Conclusions THE PARTIES resolved all disputed issues and executed a Settlement Agreement. The parties are directed to comply with the terms of the attached Settlement Agreement. Based on the foregoing, this file is CLOSED. DONE AND ORDERED this / %y of 7abuary , 2014, in Tallahassee, Leon County, Florida. LL. Yet foc! ELIZABETH DUDEK, SECKETARY Agency for Health Care Administration Page 1 of 3 Filed February 14, 2014 11:45 AM Division of Administrative Hearings Cc. I. No. 12-1696-000 A PARTY WHO IS ADVERSELY AFFECTED BY THIS FINAL ORDER IS ENTITLED TO A JUDICIAL REVIEW WHICH SHALL BE INSTITUTED BY FILING ONE COPY OF A NOTICE OF APPEAL WITH THE AGENCY CLERK OF AHCA, AND A SECOND COPY ALONG WITH FILING FEE AS PRESCRIBED BY LAW, WITH THE DISTRICT COURT OF APPEAL IN THE APPELLATE DISTRICT WHERE THE AGENCY MAINTAINS ITS HEADQUARTERS OR WHERE A PARTY RESIDES. REVIEW PROCEEDINGS SHALL BE CONDUCTED IN ACCORDANCE WITH THE FLORIDA APPELLATE RULES. THE NOTICE OF APPEAL MUST BE FILED WITHIN 30 DAYS OF RENDITION OF THE ORDER TO BE REVIEWED. Copies furnished to: Robert Rappel, D.O., J.D. Rappel Health Law Group, P.L., Bridgewater 1515 Indian River Blvd., Suite A210 Vero Beach, Florida 32960-4230 (U.S. Mail) Agency for Health Care Administration Douglas J. Lomonico, Assistant General Counsel, MS #3 (Electronic Mail) Agency for Health Care Administration Division of Health Quality Assurance Agency for Health Care Administration Home Care Unit, MS #34 Agency for Health Care Administration Bureau of Finance and Accounting, MS #14 Agency for Health Care Administration Bureau of Medicaid Program Integrity, MS#6 ATTN: Rick Zenuch, Bureau Chief Florida Department of Health Finance and Accounting Page 2 of 3 C.1I. No. 12-1696-000 CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing Final Order was furnished by United States Mail, interoffice mail, or email transmission to the above-referenced ——— addressees this /3 day of 7 tiene , 2014. RICHARD J. SHOOP, Agency Clerk Agency for Health Care Administration 2727 Mahan Drive, MS #3 Tallahassee, Florida 32308 Telephone No. (850)-412-3630 Facsimile No. (850)-921-0158 Page 3 of 3
Findings Of Fact The Respondent, Gertrude Delman Levin, R. N., holds License No. 71014-2 as a registered nurse in the State of Florida. She has practiced her profession as an employee of Bethesda Memorial Hospital in Boynton Beach, Florida, Cypress Community Hospital in Pompano Beach, Florida, and North Medical Center, Inc. in Fort Lauderdale, Florida, during the time pertinent to this hearing. On January 9, 1979, an administrative complaint was issued by the Petitioner Board seeking to place on probation, suspend, or revoke the license of Respondent Levin for alleged unprofessional conduct during the course of her employment at the foregoing medical centers. Respondent requested an administrative hearing on April 9, 1979, and her request was forwarded by the Petitioner Board to the Division of Administrative Hearings on April 13, 1979. An administrative hearing was scheduled for July 18, 1979, in Fort Lauderdale, Florida, by Notice of Hearing dated April 26, 1979. The hearing was continued upon Motion of the Respondent, and rescheduled and heard July 31, 1979. The Transcript of Proceedings was received September 6, 1979. After the hearing was called to order, the Respondent admitted the following allegations of the Administrative Complaint: On or about March 5, 1977, while on duty as a registered nurse at Bethesda Memorial Hospital, Boynton Beach, Florida, Respondent administered a controlled narcotic, to-wit: Morphine Sulphate, intravenously twice to a patient named Gladys Sargent, at approximately 1:15 a.m. and again at approximately 2:10 a.m., contrary to the physician's order which directed that the patient be given Demerol (Meperedine) 50 mg. and Vistaril 25 mg. I.M. every three hours, and failed to chart the administration of same on the medication administration record. On or about March 29, 1977, while on duty at Bethesda Memorial Hospital, Respondent charted on the medication record as having omitted to administer a heart medication, to-wit: Pronestyl Intramuscular to a patient, Phillip Bialer, at 12:00 midnight and 6:00 a.m., and charted in the Nurses Notes that the 6:00 a.m. dose was not given since the patient was unable to swallow, even though the medication was to be administered intramuscularly and not be mouth. The 12:00 midnight dose was charted in the Nurses Notes as having been given without difficulty. On or about May 13, 1977, while on duty as above, Respondent signed out for a prescription drug, to-wit: Talwin for a patient, Mable Larkin, for whom there was no physician's order for said medication. Respondent failed to chart the disposition of said Talwin on either the medication administration record or Nurses Notes. In view of the above medication errors, Respondent was terminated from her employment at Bethesda Memorial Hospital. During the month of April, 1978, while on duty as a registered nurse at Cypress Community Hospital, Pompano Beach, Florida, Respondent committed numerous medication and charting errors with respect to the controlled substance, Demerol (Meperidine), including but not limited to: (g) Signing out on the narcotic control record on April 1, 1978, at 12:30 p.m. for Meperidine 75 mg. for a patient, Lillian Sederquist, when the patient's physician's order called for only 50 mg. of Meperidine, charting on the patient's medication administration record as having administered 50 mg. to the patient and failing to account for the excess. Immediately after the foregoing admissions by Respondent, the Petitioner dropped Allegation 8 of the Administrative Complaint. In reference to the foregoing admitted Allegations 1, 2, 3 and 4, Respondent submitted documentation to show mitigating circumstances. The documentation proported to show that during the period of time from March of 1977, through May of 1977, the Respondent had advised her supervisor at Bethesda Memorial Hospital that she was under medication for an injury and that she was under stress because of her divorce, care of a small child, and other personal problems. Respondent admitted Allegation 5 (g) of the foregoing Administrative Complaint in reference to her work at Cypress Community Hospital. She did not admit "numerous" errors. From evidence and testimony relating to physician's orders, I find that: Respondent Levin signed out the narcotic, Demerol, for a patient, Benjamin Arber, at a time when the physician's order of March 23, 1978, had not been renewed. On April 6, 1978, Respondent signed out the narcotic, Demerol, for a patient, Lillian Sederquist, on then narcotic control record without a physician's orders. On April 25, 1978, Respondent signed out for 50 mg. of Demerol for a patient, Vivian Albapo. No time was indicated, and there were no physician's orders in affect at the time for 50 mg. The order was for 75 mg. of Demerol. On April 6, 1978, there were no physician's orders in effect for Meperidine for patient Sederquist, but Respondent signed out 75 mg. of Meperidine for her at 2:00 o'clock p.m. The medication was not charted on the medication administration record of the patient, and no such entry was made in the nurses notes. On April 7, 1978, Respondent signed out for 75 mg. of Meperidine at 7:00, 8:00 and 11:00 o'clock, but there were no physician's orders in effect. On the PRN record 7:00 o'clock a.m. was written over and 8:00 o'clock a.m. and 3:00 o'clock p.m. noted, but there was no notation for 11:00 o'clock a.m. The nurses notes related to Sederquist do not mention 7:00 or 11:00 o'clock a.m. On April 12, 1978, Respondent Levin signed out twice for narcotics for patient Sederquist without physician's orders and without reflecting the administration of medication to the patient. On April 13, 1978, there was a total of 75 mg. of Meperidine signed out for patient Sederquist, but there were no physician's orders. There was a medical record, but there was no notation in the nurses notes. On April 15 and 17,1978, there was a sign-out at 9:00 o'clock for Meperidine 75 mg., but there were no physician's orders in effect. There was a medication record for April 15, but none for April 17, and there was no notation in the nurses notes. A discharge order for patient Sederquist was written for April 15, 1978, and the nurses notes showed discharge via wheelchair to husband's care at 12:30 p.m. Respondent Levin had signed out for 75 mg. of Meperidine at 12:00 o'clock noon on April 15, 1978, without physician's orders. From evidence relating to wasting, charting and nurses notes, I find that: Respondent signed out for Demerol 75 mg. for a patient, Vivian Sederquist, on April 2, 1978, but it was not administered and was not shown to have been wasted. Respondent signed out for 10 mg. of Morphine on April 7, 1978, and stated it was wasted on the record, but such wastage notation was not co-signed as required. Respondent signed out for 75 mg. of Meperidine for a patient, Carmody, on April 15, 1978, and indicated that the narcotic had been wasted, but there was no indication of a co-signing witness. On April 19, 1978, Respondent signed out for 100 mg. of Demerol for a patient, Bosch, and indicated wastage, but there was no co-signature. On April 20, 1978, Respondent signed out for 100 mg. of Demerol for a patient, Lowery, and indicated that 25 mg. had been wasted, but there was no co-signee. On the same date Respondent signed out 50 mg. of Demerol for patient Bosch and indicated a contaminated needle, but there was no cc-signature. On April 21, 1978, Respondent Levin signed out for 75 mg. of Demerol and indicated a contamination, but there was no co-signature. On April 24, 1978, 50 mg. of Demerol was signed out for a patient, Jones, and 25 mg. was indicated as wasted, but there was no co-signature. On that same day and hour 50 mg. of Demerol was signed out by Respondent and 25 mg. indicated as wasted, but there was no co-signature. On May 25, 1978, 2 mg. of Dilaudid was ordered for a patient, Hollinger, but was charted for 3 mg. by Respondent Levin, and there were no nurses notes. On May 26, 1978, at 3:00 o'clock p.m. there was a sign-out for Dilaudid for patient Hollinger by the Respondent, but the nurses notes show the patient was medicated for pain at 2:45 p.m. On May 29, 1978, there was a sign-out for medication for patient Hollinger at 10:30 a.m., but the medication administration record shows 9:30 a.m. On May 30, 1978, Respondent signed out for Dilaudid for patient Hollinger at 9:00 o'clock a.m., but it was not charted on the medication administration record, and there was nothing in the nurses notes. May 18, 1978, there was a sign-out by Respondent Levin for Leritene at 11:30 a.m. for a patient, Kraus, but there is nothing on the patient's medication record or in the nurses notes relative to such drug. On May 19, 22, 24 and 25, 1978, there were sign-outs for Leritene by Respondent, but nothing was noted to this effect on the medication administration record or in the nurses notes kept by Respondent Levin. Hospital policy and good nursing practice require that no narcotics be signed out by a nurse without a physician's order effective at that time. Medication given to a patient by a nurse must be charted by that same nurse. "Wasted" narcotics must be accounted for by the nurse who signs out the drug, and the record of wasted narcotics must be witnessed by another nurse. Nurses notes should be kept by the nurse. There was testimony that at infrequent times the foregoing general hospital policy and good nursing practices were violated, but any such violations are at the peril of the nurse. From the testimony of employee witnesses at the hospitals in which Respondent was employed, it appeared that the hospitals were understaffed during the periods Respondent was employed. Narcotic control and medical records from Bethesda Memorial Hospital, Cypress Community Hospital, North Beach Medical Center and Boca Raton Community Hospital were verified, and copies were placed in evidence. The Incident report from Boca Raton Community Hospital was satisfactorily explained. Respondent Levin submitted a brief and entitled Sections 3 through 7 "Proposed Findings of Fact." There was no memorandum of law or proposed order from the Petitioner Board. The instrument from Respondent was considered in the writing of this Order. To the extent the proposed findings of fact have not been adopted in, or are inconsistent with, factual findings in this Order they have been specifically rejected as being irrelevant or not having been supported by the evidence.
Recommendation Based upon the foregoing Findings of Fact and Conclusions of Law the Hearing Officer recommends that the license of Respondent Levin be suspended for a period of not more than two (2) years and until she can show rehabilitation to the satisfaction of the Petitioner Board. DONE and ORDERED this 12th day of October, 1979, in Tallahassee, Leon County, Florida. DELPHENE C. STRICKLAND Hearing Officer Division of Administrative Hearings Room 101, Collins Building Tallahassee, Florida 32301 (904) 488-9675 COPIES FURNISHED: Julius Finegold, Esquire 1107 Blackstone Building 233 East Bay Street Jacksonville, Florida 32202 Robert C. Kain, Jr., Esquire Legal Aid Service of Broward County, Inc. 609 South Andrews Avenue Fort Lauderdale, Florida 33301 Geraldine B. Johnson, R. N. State Board of Nursing Ill Coastline Drive East, Suite 504 Jacksonville, Florida 32202
Conclusions Having reviewed the Administrative Complaint dated September 27, 2010, attached hereto and incorporated herein (Ex. 1), and all other matters of record, the Agency for Health Care Administration (“Agency”) has entered into a Settlement Agreement (Ex. 2) with the parties to these proceedings, and being well advised in the premises, finds and concludes as follows: ORDERED: 1. The attached Settlement Agreement is approved and adopted as part of this Final Order, and the parties are directed to comply with the terms of the Settlement Agreement. 2. The Respondent shall pay, within thirty (30) days of the date of rendition of this Order, an administrative fine of one thousand dollars ($1,000.00) and a survey fee of five hundred dollars ($500.00) for a total of one thousand five hundred dollars ($1,500.00) to the Agency. 1 Filed January 14, 2011 QJ Division of Administrative Hearings 3. Checks should be made payable to the “Agency for Health Care Administration.” The check, along with a reference to this case number, should be sent directly to: Agency for Health Care Administration Office of Finance and Accounting Revenue Management Unit 2727 Mahan Drive, MS #14 Tallahassee, Florida 32308 4. Unpaid amounts pursuant to this Order will be subject to statutory interest and may be collected by all methods legally available. 5. Each party shall bear its own costs and attorney’s fees. 6. The Respondent’s petition for formal administrative proceedings is hereby withdrawn. 7. The above-styled case is hereby closed. DONE and ORDERED this |) day of es , 2019, in Tallahassee, Leon County, Florida. {, Interim Secretary alth Care Administration A PARTY WHO IS ADVERSELY AFFECTED BY THIS FINAL ORDER IS ENTITLED TO JUDICIAL REVIEW WHICH SHALL BE INSTITUTED BY FILING ONE COPY OF A NOTICE OF APPEAL WITH THE AGENCY CLERK OF AHCA, AND A SECOND COPY, ALONG WITH FILING FEE AS PRESCRIBED BY LAW, WITH THE DISTRICT COURT OF APPEAL IN THE APPELLATE DISTRICT WHERE THE AGENCY MAINTAINS ITS HEADQUARTERS OR WHERE A PARTY RESIDES. REVIEW OF PROCEEDINGS SHALL BE CONDUCTED IN ACCORDANCE WITH THE FLORIDA APPELLATE RULES. THE NOTICE OF APPEAL MUST BE FILED WITHIN 30 DAYS OF RENDITION OF THE ORDER TO BE REVIEWED. Copies furnished to: John D. Ellis, Esq. Attorney for Respondent Balmy Beach Retirement Home, Inc. P.O. Box 1161 Orlando, Florida 32801 James H. Harris, Assistant General Counsel Agency for Health Care Admin. Office of the General Counsel 525 Mirror Lake Drive North, #330D (U.S. Mail) St. Petersburg, Florida 33701 Interoffice Mail) Jan Mills Agency for Health Care Admin. - Agency for Health Care Admin. 2727 Mahan Drive, Bldg #3, MS #3 Tallahassee, Florida 32308 (Interoffice Mail) Office of Finance and Accounting Revenue Management Unit 2727 Mahan Drive, MS #14 Tallahassee, Florida 32308 Bruce McKibben Administrative Law Judge Division of Administrative Hearings The Desoto building 1230 Apalahcee Parkway Tallahassee, Florida 32399-3060 (Electronic Mail) Perce ne Mail) CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of this Final Order was served on the above-named person(s) and entities by U.S. Mail, or the sa method designated, on this the IZ day of Richard Shoop, Agency Clerk ey Agency for Health Care Administration 2727 Mahan Drive, Building #3 Tallahassee, Florida 32308-5403 (850) 412-3630
The Issue The ultimate issue for determination at hearing was whether disciplinary action should be taken against Respondent's license to practice osteopathy for the reasons alleged in the Administrative Complaint.
Findings Of Fact At all times relevant to this proceeding, Respondent has been licensed to practice osteopathy under the laws of the State of Florida pursuant to License Number OS 0001510. Petitioner is the state agency empowered by Chapters 20, 455, and 459, Florida Statutes, to regulate the practice of osteopathy within the State of Florida. The addresses listed by Respondent on the copies of his renewal cards for his license in Petitioner's Composite Exhibit 1 include the address of 76 East McNab Road, Pompano Beach, Florida, 33060. Respondent and Petitioner were parties to a prior disciplinary proceeding. Department of Professional Regulation, Board of Osteopathic Medical Examiners v. Wilfred W. Mittelstadt, Case No. 84-2844 (DOAH 1986). The Final Order of the Board in the prior disciplinary proceeding was entered on November 7, 1986, filed on November 20, 1986, and affirmed per curiam by the First District Court of Appeal on April 27, 1988. Mittelstadt v. Department of Professional Regulation, Board of Osteopathic Medical Examiners, 528 So.2d 1188 (Fla. 1st DCA 1988). The Final Order in the prior disciplinary proceeding provides inter alia that during a 3_ year period from the date of the Final Order 3/ Respondent ". . . shall have his office records subjected to random inspections by the Department of Professional Regulation." The Final Order does not specify the purpose of the random inspections. Instead, the Final Order provides as an "additional part of the penalty" that Respondent is prohibited from the use of chelation therapy for the treatment of rheumatoid arthritis, copper poisoning, and vascular disease for a 3 year period. The random inspection of office records, therefore, is separate and apart from the prohibition of practicing chelation therapy for the purposes prescribed in the Final Order. On August 17, 1987, DPR Investigator Golden received a Disciplinary Enforcement Request from the Board. The Board requested Investigator Golden to inspect Respondent's office records if the Respondent was still in practice. The Board's request stated that its Final Order prohibited Respondent from using chelation therapy, that Respondent must appear before the Board with proof of CMEs, 4/ and further requested Investigator Golden to inform the Board if Respondent was still in practice. Investigator Golden spoke with Respondent by telephone on September 8, 1987. Investigator Golden telephoned Respondent's office on September 8, 1987, and asked to speak with Dr. Mittelstadt. A man subsequently identified himself to Investigator Golden as Dr. Mittelstadt. The accuracy of the telephone system, the absence of motive to falsify, and the lack of opportunity for premeditated fraud all support the conclusion that self-identification by the person being called is reliable authentication of the speaker's voice. The voice in the telephone conversation on September 8, 1987, was that of Respondent. Investigator Golden was sufficiently familiar with Respondent to identify the voice in the telephone conversation on September 8, 1987, as that of Dr. Mittelstadt. Investigator Golden based his voice identification on a face-to-face conversation with Dr. Mittelstadt prior to the telephone conversation on September 8, 1987, and on hearing the Respondent speak on the day of the formal hearing outside the hearing room. In addition, Investigator Golden physically identified Respondent under oath at the hearing. Respondent had actual or constructive knowledge of the terms of his probation. Respondent was a party to the prior disciplinary proceeding in which the Final Order was entered on November 7, 1986. Respondent filed a Motion to Stay the conditions of suspension and probation which was denied by the First District Court of Appeal. Wilfred W. Mittelstadt, D.O. v. Department of Professional Regulation, Case No. BR-150 (Fla. 1st DCA January 23, 1987). Respondent appealed the Final Order and the Final Order was affirmed per curiam. Mittelstadt v. Department of Professional Regulation, Board of Osteopathic Medical Examiners, 528 So.2d 1188 (Fla. 1st DCA 1988). Finally, Petitioner's Composite Exhibit 2 and Petitioner's Exhibit 3 establish a rebuttable presumption that the Final Order was delivered to Respondent on November 25, 1986. That presumption was not rebutted by testimony from the Respondent. The testimony of Investigator Golden demonstrates that the purpose of the Board's Disciplinary Enforcement Request on August 17, 1987, included inspection of office records. Investigator Golden's testimony also establishes that it was one of his purposes in making the telephone call to Dr. Mittelstadt on September 8, 1987, to request inspection of Respondent's office records. No evidence was presented that Investigator Golden requested access to Respondent's office records, that Respondent denied such access, that Respondent failed to make available his office records for inspection upon request by the Petitioner, or that Respondent willfully and intentionally failed and refused to produce his office records upon official request of the Petitioner. The testimony of Investigator Fischer is irrelevant to the allegation in the Administrative Complaint that Respondent refused to allow inspection of his office records on or about September 7, 1987. Further, the record does not establish that a request to inspect Respondent's office records was ever made by Investigator Golden. The Transcript at page 24 reveals the following facts: I said, "This is Jim Golden, investigator with DPR, Department of Professional Regulation." Q. All right. A. And I said "I'm calling to set up an appointment to come to your office and sit down with you in regards to the terms of your probation, disciplinary action." Do you want to just-- Q. What kind of response did you get? A. Okay. Dr. Mittelstadt refused to discuss his probation terms and even disavowed ever being disciplined by the Board stating, "I have patients to see," and hung up. Q. What did you do in response to that? A. I advised my supervisor and then initiated a supplemental report, probation report, and forwarded it with a copy of the DER to the Board. Did you make further attempts to review his records yourself? A. No, sir. There is no evidence that Petitioner made any other request to inspect Respondent's records on or about September 7, 1987, as alleged in the Administrative Complaint. Nor is there any evidence that Respondent refused such a request.
Recommendation Based upon the foregoing Findings of Fact and Conclusions of Law, it is RECOMMENDED that Respondent be found not guilty of violating the terms of his probation on or about September 7, 1987, as alleged in the Administrative Complaint. DONE and ENTERED this 8th day of August 1989, in Tallahassee, Florida. DANIEL MANRY Hearing Officer Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-1550 (904) 488-9675 Filed with the Clerk of the Division of Administrative Hearings this 8th day of August 1989.
Conclusions THIS CAUSE is before me for issuance of a Final Order. In a letter dated May 18, 2011, C.I. No. 10-1269-300, Homestead Hospital, Inc. (“Respondent”) was informed that the State of Florida, Agency for Health Care Administration (“AHCA” or “Agency”) was seeking to recoup Medicaid overpayments in the amount of Thirty-Seven Thousand, Eight Hundred Sixty-Four Dollars and Forty cents ($37,864.40). The Respondent was further informed in the letter that the Agency assessed One Thousand, Three Hundred Forty-Three Dollars and Sixty-Four cents ($1,343.64) as costs for a total amount due of Thirty-Nine Thousand, Two Hundred Eight Dollars and Four cents ($39,208.04). Pursuant to §409.913(6), Florida Statutes, the letter was sent Certified Mail, return receipt requested, to Respondent at the address last shown on the provider enrollment file. Page 1 of 4 Filed November 17, 2011 8:37 AM Division of Administrative Hearings AHCA v. Homestead Hospital, Inc. Case No. 11-3316MPI Final Order Respondent signed for the letter on May 24, 2011, and the Agency received the certified mail card on May 31, 2011. A Petition for Administrative Hearing was received by the Agency on June 13, 2011. On July 1, 2011, the Petition was forwarded to DOAH by the Agency and assigned to an Administrative Law Judge (“Judge”) . On August 25, 2011, the Respondent subsequently filed a Notice of Voluntary Dismissal with DOAH. The DOAH Judge entered an Order Closing File dated August 26, 2011, and therein remanded jurisdiction back to AHCA.
