STATE OF FLORIDA ; AGENCY.FOR HEALTH CARE ADMINISTRATION STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, AHICA No. 2009004635 vs. TBJ BEHAVIORAL CENTER, LLC d/b/a RIVER POINT BEHAVIORAL HEALTH, Respondent. / ADMINISTRATIVE COMPLAINT COMES NOW the Agency for Health Care Administration (hereinafter Agency”), by and through undersigned counsel, and files this administrative complaint against TBJ BEHAVIORAL CENTER, LLC d/b/a RIVER POINT BEHAVIORAL HEALTH, (hereinafter “Facility” or “Respondent”), pursuant to 120.569 and 120.57, Fla. Stat. (2008). NATURE OF THE ACTION 1. This is an action to impose an administrative fine in the amount of one thousand dollars ($1,000.00). JURISDICTION AND VENUE 2. The Agency has jurisdiction pursuant to § 20.42, 120.60, 395, Part J, and 408, Part IL, Florida Statutes (2008). 3. Venue lies pursuant to Fla. Admin. Code R. 28-106.207, PARTIES 4. The Agency is the regulatory body responsible for the licensure of hospitals and the enforcement of all applicable federal and state regulations, statutes and rules, governing Filed January 19, 2010 10:48 AM Division of Administrative Hearings. {i € _ hospitals pursuant to § 395, Part I, Florida Statutes (2008), and Fla. Admin, Code Rule. 59A-3. 3. Respondent operates a hospital located at 6300 Beach Boulevard Jacksonville, Florida 32216, having been issued license number 4011, Respondent was at all times material hereto a hospital under the licensing authority of the Agency, and was required to comply with all applicable rules and statutes. | COUNTI Respondent’s facility failed to ensure that one of seven sampled patients (Patient #1) had physician ordered interventions carried out to ensure not only the patient's safety but also the safety of other patients and the staff. 6. Thie Agency re-alleges and incorporates paragraphs one () through five (5) as if fully set forth herein. 7,’ The regulatory provisions of Florida Law that are pertinent to this alleged violation read as follows: 59A-3.2085(5)(e)(1)-(3) Department and Services. (5) Nursing Service. Each hospital shall be organized and staffed to provide : quality nursing care to each patient. Where a hospital’s organizational structure does not have a nursing department or service, it shall document the otganizational steps it has taken to assure that oversight of the quality of nursing care provided to each patient is accomplished. (ec) The nursing process of assessment, planning, intervention and evaluation shall be documented for each hospitalized patient from admission through discharge. 1. Each patient’s nursing needs shall be assessed by a registered nurse at the time of admission or within the period established by each facility’s policy. 2, Nursing goals shall be consistent with the therapy prescribed by the responsible medical practitioner. 3. Nursing intervention and patient response, and patient status on discharge from the hospital, must be noted on the medical record, 8. That on” January 21, 2009 and January 22, 2009 the Agency conducted a coraplaint investigation of the Respondent facility. 9. Based on record review and staff interviews, the facility failed to ensure that one of seven sampled patients (Patient #1) had physician ordered interventions carried out to ensure not only the patient's safety but also the safety of other patients and the staff. A physician's order: written on 1/8/09 at 9am for "1 to 1" observations were not followed until the patient was transferred to another unit eight and half hours later. The lack of following ordered interventions has the potential of putting the patient, staff, and other patients at risk of injury. The findings include: c Medical Record review revealed Patient #1 was admitted to the facility on 1/7/09 having been placed on a Baker Act (Florida Mental Health Act), transported to an acute care hospital for medical clearance, and then transported to this facility for psychiatric evaluation/care. Nursing documentation revealed Patient #1 as having behaviors including increased agitation, aggression, acting inappropriately with other patients ’ and staff and pulling on a physician's tie during an exam. A physician’s telephone order was recorded on 1/8/09 at 9am which stated "1 to 1 observation until further notice". Documentation revealed this order was not done due to "unable to place on 1:1". Documentation reviewed noted that Patient #1's attending physician was notified of not being able to place Patient #1 on 1:1 and an order for Ativan Img intramuscular was obtained and administered at approximately 10:15am. Documentation revealed when Patient #1 was transferred to the Emergency Stabilization Unit on 1/8/09 at 5:00pm, he/she was placed immediately on 1:1 observation. Interview with the primary nurse on 1/22/09 at 12 noon revealed she had obtained the order from the attending physician and called according to facility's procedure the staffing coordinator for staff to cover the 1:1 observations, She stated she left the unit for a mandatory meeting and upon her return was informed the 1:1 observation on Patient #1 was not done due to Jack of staff. Interview with the Licensed Practical Nurse who was covering for the primary nurse on 1/8/09 revealed she informed the Staffing Coordinator of the need for 1:1 observation on Patient #1. The staffing coordinator stated she would have to consult with the Director of Nursing. The licensed practical nurse stated both the Staffing Coordinator and the Director of Nursing arrived on the unit, but Patient #1 was not placed on a 1:1 observation. The unit did use a regular staff member to closely monitor the patient, but this was not considered a 1:1 observation. Documentation did not reflect an order for the discontinuing of the 1:1 observation until 1/9/09 at 8:20am. 10, That the Agency provided the Respondent’s facility with a mandatory correction date of February 22, 2009. —_ (— 11. That the failure to ensure that one of seven sampled patients (Patient #1) had physician ordered. interventions carried out to ensure not only the patient's safety but also the safety of other patients and the staff is in violation of Rule 59A-3.208S(5)(e)(1)-() F.A.C. 12, That the above cited deficiency subjects the Respondent to the imposition of an administrative penalty in a sum not to exceed one thousand dollars per violation per day, _ pursuant to Section 395.1065(2)(a), F.S. (2008) . WHEREFORE, the Agency intends to impose an administrative fine in the amount of one thousand. dollars ($1,000.00) against the Respondent, a hospital, pursuant to 395,1605(2)(a) Florida Statutes (2008). , CLAIM FOR RELIEF WHEREFORE, the State of Florida, Agency for Health Care Administration, respectfully requests that this court: (A) Make factual and legal findings in favor of the Agency'on Count J; (B) Recommend administrative fines against Respondent in the amount of $1,000.00 for Count & (C) Assess attorney’s fees and costs; and (@) 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, (850) 922-5873. If you want to hire an attorney, you have the right to be represented by an attorney in this matter. ( i 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. AA Respectfully submitted this G day of October, 2009. Vikram Mohan, Senior Attorney Florida Bar No. 49402 Agency for Health Care Administration 2727 Mahan Drive, Mail Stop #3 _ Tallahassee, Florida 32308 850.922.4347 (office) 850.921.0158 (fax) CERTIFICATE OF SERVICE 1 HEREBY CERTIFY that a true and correct copy of the foregoing has been served by U.S. Certified Mail, Return Receipt No. 7004 2890 0000 5526 3539 to: Facility, River Pointe Behavioral Health, 6300 Beach Boulevard, Jacksonville, Florida 32216, and by U.S. Certified Mail, Return Receipt No. 7004 2890 0000 5526 3546 to: Registered Agent, C T Corporation Systems, 1200 South Pine Island Road, Plantation, Florida 33324, and by U.S. Certified Mail, Return Receipt No. 7004 2890 0000 5526 3553 to: Owner, TBI Behavioral Center, LLC, 6640 Carothers Parkway, Suite 500, Franklin, TN 37067 on October la, 2009, Vikram Mohan, Esquire Copy furnished to: Rob Dickson, FOM UsPS - Track & Confirm Page | of | > ae sp, Track & Confirm Track & Confirm Search Results Label/Receipt Number: 7004 2890 0000 5526 3539 Service(s): Certified Mail™ Status: Delivered Your item was delivered at 12:29 PM on October 13, 2009 in JACKSONVILLE, FL 32216. So> my Site Map Customer Service Forms. Gov't Services Careers Privacy Policy Terms of Use Business Customer Gateway Ton Re Leepenstares IRE ERATE Copyright® 2009 USPS. All Rights Reserved. No FEAR Act EEO Data FOIA @ Sireaneding dey eaed e FSoesaaaisy soy dy http://trkenfrm1.smi.usps.com/PTSInternetWeb/InterLabellnquiry.do 1/15/2010 Unls ~ Lrack «& Connrm Page | of I Track & Confirm Track & Confirm Search Results Label/Receipt Number: 7004 2890 0000 5526 3553 rercemeneeratcnnemnnnanns Service(s): Certified Mail™ Track & Contin Status: Delivered Enter Label/Receipt Number, Your item was delivered at 1:49 PM on October 13, 2009 in FRANKLIN, TN 37067. (o>) vor, ia Site Map Customer Service Forms Gov't Services Careers Privacy Policy Terms of Use Business Customer Gateway . POST Heaqeoneitne topyrevenkinwit., Copyright® 2009 USPS. All Rights Reserved. No FEAR Act EEO Data FOIA @ Stvraviyy Bes yet UCAataeaigy ddtay ay http://trkenfrm1.smi.usps.com/PTSInternetWeb/InterLabelInquiry.do 1/15/2010

Docket for Case No: 10-000264