation, dated 11/13/07, at 2:30 p.m. revealed the home health agency was called and indicated the home health agency would inquire if the home health agency could provide a few visits to teach and train Patient #3. 18. Facility Case Management documentation, dated 11/13/07, at 3:00 p.m. revealed that the home health agency would accept Patient #3. 19. Psychiatric Case Management progress notes, dated 11/13/07, but without indicating a time, revealed that Patient #3 was delusional and would need transportation when discharged. 20. Nursing documentation, dated 11/13/07 at 10:00 a.m., revealed the presence of yellowish drainage from Patient #3’s upper arm wound. 21. Review of the Adult Living Facility Resident Health Assessment Form 1823 for Patient #3 revealed that Patient #3 was on contact precautions, and needed supervision with grooming and dressing, with wound care twice a day, and with a daily oral antibiotic. 22. The Form 1823 also revealed that Patient #3 required twenty-four hour nursing or psychiatric care and revealed that Patient #3 had a communicable disease. However, the form had not been signed by a physician. 23. Review of discharge instructions, signed by Patient #3 and a physician and dated 11/13/07, revealed that Patient #3 was discharged to an ALF with home health care for wound care and prescriptions were given for wound care medication and an oral antibiotic. 24. Review of nursing documentation, dated 11/13/07 at 6:00 p.m., revealed the patient was sent to the ALF by way of a Taxi cab. 25. There was no evidence of the Psychiatric Agency Case Manager assigned to Patient #3 being aware of the wound care needs, the home health agency's limited ability to provide at most a few once-per-day visits, and the home health agency’s plan to teach and train Patient #3. 26. The documentation did not reveal evidence of Patient #3's ability to do twice-a- day wound care. 27. There was no evidence of a physician being notified of Patient #3's inability to provide the wound care or the home health agency's limited ability to provide wound care. 28. There was no evidence of the ALF receiving a report or being notified of either Patient #3’s discharge and or the Respondent hospital’s discharge plan. 29. Review of a triage record revealed the patient presented to the Respondent hospital again on 11/15/07 at 2:30 p.m. with a chief complaint of a left leg wound. 30. Review of the patient's home medication revealed no evidence of Patient #3 being on the oral antibiotic for which a prescription had been provided at Patient #3’s discharge from Respondent hospital. However, nursing documentation revealed that the oral. antibiotic was administered to Patient #3 in Respondent hospital’s Emergency Room. 31. Review of the facility Social Worker Case Manager documentation, dated 11/15/07 at 4:05 p.m., revealed that Patient #3 stated if he or she was sent back to the ALF where Patient #3 had been residing, Patient #3 would cut him- or herself with a razor. 32. The documentation revealed a psychiatric consult would be requested. 33. Emergency Room nursing documentation revealed that Patient #3 was having suicidal and homicidal ideations, and that Respondent hospital’s psychiatry staff was aware of these ideations. 34. | Emergency Room nursing documentation revealed that Patient #3 was discharged at 4:40 p.m. on November 15, 2007, with instruction to the Agency Case Manager. 35. Interview with the Social Worker and Registered Nurse Case Managers on 12/7/07 at approximately 4:05 p.m. revealed that the Psychiatric Agency Case Manager did not communicate with case management for discharge planning on Patient #3’s first visit to the Respondent hospital. 36. The interviews also revealed no evidence of any psychiatric consult being conducted on the second, November 15, 2007, visit by Patient #3 to Respondent hospital. 37. The interviews and review of clinical records revealed Patient #3 was not appropriately discharged. 38. The Agency cited the Respondent for the above-cited deficiency. Specifically, the Respondent Facility failed to develop and implement policies and procedures to assess and document the availability of appropriate services to meet patients’ identified discharge need for appropriateness of continued care following discharge from Respondent hospital. 39. The above cited deficiency subjects the Respondent Facility to the imposition of an administrative penalty in a sum not to exceed one thousand dollars ($1,000.00) per violation per day. § 395.1065 (2)(a) Florida Statutes (2007). WHEREFORE, the Petitioner, State of Florida, Agency for Health Care Administration, respectfully requests this tribunal to impose an administrative fine against the Respondent in the total amount of $1,000.00, or such other relief as this tribunal deems just. Respectfully submitted this_ || day of February, 2008. cnt) Howie ames H. Harris, Esq. Fla. Bar. No. 817775 Assistant General Counsel Agency for Health Care Admin. 525 Mirror Lake Drive, 330H St. Petersburg, FL 33701 727-552-1435 NOTICE Respondent is notified that it has a right to request an administrative hearing pursuant to Section 120.569, Florida Statutes. Respondent has the right to retain, and be represented by an attorney in this matter. 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 Agency Clerk, Agency for Health Care Administration, 2727 Mahan Drive, Bldg #3,MS #3, Tallahassee, FL 32308;Telephone (850) 922-5873. RESPONDENT IS FURTHER NOTIFIED THAT THE FAILURE TO REQUEST 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. CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing has been served to: William G. Ulbricht., CEO/Registered Agent, St. Anthony’s Hospital, 1200 — 7 Ave., N., St. Petersburg, Florida 33705, by U.S. Certified Mail, Return Receipt No. 7007 0710 0004 0428 8983 on this _l|__ day of February, 2008. Gane}. Mansi James H. Harris, Esq. Assistant General Counsel Copies furnished to: William G. Ulbricht Patricia R. Caufman James H. Harris, Esq. CEO/Registered Agent Field Office Manager Agency for Health Care Admin. St. Anthony’s Hospital 525 Mirror Lake Dr., 4"" Floor | 525 Mirror Lake Drive, 330H 1200-7" Ave., N. St. Petersburg, Florida 33701 | St. Petersburg, Florida 33701 St. Petersburg, Florida 33705 | (Interoffice) (Interoffice) (U.S. Certified Mail)

Docket for Case No: 08-001289