STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, - Petitioner, vs. Case No, 2010012198 GULF COAST MEDICAL CENTER LEE MEMORIAL HEALTH SYSTEM, 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, GULF COAST MEDICAL CENTER LEE MEMORIAL HEALTH SYSTEM (hereinafter “the Respondent’), pursuant to Sections 120.569 and 120.57, tlorida Statutes (2010), and alleges as follows: ) NATURE OF THE ACTION This is an action to impose an administrative fine against a hospital in the amount of FOUR THOUSAND DOLLARS ($4,000.00) pursuant to Section 395.1041(5)(a), Florida Statutes (2010). . JURISDICTION AND VENUE I. The Court has jurisdiction over the subject matter pursuant to Sections 120.569 and 120.57, Florida Statutes (2010). 2. The Agency has jurisdiction over the Respondent pursuant to Sections 20.42 and 120.60, Florida Statutes (2010), Chapters 408, Part II, and 395, Part I, Florida Statutes (2010), and MAR 18 2011 Filed April 18, 2011 2:01 PM Division of Administrative Hearings Chapter 59A-3, Florida Administrative Code. 3. Venue lies pursuant to Rule 28-106.207, Florida Administrative Code. PARTIES 4. The Agency is the licensing and regulatory authority that oversces hospitals in Florida and enforces the applicable federal and state regulations, statutes and rules governing hospitals pursuant to Chapter 408, Part II, Florida Statutes (2010); Chapter 395, Part I, Florida Statutes (2010), 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 (2010), or any rule adopted under this part. 5. The Respondent was issued a license by the Agency to operate a 349-bed hospital (License No. 4301) located at 13681 Doctor’s Way, Fort Myers, Florida 33912, and was at all times material required to comply with the applicable federal and state regulations, statutes and rules, COUNT I The Respondent’s Nursing Staff Failed To Assess, Intervene, Evaluate And Document For Patients Or Ensure Physician’s Plan Of Care Was Implemented In Violation Of Rule 59A- 3.2085(5)(e)(1)-(3), Florida Administrative Code 6. The Agency re-alleges and incorporates by reference paragraphs one (1) through five (5). | 7. Pursuant to Florida law, 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 organizational steps it has taken to assure that oversight of the quality of nursing care provided to each patient is accomplished. The nursing process of assessment, planning, intervention and evaluation shall be documented for each hospitalized patient from admission through discharge. 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. Nursing goals shall be consistent with the therapy prescribed by the responsible medical practitioner. Nursing intervention and patient response, and patient status on discharge from the hospital, must be noted on the medical record, Rule 59A-3.2085(5)(e)(1)-(3), Florida Administrative Code. 8. On or about October 26, 2010 through October 27, 2010, the Agency conducted a Complaint Investigation (CCR# 2010-011258) of the Respondent’s facility. 9. Based on eight (8) of twenty (20) patient medical records reviewed and staff interviews, the facility nursing staff failed to assess, intervene, evaluate, and document in the patients’ records when the patients complained of pain, specifically Patient number three (3), Patient number four (4), Patient number five (5), Patient number six (6), Patient number seven (7), Patient number fourteen (14), Patient number eighteen (18), and Patient number nineteen (19). 10. An interview was conducted with Patient number three (3) on October 26, 2010 at 11:45 a.m. Patient number three (3) stated he/she complained to the night nurse he/she was having "electrical shocks up and down my leg all night long." Patient number three (3) told the nurse about this pain throughout the night. The nurse told Patient number three (3) she would call the doctor to order morphine. Patient number three (3) told the nurse to put the light on and to look at his/her leg and the nurse told Patient number three (3) it wouldn't be necessary. The surveyor asked Patient number three (3) if the morphine helped his/her pain and Patient number three (3) said no. Patient number thrce (3) was in pain all night; describing the pain as radiating up and down Patient number three’s (3) left leg. Once a different nurse saw the ants that were causing Patient number three’s (3) pain (at the time Patient number three (3) didn't know ants were in his/her bed) Patient number three (3) began getting excellent care. 11, A medical record review was conducted on October 26, 2010 at 1:00 p.m. with the Nurse Director and Nurse Manager of the telemetry (cardiac monitoring floor). The medical records are maintained in written and electronic form and require facility staff assistance for review, The medical record was reviewed for nursing pain management evaluation, intervention and response and for generalized nursing management of systems including skin. The following was revealed; medical record review for pain assessment/evaluation and intervention. Patient number three (3): Pain Evaluation October 18, 2010 7:00 p.m. to October 19, 2010 7:00 a.m, Occurred: October 19, 2010 Time 0000 (Midnight) by: (Insert initials and name of staff nurse.) Recorded: October 19, 2010 Time 0053 (12:53 a.m.) By: (Insert initials and name of staff nurse.) Pain Evaluation Type: Re-evaluation Pain score: 0 Pain Scale Used: Numbers 0-10 Patient Goal for Pain: 0 Location: (This is blank-no staff entry.) Onset: (This is blank-no staff entry.) Intensity: (This is blank-no staff entry.) Character: (This is blank-no staff entry.) Radiation: (This is blank-no staff entry.) Associated symptoms: (This is blank-no staff entry.) Exacerbating Factors: (This is blank-no staff entry.) Treatment: (This is blank-no staff entry.) Comment: (This is blank-no staff entry.) Occurred: October 19, 2010 Time 0200 (2:00 a.m.) By: (Insert initials and name of staff nurse.) Recorded: October 19, 2010 Time 0532 (5:32 a.m.) By: (Insert initials and name of staff nurse.) Pain Evaluation Type: Evaluation (pain management review) Pain score: 5 Pain Scale Used: Numbers 0-1- (on a 0 - 10 scale) Patient Goal for Pain: 0 Location: All Over Level of Sedation: Coop/Oriented/Tranquil. (Cooperative/Oriented/Tranquil) Onset: About an hour ago. Intensity: Mildly Moderate Character: Pinpricks down leg/scrot (Leg and scrotum). Radiation: Pinpricks down L (left) leg/scrot area. Associated symptoms: (This is blank-no staff entry.) Exacerbating Factors: (This is blank-no staff entry.) Treatment: (This is blank-no staff entry.) Comment: (This is blank-no staff entry.) Occurred: October 19, 2010 Time 0400 (4:00 a.m.) By: (Insert initials and name of staff nurse.) Recorded: October 19, 2010 ‘Time 0532 (5:32 a.m.) By: (Insert initials and name of staff nurse.) Pain Evaluation Type: Re-evaluation Pain score: (This is blank- no staff entry.) Pain Used: (This is blank-no staff entry.) Location: (This is blank-no staff entry.) Patient Goal for Pain: (This is blank-no staff entry.) Level of sedation: COOP/Oriented/T: ranquil Onset: (This is blank-no staff entry.) Intensity: (This is blank-no staff entry.) Character: (This is blank-no staff entry.) Radiation: (This is blank-no staff entry.) Associated symptoms: (This is blank-no staff entry.) Exacerbating Factors: (This is blank-no staff entry.) Treatment: (This is blank-no staff entry.) Comment: (This is blank-no staff entry) Nursing Entries on the Medication Administration Record: October 18, 2010 at 7:00 p.m, to October 19; 2010 7:00 a.m. Contains but not limited to Oxycodone HCL/Acetaminophen (Percocet 5/325 tablet) the following doses were documented as administered: | October 18, 2010: Time: 1703 (5:03 p.m.) two (2) unit dose tablets. October 18, 2010: Time: 2104 (9:04 p.m.) two (2) unit dose tablets, October 19, 2010: Time: 0509 (5:09 a.m.) two (2) unit dose tablets. Morphine Sulfate (Morphine 2mg/ml syringe = morphine two (2) milligrams per milliliter in syringe) October 19, 2010 Time: 0631 (6:31 a.m.) 1 mg intravenous administered: "NOW," 12. An interview with the Nursing Director was conducted after the pain evaluation and intervention was reviewed. The Nursing Director explained the expectation of the facility staff nurse is to evaluate for pain as described for the unit or floor the patient is receiving care. The nurse is to document the pain evaluation and the re-evaluation of pain assessment results on the pain management screen in the electronic medical record. This is to include the information of the type of pain, where it is located and the interventions provided to the patient. The findings of the Medication Administration Record and the pain evaluations and re-evaluations were reviewed. The director was asked to explain the re-evaluation dated October 19, 2010 at midnight, The Nursing Director stated, "This is a re-evaluation of pain identification. This would indicate a previous pain evaluation." The director and the manager of the floor could not explain the administration of pain medications as documented on the Medication Administration Record for the pain medications administered on October 18 and 19, 2010 at 1703, 2104, 0509, and 0631 (5:03 p.m., 9:04 p.m., 5:09 a.m., and 6:31 a.m.). The Nurse Director stated, "The expectation is the nurse will document the pain finding, the pain intervention and the re-evaluation of pain medication or intervention." When asked to verify the lack of evatuation, re-evaluation and the alignment of the medication administration, the Nurse Director stated, "I cannot explain why this occurred," The Nurse Director was asked about the re-evaluation of pain at midnight and the Nurse Director stated, "I cannot say for sure and cannot speak for the nurse in the Intensive Care Unit, but this re-evaluation may be from the medication given at around 9:00 p.m." The Nurse Director could not explain the medications administered without assessment or follow-up assessment stating "I cannot answer that, maybe it would be best to speak with the Director of the Intensive Care Unit. . 13. The Nurse Director was interviewed regarding the assessment and evaluation of the condition of the skin. The Nurse Director stated, "This would be found in the nursing notes and the shift evaluation. The nursing notes reveal the last entry on October 18, 2010 occurring at 1552 (3:52 p.m.) and recorded on 1557 (3:57 p.m.). The next nursing note entry was dated October 19, 2010 occurring at 0730 (7:30 a.m.) and recorded at 0930 (9:30 a.m.). This note states as follows: "Upon first round PT (patient) was C/O (complaining of) LT (left) hip and scrotal pain. While doing a safety check found PT to have lot of ants on patient and linens. PT was assisted OOB (Out of Bed) to chair. Morning care completed. Charge Nurse notified. Will transfer patient to a different room (insert room #), Plant Operations notified. Dr. Khan made aware PT had developed a raised rash on hip, scrotum, and LT leg. After bath PT stated he/she's feeling much better, Skin barrier cream applied to LT groin/leg and scrotum to ease skin rash. Will continue to monitor." 14. The Nurse Director was interviewed regarding the assessment and evaluation of the condition of the skin. The Nurse Director stated, "This would be found in the nursing notes and the shift evaluation. The nursing notes reveal the last entry on October 18, 2010 occurring at 1552 (3:52 p.m.) and recorded on 1557 (3:57 p.m.). The next nursing note entry was dated October 19, 2010 occurring at 0730 (7:30 a.m.) and recorded at 0930 (9:30 a.m.). This note states as follows: 15. Upon first round PT (patient) was C/O (complaining of) LT (left) hip and scrotal pain. While doing a safety check found pt to have lot of ants on patient and linens. Patient was assisted out of bed to chair, Morning care completed. Charge Nurse notified. Will transfer patient to a different room (insert room #). Plant Operations notified. Dr. Khan made aware patient had developed a raised rash on hip, scrotum, and left leg. After bath pt stated he's feeling much better. Skin barrier Cream applied to left groin/leg and scrotum to ease skin rash. Will continue to monitor." 16. The 7:00 am. to 7:00 p.m. Intensive Care Unit nurse shift evaluation dated October 19, 2010 at 0730 (7:30 a.m.) documented a skin assessment including (not limited to) incision, bruises, pressure ulcer (gluteal fold) and redness in the scrotum/left leg and hip, tissue evaluation: Red and painful, color is red, without drainage. 17. The Nurse Director of the telemetry floor could not explain the 7:00 p.m. to 7:00 a.m, absence of skin assessment documentation during the identification of pain in the left leg and scrotal area at 2:00 a.m. The Nursing Director also could not speak to the lack of pain intervention after the patient complaint of (c/o) pain at 2:00 a.m. The Nurse Director stated, "This (referring to the copies of the Medication Administration Record, nursing notes and pain evaluations) is the documentation in the record." 18. A telephone interview was conducted with the 7:00 a.m. to 7:00 p.m. nurse receiving Patient number three (3) on the morning of October 19, 2010. The interview was conducted at 4:55 p.m. through 5:10 p.m. The receiving staff nurse stated the 7:00 p.m. to 7 a.m. (night shift) nurse was busy with the oncoming day shift nurse (giving report on another patient). The receiving day shift nurse went to Patient number three’s (3) bedside to initiate the safety check assessment. The nurse remarked Patient number three (3) stated he/she "c/o pain all night." The nurse commented Patient number three’s (3) pain was located in the groin, left leg and scrotum. The nurse continued by stating the skin check of the area revealed Patient number three (3) had "ants all over his/her legs, groin arca, on his/her genitals and scrotal area." The nurse commented Patient number three (3) stated he/she was administered pain medications during the night shift. 19. On October 27, 2010 at 7:30 a.m. an interview was conducted with the nurse who was assigned to Patient number three (3) on October 19, 2010 from 000 to 0700. The nurse stated Patient number three (3) was alert and oriented on October 19, 2010. The nurse stated Patient number three (3) complained of "pin pricks" as pain on his/her leg and scrotum area. In her experience with patients who had a pace maker put in (AICD); this would give the patient an electrical shock feeling. Patient number three (3) asked the nurse to put the light on and to put Patient number three (3) on the bed pan. The nurse did not put the light on but turned Patient number three (3) but went to his/her right side and turned Patient number three (3) to his/her left to place the bed pan underneath Patient number three (3). At that time she saw graham cracker crumbs in Patient number three’s (3) bed and wiped them up. The nurse did not see any ants. The nurse said this was approximately "3:30ish." Patient number three (3) told her he/she did not need any pain medication. At 5:00 a.m. she gave Patient number three (3) Percocet because he/she was complaining of "pin pricks." At 6:00 a.m. the nurse went back to Patient number three (3) to assess the pain and Patient number three (3) told the nurse his/her pain did not get any better. At that time Morphine was given. The nurse did not re-assess Patient number three’s (3) pain after the Morphine was given. At shift change she did a "pass me safely." session with the nurse who was assigned Patient number three (3) for the day shift (7:00 a.m. to 7:00 p.m.) on October 19, 2010. This was approximately 7:30 a.m. At that time the day shift nurse noticed the ants on Patient number three (3). The two (2) nurses assisted Patient number three (3) out of the bed, cleaned him/her up and moved him/her to another room. The nurse did not notice any ants throughout the night in Patient number three’s (3) room. When asked if the nurse turned the light on at any time during Patient number three’s (3) care she said she did not turn the light on. The nurse would be able to sce ants in Patient number three’s (3) room with the lights off. 20, On October 27, 2010, an interview with the director of the intensive care unit was conducted at 1:00 p.m. The director was informed of the pain evaluation, pain interventions the Medication Administration Record documentation and the skin assessments. The Director commented the medical record may have additional documentation in the activity of daily living screen. The Director returned with additional documentation which included activities of the daily living assist document. This was dated October 19, 2010 as occurring at midnight and recorded at 12:52 a.m, This document indicates there was an assist for repositioning and for a set up for a snack, 2i. An activities of daily living assistance document, dated October 19, 2010 occurring at 2:00 a.m. and recorded at 5:30 a.m., indicated Patient number three (3) was turned to 10 the left side with assistance and was placed on the bed pan with assistance. Another activity of daily living assistance document occurring at 2:00 a.m. and recorded at 5:30 a.m. indicated the patient was repositioned to the right side, then to back with assistance and assisted with the bedpan. This document also indicates there was no change of linen, bed clothes, oral care, or personal hygiene provided. 22, When asked about the assessment findings including the activities of daily living assistance documents, the Nurse Director stated the evaluation of the above findings during the survey did offer concerns regarding the care and assessments provided for Patient number three (3). 23. A review of Patient number four’s (4) medical record on October 27, 2010 showed on October 24, 2010 at 0800 (8:00 a.m.) the patient complained of pain at a seven (7) on a scale of one (1) to ten (10). A review of the medication administration record showed Patient number four (4) received Fentanyl. On October 23, 2010 at 0800 (8:00 a.m.), Patient number four (4) complained of pain and the nurse gave medication and changed the patient's position, However, with these two (2) interventions to relieve Patient number four’s (4) pain there was no documentation in the nurse’s record to show the nurses re-assessed Patient number four (4) to ensure these interventions relieved his/her pain. 24. An interview with the nurse on October 27, 2010 at 9:45 a.m. stated she was not able to find anywhere in Patient number four’s (4) record where re-assessments occurred. The nurse then asked another nurse from this unit where to find these re-assessments. The nurse told her re-assessments will be found either in the nurse's notes, evaluations, re-evaluations, or the pain monitoring form. These forms were reviewed and there was no documentation of a re- assessment. 25. A review of Patient number five’s (5) medical record on October 27, 2010 showed on October 19, 2010 at 0800 (8:00 a.m.) Patient number five (5) complained of pain at a seven (7) on a scale of one (1) to ten (10). Patient number five (5) was given Percocet. On October 23, 2010 at 0309 (3:09 a.m.) Patient number five (5) complained of pain at a three (3) and the patient was given Morphine and rest. On October 23, 2010 at 0907 (9:07 a.m.) Patient number five (5) complained of pain at a six (6) and was given Percocet. A further review of Patient number five’s (5) medical record showed there were no re-assessments of Patient number five (5) for the interventions used to relieve the pain. 26. An interview was conducted with a nurse on the unit at 10:45 am. The nurse stated if a patient complains of pain and is given an intervention for this pain an assessment within the first hour should be done. This assessment should be documented on the pain evaluation form or the re-evaluation sheet. Another review of these two (2) forms was completed and there was no documentation of the re-assessments. 27. A review of Patient number six’s (6) medical record on October 27, 2010 showed on October 20, 2010 at 2010 (8:10 p.m.) Patient number six (6) complained of pain. A review of the Medication Administration Record showed pain medication was given. A further review of the record showed there was no documentation of a re-assessment on Patient number six (6) to evaluate if the patient was in pain. 28. A review of Patient number seven’s (7) medical record on October 27, 2010 showed on October 27, 2010 at 0000 (12:00 a.m.) Patient number seven (7) complained of pain at an eight (8) on a scale on one (1) to ten (10). Patient number seven (7) was given medication and positioned, Patient number seven (7) complained of pain at 0445 (4:45 a.m.) at an eight (8). Patient number seven (7) was given medication. A further review of the medical record showed there was no documentation of re-assessments completed once Patient number seven (7) was given medications for pain both times. An interview with the nurse at 11:00 a.m., who was 12 reviewing the chart, stated she was not able to find the documentation of the re-assessments for these two (2) interventions for pain. The nurse re-iterated she looked in the areas of Patient number seven’s (7) medical record where the nurse on the unit stated where the documentation was to be for pain re-assessments. 29, The facility records for Patient number fourteen (14) were reviewed on October 27, 2010 at 9:40 a.m. with the Nurse Director and the Clinical Supervisor. The records revealed Patient number fourteen (14) was in the Intensive Care Unit post admission for near fainting episodes and possible Coronary Artery Disease. The medical records revealed Patient number fourteen (14) is intubated (tube into airway providing a set number of respirations with set percentage of oxygen) and receiving intravenous pain medication as continual infusion. The following are documented pain evaluations for Patient number fourteen (14): Occurred: October 19, 2010 Time: 2000 (8:00 p.m.) By: (Insert initials and name of staff nurse.) Recorded: October 19, 2010 Time: 0053 (9:08 p.m.) By: (Insert initials and name of staff nurse.) Pain Evaluation Type: Evaluation Pain score: 8 Pain Scale Used: Numbers 0-10 Patient Goal for Pain: 0 Location: Back Level of Sedation: Anxious and Agitated Onset: Acute Intensity: Mildly Moderate Character: Achy Radiation: Back Associated symptoms: INCR HR (Increased Heart rate) 13 Exacerbating Factors: (This is blank-no staff entry) Treatment: (This is blank-no staff entry) Comment: (This is blank-no staff entry) 30. The medical record revealed Patient number fourteen (14) did not receive additional pain medication for this pain evaluation. The medical record did not contain documentation of other non-pharmacological interventions at the time the pain was identified and evaluated. . 31. The re-evaluation of pain occurred at 2209 (10:09 p.m.) and was recorded at 2210 (10:10 p.m.). The re-evaluation revealed a reduction in pain to a score of five (5) (out of a zero (0) to ten (10) pain scale). The re-evaluation of the pain did not include comments or nursing notes indicating the nursing interventions which accomplished the decrease in pain score level. 32. On October 19, 2010, the documentation revealed a Respiratory Therapy note entry. This evaluation occurred at 0400 (4:00 a.m.) and was recorded at 0507 (5:07 a.m.). The document states "PT (patient) self extubated (patient pulled out the breathing tube) placed on hi flow nasal cannula per Dr.___ (physician name) PT tolerating well. Will continue to monitor, A Pain Evaluation was completed by 4 different nurse revealed Patient number fourteen (14) Fentanyl drip off (pain and sedation intravenous infusion). 33, At 0518 (5:18 a.m.) the assigned nurse completed a nursing note stating, "Went in to PT's room for hourly check. Pt had extubated self even though restrained. Called for help as PT combative with this nurse and had been throughout the night." 34, The Nurse Director was asked if the medical record contained additional notes from the assigned nurse. The Nurse Director stated, "This is the documentation we have." A review of the Intensive Care Unit flow sheet documentation was conducted. The flow sheet did not contain assessment of Patient number fourteen’s (14) respiratory rate, breathing effort, lung 14 sounds, or respiratory status, The 0400 (4:00 a.m.) entry on the flow sheet included the heart rate at ninety-six (96), and a respiratory rate of twenty-seven (27). The Nurse Director stated the Respiratory Therapist notes indicated Patient number fourteen (14) is tolerating the hi flow oxygen via nasal cannula as “well” and a 4:20 a.m. blood gas revealed an oxygen saturation at 93.9, The facility "Shift Evaluation" completed at 0800 (8:00 a.m.) by the 7:00 a.m. to 7:00 p.m. nurse revealed Patient number fourteen (14) is intubated with lung sounds diminished in all fields with an oxygen saturation at 95%. At this time the previous documentation revealed Patient number fourteen (14) had self extubated and Patient number fourteen (14) was receiving oxygen via a cannula (two (2) small tubes inserted approximately a quarter inch into each nostril). The 7:00 p.m. to 7:00 a.m. nurse did not provide an updated shift evaluation outline with the continued agitated behaviors, the extubation of the breathing tube, nor the response to the treatment of the oxygen by nasal cannula. The Respiratory Therapist Ventilator Flow sheet entry at 4:10 a.m. states: PT self extubated Dr (physician name) in room shortly after placed on (Hi Flow Nasal Cannula). 35, An interview with the Nursing Director for the Intensive Care Unit on October 27, 2010 regarding the assessment and interventions conducted on the 7:00 p.m, to 7:00 a.m, shift was conducted at 1:30 p.m. The Intensive Care Unit Director could not comment to the survey findings regarding Patient number fourteen (14). Risk Management was conducting an investigation on Patient number fourteen’s (14) medical record that had not yet been reviewed, 36. A review of Patient number eightcen’s (18) medical record on October 27, 2010 showed on October 26, 2010 at 0800 (8:00 a.m.) Patient number eighteen (18) complained of pain at an eight (8) on a scale of one (1) to ten (10). Patient number eighteen (18) was given Dilaudid. At 1009 (10:09 a.m.) Patient number eighteen (18) complained of pain again and was given Dilaudid. Documentation showed the nurse re-assessed the patient's pain at 12:00 p.m., two (2) 15 hours after the administration of medications. However, there was no re-assessment of the first intervention of Dilaudid given at 0800 (8:00 a.m.). 37. An interview was conducted with the Unit Nurse at 1:15 p.m. on October 27, 2010. The nurse went through Patient number eighteen’s (18) medical record and stated she could not find any documentation of a re-assessment done when Patient number eighteen (18) was given medication for pain at 0800 (8:00 a.m.). 38, A review of Patient number nineteen’s (19) medical record on October 27, 2010 showed on October 22, 2010 at 1700 (5:00 p.m.) Patient number nineteen (19) complained of pain at a number three (3) on a scale of one (1) to ten (10). Patient number nineteen (19) also complained at 1126 (11:26 p.m.) of pain at a number eight (8) on a scale of one (1) to ten (10). The review was on the pain monitoring form. A further review of the medical record showed there were no interventions made by the nurse when Patient number nineteen (19) complained of pain. The nurse's notes, Medication Administration Records, evaluations, re-evaluations and pain management monitoring forms were reviewed, along with several other areas of the patient's record reviewed and showed Patient number nineteen (19) did not receive any interventions concerning these two (2) complaints of pain. 39, An interview with the nurse on October 27, 2010 at 1:45 p.m. stated she was not able to find any documentation Patient number nineteen (19) received any intervention for these two (2) complainants of pain. 40. The Agency may deny, revoke, suspend a license, or impose an administrative fine, against a hospital, not to exceed $10,000 per violation for the violation of any provision under Section 395.1041, Florida Statutes (2010), or rules adopted under this section. Section 395.1041(5)(a), Florida Statutes (2010), WHEREFORE, the Petitioner, State of Florida, Agency for Health Care Administration, intends to impose an administrative fine against the Respondent in the amount of FOUR THOUSAND DOLLARS ($4,000.00). CLAIM FOR RELIEF WHEREFORE, the Petitioner, State of Florida, Agency for Health Care Administration, respectfully requests the Court to grant the following relief: 1. Enter findings of fact and conclusions of law in favor of the Agency as set forth above, 2. Impose an administrative fine in the amount of FOUR THOUSAND DOLLARS ($4,000.00) against the Respondent. 3, Order any other relief that the Court deems just and appropriate. Respectfully submitted this Ibe te" day of (Wc ely 2011. QS mn. ap Andrea M. Lang, Assistant General Counsel Florida Bar No. 0364568 Agency for Health Care Administration Office of the General Counsel 2295 Victoria Avenue, Room 346C Fort Myers, Florida 33901 Telephone: (239) 335-1253 NOTICE RESPONDENT JS NOTIFIED THAT IT/HE/SHE HAS A RIGHT TO REQUEST AN ADMINISTRATIVE HEARING PURSUANT TO SECTIONS 120.569 AND 120.57, FLORIDA STATUTES. THE RESPONDENT IS FURTHER NOTIFIED THAT TT/HE/SHE 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 AND DELIVERED TO THE ATTENTION OF: THE AGENCY CLERK, AGENCY FOR HEALTH CARE ADMINISTRATION, 2727 MAHAN DRIVE, BLDG #3, MS #3, TALLAHASSEE, FLORIDA 32308; TELEPHONE (850) 412-3630, THE RESPONDENT IS FURTHER NOTIFIED THAT IF A REQUEST FOR HEARING IS NOT RECEIVED BY THE AGENCY FOR HEALTH CARE ADMINISTRATION WITHIN TWENTY-ONE (21) DAYS OF THE RECEIPT OF THIS ADMINISTRATIVE COMPLAINT, A FINAL ORDER WILL BE ENTERED BY THE AGENCY. CERTIFICATE OF SERVICE 1 HEREBY CERTIFY that a true and correct copy of the Administrative Complaint and Election of Rights form has been served to: Mary McGillicuddy, Registered Agent for Gulf Coast Medical Center Lee Memorial Health System, 2780 Cleveland Avenue, Suite 459, Fort Myers, Florida 33901, by U.S. Certified Mail, Return Receipt No. 7009 1680 0001 5449 4387 and James Nathan, Chief Executive Officer, Gulf Coast Medical Center Lee Memorial Health System, 13681] Doctor's Way, Fort Myers, Florida 33912, by U.S. Certified Mail, Retum Receipt No. 7009 1680 0001 5449 4394, on this_IG** day of __ Weta 2011. hnmdeven Wn. oa Le Andrea M, Lang, Assistant General Cotinsel Florida Bar No. 0364568 Agency for Health Care Administration Office of the General Counsel 2295 Victoria Avenue, Room 346C Fort Myers, Florida 33901 Telephone: (239) 335-1253 Copies furnished to: Andrea M. Lang, Senior Attomey Agency for Health Care Administration Office of the General Counsel 2295 Victoria Avenue, Room 346C Fort Myers, Florida 33901 .| James Nathan, Chief Executive Officer Gulf Coast Medical Center Lee Memorial Health System 13681 Doctor's Way Fort Myers, Florida 33912 S. Certified Mail Mary McGillicuddy, Registered Agent for Gulf Coast Medica! Center Lee Memorial Health System 2780 Cleveland Avenue, Suite 459 Fort Myers, Florida 33901 (U.S. Certified Mail) Harold Williams Field Office Manager Agency for Health Care Administration 2295 Victoria Avenue, Room 340A Fort Myers, Florida 33901 (Interoffice Mail) COMPLETE THIS SECTION ON DELIVERY A, Signature, / o” x SN ly 8, Recelved by (Printed Namé) SENDER: COMPLETE THIS SECTION - @ Complete Items 1, 2, and 3. Also complete Item 4 If Restricted Delivery ls destred. . @ Print your name and addrass on, the reverse 80 that we can return the card to you, . li Attach this card to the back of the mallplece, - or on the front if space permits.- 4. Apllcle Addressedtoc: §ZO(OO/LITS James Ma than , C&o Ct € Coast Medical Ceafer ! Lee Memoria) Heal ty Syeten 1886, Doctor's Way | Fort Myers, Floride 23449 » Tanafor fom wavviob eb) 7009 1ba0 000% 5449 43594 Pa ici hcl a Oe ODS OO OO PS Form 3811, February 2004 Domestic Return Recelpt 402805-02-M-1640 C, Pa Delivery: mie D, Is delivery addyess different from tern 1? Yes If YES, enter delivery address below: 1 No 3. Gervice Type Co Certified Mat (1 Express Mall C1 Reglatered CJ Retum Receipt for Merchandise Insured Mall (£7 6.0.0. 4, Restricted Delivery? (Exta Feo) «=: Yes

Docket for Case No: 11-001935

Orders for Case No: 11-001935