ad ~e STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, we. ) - Case No: 2011003063 BAYFRONT MEDICAL CENTER, INC., Respondent. ADMINISTRATIVE COMPLAINT ‘COMES NOW the Agency For Health Care Administeation (hereinafter Agency), by and through the undersigned counsel, and files this Administrative Complaint against Bayfront Medical Center, Inc., (hereinafter Respondent), pursuant to Sections 120.569 and _ 120.57, Florida Statutes, (2010), and alleges: | NATURE OF THE ACTION This is an action to impose an administrative fine in the amount of two thousand dollars ($2,000.00) based upon two deficient practices pursuant to Sections 120.569, 120.57, 395.1055 and 395.1065, Fla. Stat. (2010). JURISDICTION AND VENUE 1. - The Agency has jurisdiction pursuant to Chapters 395, Part I, and 408, Part II, Fla. Stat. (2010). 2. Venue lies pursuant to Section 120.57, Florida Statutes, and Chapter 28-106.207 Florida _ Administrative Code, Filed June 13, 2011 12:59 PM Division of Administrative Hearings oe we _ PARTIES .3 The Agency is the regulatory authority with regard to hospital licensing and regulation pursuant to Chapters 395, Part I, and 408, Part II, Florida Statutes, and Chapter 59A-3, Florida Administrative Code, respectively, 4,°° Respondent is a hospital located at 701- 6" Street South, St. Petersburg, Florida 33701, and is licensed under Chapter 395, Part I, Florida Statutes and Chapter 59A-3, Florida Administrative Code, license number 4303. | 5. Respondent was at al] times material hereto a licensed facility under the licensing authority of the Agency, and was required to comply with all applicable rules, and statutes, COUNT 1 - tag 11120 6. The Agency re-alleges and incorporates paragraphs (1) through (5) as if fully set forth © herein, | 7. Florida law requires each hospital to be organized and staffed to provide quality nursing care to each patient. The nursing process of assessment, planning, intervention and evaluation must be documented for each hospitalized patient from admission through discharge. a) 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; b) Nursing goals shall be consistent with the therapy prescribed by the responsible medical provider; c). 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), FAC. 8. On March 3, 2010, the Agency conducted a complaint investigation, CCR #2011002139, of the Respondent facility. 9. Based on record review and staff interviews, it was determined that the nursing staff failed to implement the nursing care plan for two patients. Findings included: Patient #1 was admitted to the facility on January 22, 2011. The History and Physical documented a diagnosis of colon cancer with metastasis to the liver and lungs aind significant ascites due to liver failure. The nursing care plan included skin care as one a problem to be addressed. Assessment of the patient's skin was required at least once each shift. The patient was to be repositioned every 2 hours and the position documented each time. However, the medical record lacked documentation by the nursing staff of the patient's position during the following dates and times: e January 23, 2011 from 4:00 - 8:00 a.m. " e February 16,2011 ftom 2:00 - 6:00 a.m. and from 4:00 - 8:00 p.m. ¢ February 23,2011 — from 4:00 - 8:00 p.m. and from 11:00 p.m. - 5:00 : a.m. the next morning - ® February 24,2011 from 5:00 a.m. - 12:00 Noon “The required skin assessment was not documented on February 19, 201 1, A stage II pressure ulcer was documented in Patient #1’s chart on February 23, - .2011 at 3:00 a.m. Subsequently that day, after the pressure ulcer was found, the nuising record reflects that the nursing staff failed to reposition the patient for a total of ten (10) hours, During an interview on March 2, 2011, the Director of Nursing confirmed the above, Patient #3 was admitted to the facility on March 1, 2011. The History and ' Physical documented the diagnosis as cirrhosis of the liver..On March 1, 2011, the patient’s physician ordered a fluid restriction of 1500 cc/day. But the intake and output (“I & O”) record revealed the staff did not document the patient’s fluid - intake for eighteen hours starting the day after the patient’s admission, There was no documentation for intake from 1:26 p.m. on March 2 through 7:00 a.m, on March 3, 2011. During a March 3, 2011 interview at 9:30 a.m., the Director of Nursing confirmed there was no evidence that the nursing staff had monitored the fluid intake as ordered. 10. - The nurses’ failure to turn and reposition as ordered, correctly document and to keep an accurate record of the intake and output placed the patients at risk of harm and denied them their rights to quality nursing care while hospitalized, violating Florida law. we ~ 11, The Agency found the complaint (CCR # 2011002139) of the Respondent facility substantiated and cited the facility for the above referenced deficiency. 12. The deficiency subjects the Respondent to the imposition of an administrative penalty in a sum not to exceed one thousand dollars ($1,000.00) per violation per day. Section § 395.1065 (2)(a) Fla. Stat. (2010). WHEREFORE, the Agency intends to impose an administrative fine in the amount of $1,000.00 against Respondent, a hospital in the State of Florida, pursuantto § 395.1065 (2)(a) Fla. Stat, (2010). . COUNT I - tag H094 13. The Agency re-alleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 14, Hospitals are required as a matter of law to assure the correct use of medications. Medications must be given correctly and exactly as ordered by the nursing staff. ) Administration of drugs shall be undertaken only upon the ordars of authorized ~ members of the professional staff, where the orders are verified before administration, the patient is identified, and the dosage and medication 1 is noted in the patient’s chart or medical record. Fla. Admin R. 594-3.2085(2)(m). 15. On March 3, 2010, the Agency conducted a complaint investigation, CCR #2011002139, _ of the Respondent facility. 16. Based. on record review and staff interview, it was determined that the facility failed to administer an important medication as ordered. Findings included: Patient #3 was admitted to the facility on March 1, 2011. The History and Physical documented the diagnosis as cirrhosis of the liver. The patient was assessed with worsening ascites’ and hypertension. Daily weights and fluid restrictions (See #9, above) were ordered. The patient weighed: e 222 pounds.on March 1, 2011, the date of admission. e 203 pounds on March 2, 2011 and e 203 pounds on March 3, 2011. Review of physician orders. for Patient #3 revealed an order dated March 1, 2011, - for Lasix 40 milligrams, every 12 hours, for 3.doses. . e The first dose was administered March 1, 2011 at 6:30 p.m. -@ The second dose was administered on March 2, 2011 at 6:21 a.m. ¢ However, the third dose was not administered as ordered - within 12 hours of the second dose, Though scheduled to be given at 6:30 p.m. on March 2, 2011, it was not given to the patient until 9:00 p.m. During an interview on March 3, 2011 at approximately 9:30 a.m., the Director of Nursing confirmed this finding. 17. - The facility’s failure to provide nursing care and services to meet the needs of Patient #3 by failing to administer an important medication in accord with the physician’s order was a violation of law. 18, The deficiency subjects the Respondent to the imposition of an administrative penalty in a sum not to exceed one thousand dollars ($1,000.00) per violation per day. Section § 395.1065 ~ (2)(a) Fla. Stat. (2010). | | ' WHEREFORE, the Agency intends to impose an administrative fine in the amount of $1,000.00 against Respondent, a hospital in the State of Florida, pursuant to § 395.1065 (2)(a) Fila, Stat. (2010). NOTICE OF RIGHTS Respondent is notified that it has a right to request an administrative hearing pursuant to Section ! Ascites is free fluid in the peritoneal cavity. The most common cause is portal hypertension. Symptoms usually result from abdominal distention. Ascites can result from chronic, but not acute, liver diseases, Small amounts of ascitic fluid cause no symptoms. Moderate amounts cause increased abdominal girth and weight gain. Treatments include bed rest, dietary Na+ (salt) restriction, diuretics, and therapeutic paracentesis (removal of fluid with long needle inserted into cavity). The diuretic Furosemide (“Lasix”) is commonly used to remove excess fluid. See The Merck Manual (2011 online). 5 120.569, Florida Statutes, 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) 412-3689. RESPONDENT JS 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 OFA FINAL ORDER BY THE AGENCY, . ' CERTIFICATE OF SERVICE | HEREBY CERTIFY that a true and correct copy of the foregoing has been served by US. Certified Mail, Return Receipt No. 7010 0780 0001 9836 0097 to Sue G, Brody, Chief Executive Officer, Bayfront Medical | Center, Inc., 701 6" Street South, St. Petersburg, FL 33701, this (Sy of April, 2011. . AGENCY FOR HEALTH CARE ADMINISTRATION 525 Mirror Lake Drive, 3305 St. Petersburg, FL 33701 (727) 552-1945; FAX: (727) 552-1440 Copies furnished to: Patricia Caufman, FOM ‘\ my -’ STATE OF FLORIDA ‘ AGENCY FOR HEALTH CARE ADMINISTRATION RE: Bayfront Medical Center, Inc, CASE NO, 2011003063 CTI FF RIGHTS This Election of Rights form is attached to a proposed action by the Agency for Health Care Administration (AHCA). The title may be Notice of Intent to Impose a Late Fee, Notice of Intent to Impose a Late Fine or Administrative Complaint. Your Election of Rights must be returned by mail or by fax within 21 days of the day you receive th hed Notice of Intent to Impose a Late Fee, Notice of Intent to Im Late Fine or Administrative Complaint If your Election of Rights with your selected option is not received by AHCA within twenty- one (21) days from the date you received this notice of proposed action by AHCA, you will have given up your right to contest the Agency’s proposed action and a final order will be issued. (Please use this form unless you, your attorney or your representative prefer to reply according to Chapter! 20, Florida Statutes (2006) and Rule 28, Florida Administrative Code.) PLEASE RETURN YOUR ELECTION OF RIGHTS TO THIS ADDRESS: - Agency for Health Care Administration Attention: Agency Clerk 2727 Mahan Drive, Mail Stop #3 Tallahassee, Florida 32308. Phone: 850-412-3630 Fax: 850-921-0158. PLEASE SELECT ONLY 1 OF THESE 3 OPTIONS OPTION ONE (1) E admit to the allegations of facts and law contained in the Notice of Intent to Impose a Late Fine or Fee, or Administrative Complaint and I waive my right to object and to have a hearing. J understand that by giving up my right to a hearing, a final order will be issued that adopts the proposed agency action and imposes the penalty, fine or action. OPTION TWO (2)__ I admit to the allegations of facts contained in the Notice of Intent to Impose a Late Fee, the Notice of Intent to Impose a Late Fine, or Administrative Complaint, but I wish to be heard at an informal proceeding (pursuant to Section 120.57(2), Florida Statutes) where I may submit testimony and written evidence to the Agency to show that the proposed administrative action is too severe or that the fine should be reduced. OPTION THREE (3)___—iI- dispute the allegations of fact contained in the Notice of Intent to Impose a Late Fee, the Notice of Intent to Impose a Late Fine, or Administrative Complaint, and I request a formal hearing (pursuant to Subsection 120.57(1), Florida Statutes) before an Administrative Law Judge appointed by the Division of Administrative Hearings. PLEASE NOTE: Choosing OPTION THREE (3), by itself, is NOT sufficient to obtain a formal hearing, You also must file a written petition in order to obtain a formal hearing before the Division of Administrative Hearings under Section 120.57(1), Florida Statutes. It must be received by the Agency Clerk at the address above within 21 days of your receipt of this proposed administrative action. The requést for formal hearing must conform to the requirements of Rule 28-106.2015, Florida Administrative Code, which requires that it contain: 1. Your name, address, and telephone number, and the name, address, and telephone number of your representative or lawyer, if any. 2. The file number of the proposed action. 3. A statement of when you received notice of the Agency’s proposed action, 4. Astatement of all disputed issues of material fact. If there are none, you must state that there are none. - Mediation under Section 120.573, Florida Statutes, may be available in this matter if the Agency agrees, . License type: (ALF? nursing home? medical equipment? Other type?) Licensee Name: License number: Contact person: ‘ Name Title Address: Street and number City Zip Code Telephone No. Fax No. Email(optional) Thereby certify that I am duly authorized to submit this Notice of Election of Rights to the Agency for Health Care Administration on behalf of the licensee referred to above. Signed: Date: Print Name: Title: Late fee/fine/AC wa.can return:thie card: to you... thi card to:the-back of the mallplece,. nm the front If space permits. ae _ Bayfront Medical Center, Inc. 701 6" Street South St. Petersburg, FL 33701 3 SECTION ON DELIVERY

Docket for Case No: 11-002952

Orders for Case No: 11-002952