STATE OF FLORIDA : AGENCY FOR HEALTH CARE ADMINISTRATION . SSEP 23 PH &:23 STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, Vv. FLORIDA HOSPITAL-OCEANSIDE, Respondent. ADMINISTRATIVE COMPLAINT COMES NOW the Agency for Health Care Administration (hereinafter “AHCA”), by and through undersigned counsel, and files this Administrative Complaint against FLORIDA HOSPITAL-OCEANSIDE, (hereinafter “Respondent” ) and alleges: NATURE OF THE ACTION 1.. This is an action to impose an administrative fine in the amount of two thousand ($2,000) dollars, based upon the Respondent being cited for two (2) confirmed violations of Rule 59A-3.255(6) (a), Florida Administrative Code (2007). JURISDICTION AND VENUE 2. The Agency has jurisdiction pursuant to Sections 120.569 and 120.57, Florida Statutes (2007), and Chapter 395, Part I, Florida Statutes (2007). 3. Venue lies in Volusia County, Division of Administrative Hearings, pursuant to Rule 28-106.207, Florida Administrative Code (2006). PARTIES 4. The Agency is the regulatory body responsible for the licensure of hospital registries and the enforcement of all applicable federal and state regulations, statutes and rules, governing nurse registries pursuant to § 400, Part ‘III, Florida Statutes (2007), and Fla. Admin. Code R. 59A- 18. The Agency is authorized to deny, revoke or suspend the license of, or impose an administrative fine against, a nurse registry, for violations of the applicable federal and state regulations, statutes and rules, pursuant to §&§ 400.506, and 408.815(1) (c), Fla. Stat. (2007). S. The State of Florida, Agency for Health Care Administration (“AHCA”) is the enforcing authority with regard to hospital licensure pursuant to:Chapter 395, Part I, Florida Statutes (2007), and Chapter 59A-3, Florida Administrative Code (2007). . 6. Respondent is a Florida non profit hospital located at 264 South Atlantic Avenue, Ormond Beach, Florida 32176. Respondent was, at all’ times material hereto, a licensed hospital, License number 4201, under Chapter 395, Part I, Florida Statutes (2007), and Chapter 59A-3, Florida Administrative Code (2007). cOUNT I RESPONDENT FAILED TO ENSURE THAT FOR 2 OF 31 (#2, #16) PATIENTS THE ON CALL DOCTOR RESPONDED WITHIN THE 30 MINUTE TIME FRAME, IN CONTRAVENTION OF RULE 59A-3.255(6) (a), FLORIDA ADMINISTRATIVE CODE (2007) AN ADMINISTRATIVE FINE OF $1,000 IS WARRANTED. PURSUANT TO SECTION 395.1065(2) (a), FLORIDA STATUTES (2007) 7... BHCA_re-alleges. and incorporates.paragraphs (1) through (6) as if fully set forth herein. 8. On April 11, 2008, AHCA conducted an unannounced , complaint investigation. 9. Based on a review of facility documentation and staff interview, the facility failed to ensure that for 2 of 31 patients (#2, #16), on call physicians responded — within the 30 minute time frame, or that a physician responded to a request to come to the Emergency Department to exam a patient when requested. The surveyor’s findings were as follows: Review of the Emergency Department record for Patient #2, who presented to the Emergency Department on 1/2/08 ‘with a chief complaint of a possible stroke, revealed that two emergency physicians had seen the patient, and it was noted that a diagnosis of Wernicke’s encephalopathy (Senile psychotic syndrome involving confabulation and disorientation with preservation of mobility, loquacity, and good spirits) had been considered by both physicians. The first physician that had seen the patient contacted the hospitalist on call at 7:20am, and then the second physician had also contacted this same hospitalist at 9:28am, the hospitalist felt that the patient should be discharged and followed as an outpatient. The second Emergency Department physician's progress note stated that he would contact the neurologist on call, and then call the hospitalist again. Two calls were placed Nursing notes at 9:28am state that the physician was talking to the hospitalist again, and that the neurologist was again called. A call was received around 10am from the hospitalist on call, accepting the patient, and that he would consult neurology himself. Interview was conducted on 4/11/08 at 10:15am, with the second emergency department physician seeing the patient. He could not remember if the neurologist on call had ever returned the call, and did not know why the hospitalist had changed his mind about accepting the patient. Interview on 4/11/08 at 9:15am, with the nurse that had been on the day shift revealed that if the physician does not call back, they will call the exchange again. They do not have any documentation to indicate if a physician does or does not return a call, and do not write any type of report. She was unable to remember if the neurologist returned the call. Review of the medical record for Patient #16, a forty- three year old, revealed that the patient was brought to the emergency department on 2/10/08 at 0659 with a complaint of shortness of breath and vomiting. The patient had a past medical history including being an asthmatic, bronchitis, hepatitis C, bipolar, COPD, and acid reflux disease. The patient stated they had been to an emergency room the day before and had been given approximately 9 _ prescriptions. The patient was unable to have.any of the prescriptions filled except for the antibiotic. At the time of presentation to the emergency room, the patient had a temperature of 100 degrees, chest pain in the bronchial region with the coughing, intense coughing with secretions, and audible wheezes. Blood work included a white blood count of 19.7(normal 3.4-10.1), Potassium low at 3.5 (normal 3.6-5.1). Oxygen saturation was 98% on room air, and the chest x-ray demonstrated chronic obstructive ‘pulmonary disease along with pulmonary interstitial disease and alveolar filling bilaterally through most of the interstitial region. The patient had a long history of noncompliance with asthmatic medications and stated that the breathing was much. worse than it had been, and also complained of increased body temperature. Physical exam noted the pharynx with erythema, significant tracking and large amount of secretions. Lung fields demonstrated significant wheezes in alli fields, increased cough with sputum, which was greenish in nature. Physician documentation states that they tried to admit this patient to the hospitalist on call. Per physician documentation, it was explained to the hospitalist that the patient was a non-compliant asthmatic “and would not benefit from going home and should probably be observed at least until a pulmonologist or they could review and help the patient try to find a way to get compliant with the asthma and COPD medications. It was explained to the hospitalist that the white blood count was 19.7, the patient. had been to an emergency room the previous. day, and had not filled the prescriptions,..and.. that perhaps it would benefit the patient to be seen by social services. Per physician documentation, the hospitalist decided that the patient should not be admitted, and "was offered to come to the emergency room if he wished to take control of the patient if he did not want to admit". There was no. documentation of the response by the hospitalist, and no documentation to show if the hospitalist came to the emergency department to see the patient. Per physician documentation, the hospital administrator on call was called. The physician noted that she suggested that an emergency room to emergency room transfer should be done, and that she would work on trying to see if perhaps pulmonology or other services and social service would be available for the patient. 10. The findings listed above constitute a violation of Rule 59A-3.255(6) (a), Florida Administrative Code (2007). Respondent did not have appropriate policies and procedures in place and implemented, which resulted in. patients #2 and #16 not receiving care that reflected the needs of this patient. 11. A fine of one thousand ($1,000) dollars for this violation is statutorily authorized pursuant to Section 395.1065(2), Florida Statutes (2007). COUNT IT RESPONDENT FAILED TO ENSURE THAT FOR 1 OF 31 PATIENTS (#2) THE..ON._CALL. DOCTOR RESPONDED. WITHIN. THE. 30 MINUTE. .TIME..... FRAME, IN CONTRAVENTION OF RULE 59A-3.255(6) (a), FLORIDA : ADMINISTRATIVE CODE (2007) AN ADMINISTRATIVE FINE OF $1,000 IS WARRANTED. PURSUANT TO SECTION 395.1065(2) (a), FLORIDA STATUTES (2007) 12. AHCA re-alleges and incorporates paragraphs (1) through (6) as if fully set forth herein. 13. On April 11, 2008, AHCA conducted an unannounced complaint investigation. 14. Based on a review of facility documentation and staff interview, the facility failed to ensure that for 1 of 31 patients (#2), on call physicians responded within the 30 minute time frame, or that a physician responded to a request to come to the Emergency Department to exam a patient when requested. The surveyor’s findings were as follows: Review of the Emergency Department record for Patient #2, who presented to the Emergency Department on 1/2/08 with a chief complaint of a possible stroke, revealed that two emergency physicians had seen the patient, and it was noted that a diagnosis of Wernicke's encephalopathy (Senile psychotic syndrome involving confabulation and disorientation with preservation of mobility, loquacity, and good spirits) had been considered by both physicians. The first physician that had seen the patient contacted the hospitalist on call at 7:20am, and then the second physician had also contacted this same hospitalist at 9:28am, the hospitalist felt that the patient should be discharged and followed as an outpatient. 00. _. The second Emergency Department physician's progress note stated that he would contact the neurologist on call, and then call the hospitalist again. Two calls were placed to the neurologist without response per the progress notes. Nursing notes at 9:28am state that the physician was talking to the hospitalist again, and that the neurologist was again called. A call was received around 10am from the hospitalist: on call, accepting the patient, and that he would consult neurology himself. Interview was conducted on 4/11/08 at 10:15am, with the second emergency department physician seeing the patient. He could not remember if the neurologist on call had ever returned the call. Interview on 4/11/08 at 9:15am, with the nurse that. had been on the day shift revealed that if the physician does not call back, they will call the exchange again. They do not have any documentation to indicate if a physician does or does not return a call, and do not write any type of report. She was unable to remember if the neurologist returned the call. 15. The findings listed above constitute a violation of Rule 59A-3.255 (6) (a), Florida Administrative Code (2007). Respondent did not have appropriate policies and procedures in place and implemented, which resulted in patient not receiving care that reflected the needs of this patient. 16. A fine of one thousand ($1,000)-.dollars for this violation is statutorily authorized pursuant to Section 395.1065(2), Florida Statutes (2007). CLAIM FOR RELIEF WHEREFORE, the 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 on Count I and II; (B) Recommend an:administrative fine against Respondent in the amount of two thousand ($2,000) dollars for Count I and II, pursuant to Section 395, Part I; Florida Statutes (2007); (C) Assess attorney's fees and costs; and (DB) Grant all other general and equitable relief allowed by law. 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 Election of Rights form. All requests for hearing shall be made to the attention of Richard Shoop, Agency Clerk, Agency for Health Care Administration, 2727 Mahan Drive, MS #3, Tallahassee, Florida 32308. 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. Respectfully submitted, Moore, Esq. Florida Bar # 768715 Agency for Health Care Administration . 2727 Mahan Drive, MS #3 Tallahassee, Florida 32308 (850) 922-5873 10 CERTIFICATE OF SERVICE | I HEREBY CERTIFY that a true copy hereof has been sent by U.S. Certified Mail, Return: Receipt No. 7004 2890 0000 5526 8329, to Registered Agent, T.L Trimble, 111 North Orlando Avenue, Winter Park, FL 32789, on this the __ day of July, 2008, and by U.S. Certified Mail, Return Receipt No. -7004. 2890 0000-5526 8343,:.to Owner;--Memorial--Health —- systems Inc, 701 W. Plymouth Avenue, Deland,,FL 32724, on “this the U_ day of July, 2008 and by U.S. Certified Mail, Return. Receipt No. 7004 2890 0000 5526 8336, to Administrator, Daniel Andrew Wolcott, 264 South Atlantic Avenue, Ormond Reach, FL 32176, on this the VW day of July, 2008. Copies furnished to: Patricia Caufman Field Office Manager Agency for Health Care Administration (Interoffice Mail) COMPLETE THIS GECTIOW ON DELIVERY SENDER: COMPLETE THIS SECTION ® Complete items 1, 2,-and,.3..Also-complete > item 4 if Restricted Delivery is desired. tg @ Print your name and addréss on the reverse so that we can return the card to you... at § Attach this card to the back of the maiipioce,” . or on the front if space permits. 1. Article Addressed to: Memovial Heal Th Gystoms TO. W- nan Muth wey velangd, FL $2124 D. jis delivery address different from item 1? C1 Yes if YES, enter delivery address below: (1. No Certified Mail “ C) Express Mail O Registered C2 Return Receipt for Merchandise Cl insured Mail 01 C.0.D. 4. Restricted Delivery? (Extra Fee) * rancor tom serace woop TOO U 2540 0000 SSL FH PS Form 3811, February 2004 Domestié Return Receipt 4102595-02-M-1540 SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY m™ 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 maiipiece, or on the front if space permits. TL . Ty wll, [M1 Novy Ovlandd Ave Wi Yn PAL, FL 3. ice Type 421 54 Certified Mail 1 Express Mail Registered D Return Receipt for Merchandise Oi Insured Mail [1 0.0.0, 4; Restricted Delivery? (Extra Fee) O Yes 2. Article Number (renster from service labo) ~)() OU CB .PS Form 3811, February 2004 Domestic Return Receipt 102865 02-M-t540 oe D. ie doivery access 2 iferent A omitern t2 CY Yes If YES, enter delivery address below: O1No

Docket for Case No: 08-004763