vs.
Respondent.
Case No. 2011009224
This is an action to impose an administrative fine of five thousand dollars ($5,000.00) pursuant to §400.484(2)(b), Florida Statutes (2011).
I. The Agency has jurisdiction pursuant to Sections 20.42, 120.60, Chapter 400, Part III, and Chapter 408, Part II, Florida Statutes (2011).
Venue lies pursuant to Florida Administrative Code R. 28-106.207.
PARTIES
The Agency is the regulatory authority responsible for !icensure of home health agencies clinics and enforcement of all applicable state statutes and rules governing home health agencies pursuant to the Chapters 400, Part III, and 408, Part II, Florida Statutes, and Chapter 59A-8,
Florida Administrative Code.
Respondent is licensed as a home health agency provider located at 3100 University Blvd. South, Suite 108, Jacksonville, Florida 32216, license number 21887096.
· Respondent was at all times material hereto licensed under the licensing authority of the Agency, and was required to comply with all applicable rules and statutes.
COUNT I (Tag H119)
The Agency re-alleges and incorporates paragraphs (1) through (5) as if fully set forth
herein.
That pursuant to Florida law, any person, including, but not limited to, any:
Physician, osteopathic physician, medical examiner, chiropractic physician, nurse, paramedic, emergency medical technician, or hospital personnel engaged in the admission, examination, care, or treatment of vulnerable adults;
Health professional or mental health professional other than one listed in subparagraph 1.;
4. Nursing home staff; assisted living facility staff; adult day care center staff; adult family-care home staff; social worker; or other pro:f'essional adult care, residential, or institutional staff;
who knows, or has reasonable cause to suspect, that a vulnerable adult has been or is being abused, neglected, or exploited shall immediately report such knowledge or suspicion to the central abuse hotline.
§415.1034(1), Florida Statutes (2011)
That pursuant to Florida law, "Vulnerable adult" means a person 18 years of age or older whose ability to perform the normal activities of daily living or to provide for his or her own care
or protection is impaired due to a mental, emotional, sensory, long-term physical, or developmental disability or dysfunction, or brain damage, or the infirmities of aging.
§415.102(27), Florida Statutes (2011)
That pursuant to Florida law, a person who knowingly and willfully fails to report a case of known or suspected abuse, neglect, or exploitation of a vulnerable adult, or who knowingly and willfully prevents another person from doing so, commits a misdemeanor of the second
degree, punishable as provided ins. 775.082 ors. 775.083.
§415.111(I), Florida Statutes (20I1)
That on July 19, 2011, the Agency conducted an unannounced complaint (CCR# 2011007691) investigation of the Respondent.
Based on review of the complaint allegations, review of the patient record and interviews with the Administrator, Director of Clinical Services (DOCS), and Quality Coordination nurses, the agency's personnel failed to recognize the serious self-destructive behavior of 1 of 3 patients (Patient #1), and failed to intervene themselves or to immediately report the situation to the Department of Children & Families Abuse Hotline.
Patient #1 had a start of care (SOC) date of 5-22-11 and was being seen for the diagnoses of Malaise and Fatigue, Abnormality of Gait, Attn to Physical Therapy, Malignant Neoplasm of the Mouth, and Oral Soft Tissue Disease amongst others.
The nursing home sent information, prior to his nursing home discharge, to the home health agency.
The patient's history showed that on 2-01-11 he was "status post radical tongue resection" for Malignant Neoplasm, which resulted in a Gastrostomy tube for Jevity feedings and all medications per the PEG (percutaneous endoscopic gastrostomy) tube.
The patient was in Respiratory Failure on a Ventilator post-op (unknown period of time), Hyponatremia post op due to fluids and Dilantin for seizures; known history of alcoholism and Hypertension.
The patient was in the hospital 6 weeks post-op and in a skilled nursing facility (SNF)
from 3-16-11 to 5-19-11 (2 months).
He came home on Hydrocodone for pain, Wellbutrin for depression, Amiodarone and Metoprolol for Hypertension, Dilantin for seizures and Nexium for G tube problems, all via G Tube.
Patient #1 had the assessment visit by the RN on 5-22-11 and the Physical Therapy
Evaluation visit on 5-23-11.
For the next 15 days there were missed visit slips and notes about missed phone calls, however, no one spoke to the patient by phone and no one entered the home or saw the patient in person.
Statiing on 6-06-11 the assumption was made that the patient was purposefully non- compliant.
On 6-08-11 he was found to have stopped eating, he had started drinking and was using the G Tube to facilitate his intake of beer.
On this date the RN left a message regarding the drinking for the operative surgeon from 2-01-11, no response was received.
The nurse did not contact the referring physician or the patient's primary care physician.
Calls were made to the surgeon during the period of 7-19-11 to 7-22-11. When he responded to the agency DON, the surgeon stated he knew about the alcohol abuse and had not responded to the message.
Calls placed during the period of 7-19-11 to 7-22-11 to the hospitalist, who had attended the patient in both the hospital and nursing home, and had written the original referral orders for home care, were not returned.
There was also a primary physician on the record who refused to write orders because he had not seen the patient since prior to the surgery.
On 6-09-11 the notes indicated a demonstration and return demonstration regarding Jevity feedings through the G Tube.
The RN was interviewed on 7-19-11 via phone and stated once the beer was in the home that the patient appeared to be drinking steadily. The RN was asked if the patient had also stopped taking medications through the G Tube, the RN was unsure.
When asked why he did not pursue a physician of record that would provide direction or why he did not call DCF (Department of Children and Families) APS (Adult Protective Services) to report self-neglect he did not have a response.
On 6-13-11 the PTA (physical therapy assistant) saw the patient for the 2nd and last time, he wrote about no visits were made due to poor compliance and discharged the PT component due to patient's non compliance.
The note stated he spoke to the sister regarding compliance and suggested a possible Hospice consult, she stated on 7/18/11 at 7:40pm during a phone interview that he only called to give her excuses for not seeing her brother.
On 6-14-11 the RN made his last visit, notes were difficult to read, per interview with the
RN on 7-19-11 via phone, there were comments about not answering the door, non-compliance, the patient fell and daughter-in-law's husband called 911, the patient refused to go to ER at that time.
A communication note for 6-14-11 stated the patient was not feeding self through tube and was drinking a 6 pack of beer+ per day. The RN discharged the patient.
Repeated interview and discussion with agency staff on 7-19-11 yielded an
overwhelming and repeated verbalization of both an attitude and judgement that this patient was difficult and willfully non-compliant.
When the totality of his circumstances (malignancy,disfiguring surgery, depression, known history of alcohol abuse, weight loss etc.) were enumerated there was a collective "we did not see it that way while it was going on" type of response.
Separate from care delivery, the agency had 2 physicians each expecting the other to sign the orders for Patient #l's care.
The original Plan of Care (POC) called for SN (skilled nurse) for I WK!, 2WK2, the PT 3WK4, and MSW (social worker) IMO!.
However, requests were also made and authorized by the insurance company that were never put into written physician orders for: 5-22-11 to 6-30-11, IO RN visits, 15 PT (physical therapy) visits, 10 OT (occupational therapy) visits, 1 SW visit and 6-10-11 to 6-30-11, 12 HHA (home heath aide) visits.
Patient# 1 received 4 RN visits on 5-22, 6-8, 6-9, and 6-14-11 and 2 PT visits on 5-23-11 and 6-13-11.
He never received the total RN and PT visits authorized, and he never received any OT, HHA or SW visits.
There was a transfer assessment on the record dated 6-16-11, which showed the patient transferred into the hospital and was discharged from the home health agency.
The form stated Patient #1 was admitted into the hospital for dehydration and
malnutrition. Per the complainant Patient #I was in the hospital for a number of days and then 28 more days in the nursing home.
Class "II" violations are those conditions or occurrences related to the operation and maintenance of a provider or to the care of clients which the agency determines directly threaten the physical or emotional health, safety, or security of the clients, other than class I violations. The agency shall impose an administrative fine as provided by law for a cited class II violation. A fine shall be levied notwithstanding the correction of the violation. §408.813(2)(b), Florida Statutes (2011)
A class II deficiency is any act, omission, or practice that has a direct adverse effect on the health, safety, or security of a patienL Upon finding a class II deficiency, the agency shall impose an administrative fine in the amount of $5,000 for each occurrence and each day that the deficiency exists. §400.484(2)(b), Florida Statutes (2011)
The Agency provided Respondent with a mandatory correction date of August 19, 2011.
Fla. Bar. No. 7
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 attomey in this matter. Specific options for administrative action are set out in the attached Election of Rights.
RESPONDENTIS FURTHER NOTIFIED THAT THE FAILURE TO REQUEST A HEARING WITHIN 21 DAYS OF RECEIPT OF THIS COMPLAINT WILL RESULT IN AN
I HEREBY CERTIFY that a true and correct copy of the foregoing has been served by
U.S. Certified Mail, Return Receipt No. 7010 1670 0000 1044 3718 to Laurie Wohl, Administrator, 3100 University Blvd. South, Suite 108, Jacksonville, Florida 32216 and by U.S. Mail to Teresa Ragatz, Registered Agent, 1200 Brickell Avenue, Suite 1900, c/o Isicoff,Ragatz & Koenigsberg, Miami, Floiida 33131 on September .LZ:. , 2011.
