09-003159 Agency For Health Care Administration vs. Northpointe Retirement Community, Inc., D/B/A Northpointe Retirement Community
 Status: Closed
Recommended Order on Friday, January 29, 2010.


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Summary: Petitioner proved four of five charged Class I deficiencies, resulting in resident's fall and death. Recommend $35,000 in fines and withhold revocation by instituting strict quarterly corrective plans and agency surveys, for benefit of other residents.

1STATE OF FLORIDA

4DIVISION OF ADMINISTRATIVE HEARINGS

8AGENCY FOR HEALTH CARE )

13ADMINISTRATION, )

15)

16Petitioner, )

18)

19vs. ) Case No. 09-3159

24)

25NORTHPOINTE RETIREMENT COMMUNITY, INC., d/b/a )

31NORTHPOINTE RETIREMENT )

34COMMUNITY, )

36)

37)

38Respondent. )

40)

41RECOMMENDED ORDER

43Pursuant to proper notice this matter came on for formal

53proceeding and hearing before P. Michael Ruff, duly-designated

61Administrative Law Judge of the Division of Administrative

69Hearings. The hearing was conducted in Pensacola, Florida, on

78September 10, 11, 30, and October 21, 2009. The appearances

88were as follows:

91APPEARANCES

92For Petitioner: Richard Joseph Saliba, Esquire

98Mark H. Hinely, Esquire

102Agency for Health Care Administration

107Fort Know Building 3

1112727 Mahan Drive, Mail Stop 3

117Tallahassee, Florida 32308

120For Respondent: Kerry Anne Schultz, Esquire

126Fountain, Schultz & Associates, P.L.

1312045 Fountain Professional Court, Suite A

137Navarre, Florida 32566

140STATEMENT OF THE ISSUE

144The issues to be resolved in this proceeding concern

153whether Northpointe Retirement, Inc., d/b/a Northpointe

159Retirement Community (Respondent) (Northpointe) has committed

165five "Class I" deficiencies, pursuant to the statutes and rules

175referenced herein, regarding circumstances surrounding the death

182of "Resident No. 1" and whether Northpointe should be required

192to pay an administrative fine totaling $50,000.00 and have its

203license revoked.

205PRELIMINARY STATEMENT

207This matter arose upon the filing of an Administrative

216Complaint on July 11, 2009, by the Petitioner Agency for Health

227Care Administration (Petitioner) or (Agency), whereby it seeks

235to impose administrative fines and to revoke the license of the

246Respondent's assisted living facility (ALF). The Amended

253Complaint herein was filed July 27, 2009. The case was set for

265hearing for August 17, 2009, but was continued by agreement of

276the parties. It was scheduled for hearing again on

285September 10, 2009, and the hearing commenced on that date. The

296hearing continued on to September 11, September 30, and

305concluded on October 21, 2009.

310The matter came on for hearing as noticed over a period of

322four days. The Petitioner presented eight witnesses and the

331Respondent presented eleven witnesses, as are named in the

340Transcript of the proceeding. Additionally, each party

347presented its exhibits in bound notebooks and the exhibits

356admitted into evidence are reflected in the court reporter's

365official Transcript. Additionally, the video-taped deposition

371of Dr. Jack Abramson was presented and admitted into evidence by

382the Petitioner. For the Respondent, the video-taped deposition

390of Carol Mulloy, the granddaughter and attorney-in-fact for

398Resident No. 1 was offered and admitted into evidence for

408consideration by the undersigned.

412The parties elected to obtain a transcript of the

421proceeding, which was filed on November 10, 2009. They also

431requested an extended period of 30 days to submit proposed

441recommended orders. The Proposed Recommended Orders were

448therefore timely submitted on or before December 11, 2009. The

458Proposed Recommended Orders have been considered in the

466rendition of this Recommended Order.

471FINDINGS OF FACT

4741. The Respondent, Northpointe, operates an ALF consisting

482of two buildings in Pensacola, Florida. The care provided to

492the residents by the Respondent is primarily custodial in nature

502and includes assisting with activities of daily living such as

512bathing, dressing, grooming, and the feeding of residents. The

521Respondent is largely reliant on the health assessment and

530orders provided by a resident's physician. Decisions regarding

538healthcare diagnosis and treatment are made by physicians and

547other healthcare professionals, outside of the Respondent's

554facility.

5552. Resident No. 1 arrived at the Respondent's facility in

565March of 2008. She was an 88-year-old female, with some chronic

576medical conditions such as hypertension, hypothyroidism, and

583arthritis. She had a habit of staying awake at night and

594sleeping during the day. She was a vegetarian, with food

604allergies, so she would rarely take meals in the dining room and

616preferred to prepare her own food and eat in her room.

6273. The resident's healthcare provider at the time she came

637to the Respondent's facility was James Chaney, an Advanced

646Registered Nurse Practioner (ARNP) under the supervision of

654Dr. Gotthellf, MD. Dr. Mikhchi, the administrator of the

663Respondent and Sara Hines, the assistant administrator, stated

671that Resident No. 1 came to the Respondent's facility because

681she needed additional assistance with activities of daily

689living.

6904. James Chaney completed a "form 1823 assessment" of

699Resident No. 1 upon her arrival at the Respondent's facility.

7095. In March of 2008, Resident No. 1 was taking two

720medications for blood pressure, as well as aspirin, a thyroid

730supplement, and Prozac for depression. James Chaney first

738examined her at the Respondent's facility on March 28, 2008.

748Resident No. 1 regained her independence in terms of taking care

759of herself and her activities of daily living, within weeks of

770her arrival at the Respondent's facility. James Chaney next

779examined her at the Respondent's facility on April 23, 2008. At

790that time he communicated with the Respondent's staff regarding

799Resident No. 1. He noted that Resident No. 1 was doing well and

812adjusting well to her move to the Respondent's facility.

8216. James Chaney examined Resident No. 1 at the

830Respondent's facility essentially once a month over the ensuing

839months, until November 2008. He noted generally, during those

848visits, that Resident No. 1 was doing well, aside from having

859elevated blood pressure.

8627. Mr. Chaney examined the Resident at the Respondent's

871facility on October 14, 2008. He communicated with the

880Respondent's staff at the facility regarding Resident No. 1 at

890that time. He noted that she was well-dressed and pleasant, as

901usual, and noted that she had a high functional level.

9118. James Chaney next examined Resident No. 1 on

920November 11, 2008, at the Respondent's facility. He

928communicated with his staff at that time regarding Resident No.

9381 and noted that there were no unusual occurrences. Resident

948No. 1 was continuing to do well and was maintaining a good level

961of independence, according to Mr. Chaney. He did not feel the

972need to change her medication at that time.

9809. On or about November 18, 2008, Sara Hines, the

990Assistant Administrator, had a conversation with Resident No.

9981's granddaughter. She then learned that Resident No. 1 had

1008hallucinations. This apparently involved Resident No. 1's

1015coming out of her room several times saying that the "little boy

1027next door" was crying because his father was trying to kill him

1039or else that someone next door was being killed. On November

105019th she was observed to be roaming the halls and yelling that a

1063man was beating a child. Dr. Mikhachi testified that a meeting

1074was held between he, Sara Hines, and Dr. Christina Mikhchi as a

1086result of his learning of Resident No. 1's hallucinations.

1095James Chaney or his office was apparently contacted by the

1105Respondent's staff on or about November 21, 2008, and he replied

1116that he would be out to see Resident No. 1 on November 24, 2008.

1130Dr. Mikhachi directed the staff at the Respondent's facility to

1140increase supervision of Resident No. 1, should she experience

1149another hallucination, by making attempts to calm her, take her

1159back to her room to talk about her family photographs, which she

1171enjoyed doing. He directed them to get her involved in tasks

1182she enjoyed, such as folding clothes or serving ice tea in the

1194dining room to other residents; or to take her to visit a friend

1207at the facility and to call her granddaughter.

121510. Mr. Chaney examined Resident No. 1 at the Respondent's

1225facility on November 24, 2008. He indicated that the staff had

1236informed him that Resident No. 1 had hallucinations. He

1245conducted the examination because of the staff's request.

1253Delusions are a significant change in status of the resident.

1263Resident No. 1's mental status had changed significantly between

1272Mr. Chaney's November 11, 2008, visit and his November 24, 2008,

1283visit.

128411. On December 3, 2008, Resident No. 1 was again having

1295hallucinations and called the emergency 911 number. She

1303summoned Sheriff's deputies to the Respondent's facility and her

1312room by acting on her delusion or hallucination concerning

1321children being beaten or killed. A CNA note for that occasion

1332reflects the incident, but Mr. Chaney was not told, and no call

1344was made to him or his office. This was a significant change

1356once again, because now Resident No. 1 was acting out on her

1368hallucinations.

136912. The CNA note for December 6, 2008, indicates that

1379Resident No. 1 was "wandering like crazy," "very hard to keep up

1391with," "going out the door so many times." Mr. Chaney testified

1402that he felt the behavior amounted to "exit seeking" or seeking

1413to leave the facility. This was important for him to know and

1425seemed to be a change in behavior, in terms of increased

1436agitation and excitability on the part of Resident No. 1.

1446Mr. Chaney's notes from that December 9, 2008, visit do not

1457indicate that he was then aware of "exit seeking" behavior.

1467Mr. Chaney said he would have recommended more frequent

1476monitoring if he had known. He would have told the staff that

1488Resident No. 1 was a high risk for that type of behavior if he

1502had known about it.

150613. A significant change was noted on Mr. Chaney's

1515December 9, 2008, visit, when he diagnosed Resident No. 1 with

"1526agitation" for the first time. He felt she had an escalation

1537in her symptoms and ordered a psychological evaluation. She was

1547starting an atypical, anti-psychotic medication, Risperdal,

1553coupled with a decrease in the amount of Prozac she was being

1565prescribed. He therefore felt he needed an expert evaluation.

157414. Mr. Chaney's next visit was on December 14, 2008.

1584During that visit he was not told about an incident that

1595occurred on December 12, 2008, in which Resident No. 1 was

1606observed walking out the front door while talking about

"1615killings" occurring, apparently a recurrence of the

1622hallucination about persons or children being murdered. Another

1630nurse or CNA note for that day stated that Resident No. 1 was

1643wandering around outside of her room carrying a blanket and

1653trying to enter another resident's room with the blanket,

1662because she believed it was her granddaughter's room.

1670Mr. Chaney was not told of these incidents. If he had been told

1683of them he would have recommended increased monitoring and

1692supervision of Resident No. 1. On December 14, 2008, at his

1703visit to the Respondent's facility and Resident No. 1, he noted

1714a significant decline in her status as to dementia and delirium,

1725agitation, and hallucinations.

172815. After Mr. Chaney left the facility on December 14,

17382008, Resident No. 1 suffered a fall. Mr. Chaney was not

1749immediately informed of it by the Respondent. Resident No. 1

1759was transported to the emergency room at the hospital by

1769ambulance because of confusion, irritation, hallucination, and

1776falling. Mr. Chaney was not informed by the Respondent

1785concerning the circumstances surrounding the fall. Resident No.

17931 was diagnosed at the hospital with a urinary tract infection.

1804She was given Bactrim, an antibiotic, and discharged back to the

1815Respondent's facility. The fall and the urinary tract infection

1824constituted a significant change in Resident No. 1's condition.

183316. Mr. Chaney, as her medical provider was not called by

1844the Respondent. Rather he found out about that situation a day

1855or so after the diagnosis was made as to the urinary tract

1867infection. He learned of the fall by reading the Adverse

1877Incident Report prepared by the Respondent, but was not made

1887aware of the particular circumstances surrounding Resident No.

18951's fall. It was important for Mr. Chaney to have been informed

1907of the urinary tract infection because it could have affected

1917the resident's treatment regimen. Urinary tract infections in

1925elderly people can result in symptoms indicating delirium.

193317. If Resident No. 1 made statements regarding suicidal

1942ideation, such as that "voices were telling her to jump out of a

1955window," it would be important for Mr. Chaney and his

1965supervising physician to know because she should then have been

1975transported for an inpatient psychiatric evaluation as soon as

1984the statements were made. However, it has not been proven by

1995persuasive evidence that she made such statements. The

2003testimony in this regard was by Ms. Endress, the surveyor, who

2014based her testimony about the statements on her interview with

2024Brenda Wilson. Brenda Wilson, however, recanted her statements

2032to Ms. Endress to that effect, in her testimony at hearing,

2043saying essentially that she had felt intimidated during her

2052interview with Ms. Endress during Ms. Endress' survey. Brenda

2061Wilson, in her testimony, denied that Resident No. 1 had made

2072such statements involving self-harm. Brenda Golden testified

2079that Brenda Wilson had told her, after the interview, that she

2090had basically told Ms. Endress what she wanted to hear. It was

2102thus not persuasively established that the suicidal statements

2110at issue were actually made.

211518. Mr. Chaney diagnosed Resident No. 1 with agitation,

2124depression, hallucinations, and dementia. Those diagnoses show

2131that Resident No. 1 was in a circumstance where she could change

2143for the worse quickly. It was thus important for the facility

2154to contact Mr. Chaney immediately following significant changes

2162in condition, in order for him to provide appropriate care.

217219. Brenda Wilson is an employee of the Respondent and

2182provided direct care to Resident No. 1 in the course of her

2194employment. She observed Resident No. 1 hallucinating,

2201concerning hearing voices about a man beating two screaming

2210children. She had observed Resident No. 1 walking down the hall

2221to other resident rooms and stating that a man was beating

2232children inside the room.

223620. Ms. Wilson was on duty on the night of December 23,

22482008, until the morning of December 24, 2008. She provided care

2259for Resident No. 1 during that time. She observed that Resident

2270No. 1 became agitated that night, walking out of her room and

2282down the hall, putting her head up to other resident's doors

2293trying to find the voices she was apparently "hearing." Ms.

2303Wilson called Sara Hines, the assistant administrator, and told

2312her that Resident No. 1 was a little agitated, but more

2323importantly she was talking very loud.

232921. Resident No. 1 was more agitated than normal on that

2340morning which is why Ms. Wilson called Ms. Hines. Ms. Wilson

2351indicated to Ms. Hines that she was unable to care for all the

2364residents under her supervision on the morning of December 24th,

2374because Resident No. 1 was following her to other resident

2384rooms. Ms. Hines told Ms. Wilson to stay with Resident No. 1

2396and watch her closely.

240022. Brenda Golden is a Med Tech Manager for Northpointe.

2410She was so employed during the entirety of 2008 and is a member

2423of the Respondent's management. She provided care for Resident

2432No. 1 as well. She had observed Resident No. 1 hallucinating.

2443On the morning of December 24, 2008, she was working in the

2455Westpointe building next door. It is part of the same facility,

2466but a separate building. Around 6:30 a.m. the administrator

2475informed her that something was wrong with Resident No. 1 and

2486asked her to check on Resident No. 1 right away. The

2497administrator did not tell her that Resident No. 1 was agitated.

250823. Ms. Golden went to check on Resident No. 1 in her room

2521and saw that the screen on the window was torn. When she went

2534over to the screen and looked out she saw Resident No. 1 lying

2547on the ground below. Ms. Golden stated that Resident No. 1 told

2559her, when she went down to assist her, that she had jumped out

2572of the window because the "voices" had told her to do so.

2584Ms. Golden also heard Resident No. 1 tell the paramedics who

2595were summoned, that voices had told her to jump. Ms. Wilson was

2607not in Resident No. 1's room when Resident No. 1 jumped out of

2620the window.

262224. Resident No. 1 was conscious and appeared lucid when

2632the paramedics arrived. She did not appear to have any broken

2643bones. She was transported to the hospital, but later that

2653morning or that day declined precipitously and died.

266125. Sara Hines was the assistant administrator in 2008.

2670She was aware of the hallucinations and that they had gotten

2681more intense in December of 2008. After Ms. Hines spoke with

2692Ms. Wilson on the morning of December 24th she waited

2702approximately 25 minutes to speak to the administrator about

2711Resident No. 1's condition that morning. She did not contact

2721Resident No. 1's health care provider after speaking with

2730Ms. Wilson and the administrator. After Resident No. 1's fall

2740that day she completed the adverse incident report and stated

2750that Resident No. 1 had jumped from the window because of

2761voices.

276226. Ms. Hines did not make any determinations to increase

2772supervision of the resident after finding out about the

2781scheduled psychiatric evaluation which Mr. Chaney and the

2789resident's family had scheduled. The administrator did not make

2798any changes in the resident's supervision based on that

2807information either.

280927. Rebecca Yokom is an employee with Northpointe who

2818provided care to Resident No. 1 during 2008. She observed

2828Resident No. 1 hallucinate approximately six times that year.

2837None of the other residents she cared for hallucinated.

284628. Mohamad Mikhici is the owner and administrator for

2855Northpointe. He acknowledged that Resident No. 1 was re-located

2864from the Westpointe Assisted Living Facility to the Northpointe

2873because she had fallen several times.

287929. After the hallucinatory episodes began, on

2886November 18, 2008, the administrator told Resident No. 1's

2895granddaughter that, if the frequency and intensity of

2903hallucinations continued, Resident No. 1 would not be

2911appropriately placed in the facility. He was told by Ms. Hines,

2922his assistant, that Resident No. 1 was still hallucinating from

2932December 16th through December 22, 2008. Obviously she also

2941hallucinated on December 3 and 12; as well as on the nights of

2954December 23-24, 2008, based upon the above findings.

296230. The administrator, Dr. Mikhici, did not communicate

2970with the Sheriff's Department on December 3, 2008, when deputies

2980were mistakenly summoned to the facility because Resident No. 1

2990had called 911, as prompted by her hallucination at the time.

3001The administrator acknowledged that the only intervention they

3009initiated as a result of the that incident was to remove the

3021phone from the resident's room.

302631. The administrator acknowledged that he knew he had

3035authority to increase monitoring and supervision of Resident No.

30441. He acknowledged that he did not personally read the CNA log

3056nor did he regularly review Resident No. 1's records. He relied

3067on his staff to do so.

307332. Dr. I. Jack Abramson holds medical licenses in a

3083number of states including Florida. He completed a residency in

3093psychiatry at Beth Israel Hospital and at Harvard Medical

3102School. He holds sub-specialty certifications in geriatric

3109psychiatry, as well as forensic and addiction psychiatry. The

3118parties stipulated to his expertise and the introduction of his

3128video-taped deposition into evidence. Dr. Abramson reviewed the

3136documents, including survey documents, statements of

3142deficiencies, hospital records, staff sheets and the facility

3150records for Resident No. l, all of which were stipulated into

3161evidence by the parties and attached and incorporated into his

3171deposition.

317233. Dr. Abramson opined that Resident No. 1 was impaired

3182by delusional thinking, paranoid ideations and hallucinations.

3189This produced a great deal of psychic turmoil inside her,

3199ultimately resulting in her jumping from the window on

3208December 24, 2008. She was significantly impaired in the last

3218month of her residence and not functioning independently while

3227residing at an ALF which was unable to adequately provide care

3238needed for her safety and security. She was actively psychotic

3248and delusional thinking influenced her behavior. She was unable

3257to control her behaviors at various points in time after the

3268middle of November 2008.

327234. Based upon the facts found above concerning her

3281delusions and hallucinations, there was a period of a month to

3292five weeks where the hallucinations manifested themselves in a

3301sufficiently pronounced way to provide adequate warning to the

3310facility that her mental status was deteriorating. There were

3319many opportunities to observe decline in her functioning and

3328then the fall occurred on December 14, 2008, which is a proto-

3340typical decline in function in terms of the evaluation and

3350treatment of geriatric patients. With the hallucinations and

3358confusion around the beginning of December, with Resident No. 1

3368yelling about a little boy being murdered, or someone being

3378murdered in the room next to hers; with the evidence concerning

3389her going into other rooms to look for her granddaughter, who

3400she believed was in some sort of distress, and the other aspects

3412of the hallucinatory episodes, Resident No. 1 was inappropriate

3421for placement in a ALF environment, at least after late November

3432or early December 2008.

343635. That portion of Dr. Abramson's opinion concerning

3444suicidal threats, leading to his opinion that arranging for

3453involuntary examination might have been appropriate, is not

3461accepted. This is because the evidence does not persuasively

3470show that she actually made suicidal threats.

347736. Dr. Abramson also believed that there was no evidence

3487of any record of communication between the facility and the

3497physician (or Mr. Chaney the ARNP). This is only partly true.

3508There was insufficient communication, as shown by the above

3517findings of fact, but there was not an absolute dearth of such

3529communication.

353037. Dr. Abramson found and opined that Resident No. 1 was

3541not functioning independently, was unable to care for her own

3551needs of daily living, based upon cognitive difficulties, her

3560delusional state and delirium. These factors, taken together,

3568would have required her to be transferred to a more appropriate

3579facility, according to Dr. Abramson. Thus he believes discharge

3588of Resident No. 1 to another more appropriate skilled nursing

3598facility was appropriate because of her delusional and

3606hallucinatory state. He believes that she was a candidate for

361624-hour supervision by mid-December 2008.

362138. Dr. Abramson opined that within a reasonable degree of

3631psychiatric probability, injury or death was preventable. Had

3639Resident No. 1 been sent to a more secure skilled facility, she

3651would have been under closer supervision and would not have been

3662able to act in the way she did. An earlier intervention with

3674her delusions and hallucinations might have calmed them

3682adequately or put them into remission, so that she wouldn't have

3693felt the need to escape from those delusions.

370139. She thus became a danger to herself by mid-December,

3711based upon her inability to adequately care for her needs and

3722her cognitive and perceptional impairments by the time she had

3732the urinary tract infection on December 14, 2008. She was also

3743clearly a danger to herself on December 23 and 24, 2008, based

3755upon the above facts even without making suicidal threats. Her

3765injury or death would have been preventable if her care in a

3777more structured, supervised setting had been arranged, and

3785possibly had psychiatric consultation been arranged at an

3793earlier date. It is true that Mr. Chaney and the family, on

3805December 9, 2008, scheduled a psychiatric evaluation and the

3814Respondent was informed of that. The evaluation, however, was

3823not scheduled until early in January 2009.

383040. The Respondent could have arranged for Resident No. 1

3840to be placed in a more skilled facility, such as a nursing home

3853facility while psychiatric treatment was implemented or

3860alternatively by at least providing a higher level of

3869supervision, such as constant supervision, until a placement

3877decision and psychiatric evaluation could be completed. The

3885failure to accomplish a higher level, protected supervision

3893regime, or to transfer Resident No. 1 to a higher skilled

3904facility, as well as the inadequate communication with the

3913treating physician and his staff, contributed to the injury and

3923death to Resident No. 1.

392841. Thus, while the specifics of Resident No. 1's death by

3939jumping out of a window, or suicide, might not have been

3950foreseeable, it was foreseeable, based upon the opinion of

3959Dr. Abramson, that she was placed in a situation where serious

3970injury could occur. Dr. Abramson's opinion that the death of

3980Resident No. 1 was preventable and that to a great extent

3991Resident No. 1's actions and behaviors were foreseeable and

4000could have been avoided, with the added interventions referenced

4009above, is deemed credible, persuasive, and is accepted.

4017CONCLUSIONS OF LAW

402042. The Division of Administrative Hearings has

4027jurisdiction of the subject matter of and the parties to this

4038proceeding. §§ 120.569 and 120.57(1), Fla. Stat. (2009).

404643. The Petitioner alleges, as to Count I of the

4056Administrative Complaint, that the administrator failed to

4063properly monitor Resident No. 1 to determine if continued

4072appropropriate placement should be in the Respondent's facility,

4080rather than a higher level of care facility, such as a skilled

4092nursing home, citing Section 429.26(1), Florida Statutes (2008),

4100and Florida Administrative Code Rule 58A-5.0181(1) and (4). The

4109Petitioner maintains that this failure to monitor, and determine

4118the appropriateness of continued placement. resulted in Resident

4126No. 1's jumping out of the second story window, which

4136the Petitioner maintains constituted a Class I deficiency,

4144pursuant to Section 429.19(2)(a), Florida Statutes (2008).

415144. Resident No. 1 had multiple instances of

4159hallucinations and confused unstable behavior based on those

4167hallucinations, beginning November 18, 2008. That situation

4174became more severe in early December, such that on December 9,

41852008, Mr. Chaney the ARNT recommended, and he and the family

4196obtained an appointment for a psychiatric evaluation, to be

4205accomplished in early January 2009.

421045. The administrator cautioned Resident No. 1's

4217granddaughter in late November 2008, that if the resident's

4226behavior did not correct itself or improve, concerning the

4235hallucinations and related behavior, the resident might no

4243longer be appropriately placed in the Respondent's facility.

4251Documentation of the Respondent, specifically the CNA notes for

4260the months of November and December, 2008 show that, starting in

4271late November, Resident No. 1 had multiple instances of

4280hallucinations and mentally unstable behavior based on the

4288hallucinations.

428946. The Petitioner maintains that the testimony of Marlene

4298Hunter, the administrator, Mohammad Mikhici; Dr. Jack Abramson

4306and Barbara Alford; and the purported lack of documentation in

4316the record regarding monitoring Resident No. 1, shows that the

4326monitoring was deficient as to the question of appropriateness

4335of continued residency of Resident No. 1 at the Respondent's

4345facility. See § 429.26(1), Fla. Stat. (2008), and Fla. Admin.

4355Code R. 58A-5.0181(1) and (4). The monitoring requirement in

4364Section 429.26(1), Florida Statutes (2008), is based on the

4373resident's specific needs. Resident No. 1 had significant

4381monitoring needs because of the fact that she was hallucinating

4391and in early December started acting on those hallucinations.

4400She was on anti-psychotic medication and, as of December 9,

44102008, was scheduled for a psychiatric consultation.

441747. The administrator demonstrated that he was aware of

4426monitoring requirements for purposes of determining continued

4433appropriateness of placement, as shown by his admonition to

4442Resident No. 1's granddaughter, in late November, that if the

4452hallucinatory behavior continued then the resident may have to

4461be placed in a more skilled care facility. The Petitioner

4471demonstrated, however, that the administrator failed to monitor

4479the resident closely enough by observing the resident and

4488adequately consulting with the resident's health care provider

4496concerning this question. The resident's particular needs

4503demanded that he do so, as shown by the above-found facts

4514concerning the progression of the resident's aberrant behavior.

4522As shown by Dr. Abramson's testimony the failure to monitor the

4533resident for continued appropriate placement resulted in

4540Resident No. 1 remaining placed at the facility through

4549December 24, the day she died.

455548. The direct cause of the death of Resident No. 1 was

4567her hallucinations, prompting her to jump out of the window when

4578no staff member was present in the room to stop her. However,

4590the failure of the administrator to monitor her continued

4599placement at the facility had an indirect effect simply because

4609it likely caused her to remain at the facility long enough for

4621this to occur. This constituted a Class I deficiency, pursuant

4631to Section 429.19(2)(a), Florida Statutes (2008).

4637Count II

463949. The Petitioner maintains that the Respondent failed to

4648ensure that Resident No. 1 received adequate care, in violation

4658of Florida Administrative Code Rule 58A-5.019(1), by failing to

4667initiate proceedings pursuant to the Baker Act, Section

4675394.463(1), Florida Statutes (2008). The Petitioner contends

4682that this resulted in the resident's jumping out of the second

4693story window and dying shortly thereafter. It is alleged that

4703this failure constituted a Class I deficiency, pursuant to

4712Section 429.19(2)(a), Florida Statutes (2008).

471750. It is true that Resident No. 1 hallucinated, and acted

4728on the hallucination, in terms of wandering to other residents'

4738rooms, verbalizing her delusional ideas, and ultimately jumping

4746from the window because of hallucinations. She was diagnosed by

4756the health care provider with delirium, agitation, and dementia

4765and had been prescribed Prozac and, more recently, Risperdal, an

4775anti-psychotic. As of December 9, 2008, Mr. Chaney had

4784scheduled her for a psychological evaluation. Mr. Chaney's

4792testimony, which is accepted, indicates that he did not believe

4802that an involuntary mental illness examination, pursuant to the

4811Baker Act, was necessary. This was because of his diagnosis,

4821the scheduling of the psychological evaluation, and the lack of

4831indication of threats of self-harm by the resident.

483951. In light of the above findings of fact concerning

4849Brenda Wilson and Norma Endress, and their interview during the

4859investigation, it has not been established by preponderant,

4867persuasive evidence that Resident No. 1 actually made threats of

4877self-harm in the nature of wanting to kill herself. The

4887testimony of Barbara Alford, Marlene Hunter, and Dr. Abramson,

4896as well as Norma Endress concerning the resident's purported

4905threats of self-harm, were all based upon the version of events

4916described by Brenda Wilson in the interview with Norma Endress.

4926That was later recanted, and in the above Findings of Fact show

4938that there is no persuasive, substantial evidence that the self-

4948harm threats were actually made.

495352. In any event, the question only arose on the last

4964night or morning of the resident's life, shortly before she

4974jumped from the window. It is noteworthy that under the

4984pressure of events at that time, it is understandable that a

4995report to the health care provider, concerning the threats,

5004would not have been made early on the morning of December 24,

50162008, because of the immediate emergency concerning the

5024resident.

502553. In summary, it has not been proven that the resident

5036had become the apparent danger to herself that the Respondent

5046should have seen or foreseen, in terms of threatened self-harm.

5056Therefore, the Respondent should not be held to the standard of

5067having to seek an involuntary examination. Therefore, Count II

5076of the Administrative Complaint has not been established as a

5086violation of Florida Administrative Code Rule 58A-5.019(1).

5093Therefore, as to this count, there was not a Class I deficiency,

5105as envisioned in Section 429.19(2)(a), Florida Statutes (2008).

5113Count III

511554. Concerning Count III, the persuasive evidence

5122establishes that the Respondent failed to notify the resident's

5131healthcare provider of certain changes and conditions (although

5139it did so as to some). It failed to adequately document contact

5151with the healthcare provider. It is determined that significant

5160changes were documented in the CNA notes. Nonetheless, the

5169failure to consistently and timely notify the healthcare

5177provider of significant changes and conditions is a violation of

5187Florida Administrative Code Rule 58A-5.0185(4)(b).

519255. Witness Alford for the Petitioner noticed some pattern

5201of failing to contact the healthcare provider of the resident

5211concerning some significant changes, although some, as

5218delineated in the above Findings of Fact, were notified to the

5229healthcare provider. The first hallucinatory incident of

5236November 18 and 19, 2008, were timely reported to Mr. Chaney.

5247According to witness Alford, the primary healthcare provider

5255should be notified of such changes within a 24-hour period or a

5267resident can be placed at a continued risk.

527556. Mr. Chaney established that he was not made aware of

5286some significant changes in Resident No. 1's behavior and

5295condition and the failure had an effect on his assessments of

5306the resident. The administrator Dr. Mikhici admitted that he

5315had not personally contacted the healthcare provider regarding

5323significant changes, although it was his position that his staff

5333had done so, or that he relied on them to do so.

534557. The above Findings of Fact, based upon the persuasive

5355evidence, show that the Respondent was repeatedly deficient in

5364adequately reporting to the healthcare provider regarding

5371significant changes in Resident No. 1's condition and behavior.

5380That failure to adequately report affected the type and quality

5390of care the resident received because it likely delayed or

5400prevented the ordering by the physician of enhanced supervision

5409of the resident. This would tend to place the resident at a

5421heightened risk for injury or death. The failure to adequately

5431report significant changes in the resident's condition and

5439behavior was a violation of Florida Administrative Code Rules

5448Mr. Chaney and Dr. Abramson shows that a failure to adequately

5459communicate significant changes in condition, and to adequately

5467document such changes and contacts, would limit the ability of

5477the healthcare provider to provide adequate care, at least in

5487terms of recommending enhanced supervision of the resident. It

5496would place the resident in imminent danger, which constitutes a

5506Class I deficiency, pursuant to Section 429.19(2)(a), Florida

5514Statutes (2008).

5516Count IV

551858. The evidence, culminating in the above Findings of

5527Fact, establishes that the Respondent violated Florida

5534Administrative Code Rule 58A-5.0182(1)(b) by failing to provide

5542adequate supervision for Resident No. 1. This constituted a

5551Class I deficiency.

555459. Mr. Chaney would have ordered more monitoring and

5563supervision of Resident No. 1 if he had known about some of the

5576behaviors which were not reported to him. The resident had

5586greater supervision needs than the typical ALF resident.

5594Despite the Resident's condition, the hallucinatory behavior and

5602the attendant appointment for a psychological consult after

5610December 9, 2008, the assistant administrator, Ms. Hines, did

5619not make any determination about increasing supervision of the

5628resident. The administrator did not make any such changes to

5638the supervision regime, based upon the condition of Resident No.

56481 and the scheduling of a psychological evaluation for her.

565860. Resident No. 1's condition, on December 24, 2008, was

5668reported by Brenda Wilson to management. Her past behavior was

5678known to the staff and management. However, neither Brenda

5687Wilson, whose shift was just ending at 7:00 a.m. nor Rebecca

5698Yokom who was coming on duty at that time, and responsible for

5710caring for Resident No. 1 that morning, was in the resident's

5721room when the resident jumped out of the window. Someone should

5732have been present to supervise her.

573861. The Respondent failed to ensure the resident's safety

5747and health when it failed to provide a higher level of

5758supervision for the resident. The Respondent was thus negligent

5767and the negligence resulted in imminent danger of injury or

5777death to the resident.

578162. Florida Administrative Code Rule 58A-5.0182(1)(b)

5787requires ALF's to provide supervision appropriate for each

5795resident. The Respondent failed to provide supervision that was

5804necessary for Resident No. 1's heightened needs, and the failure

5814to do so resulted in an immediate risk and potential for injury

5826or death. It constituted a Class I deficiency, pursuant to

5836Section 429.19(2)(a), Florida Statutes (2008).

5841Count V

584363. Florida Administrative Code Rule 58A-5.0181(5)

5849provides that a resident should be discharged if the resident's

5859needs can no longer be met under the criteria for assisted

5870living facility residence. The persuasive, substantial evidence

5877and the above Findings of Fact show that, at least as of

5889December 3, 2008, when Resident No. 1 acted on her

5899hallucinations and made the call to the 911 number which

5909ultimately summoned Sheriff's deputies; that the Respondent knew

5917or should have known that her placement in the ALF facility of

5929the Respondent was no longer appropriate. While it is true that

5940it may take some extended period of time to secure a placement

5952in a skilled nursing facility or other appropriate facility, the

5962Respondent, under the above-found facts, should have initiated

5970steps to secure a change of her placement. The resident was not

5982independently functioning, required skilled observation and

5988likely required skilled nursing observation because of her

5996delusional and hallucinatory state. These required more

6003intensive services than could have been provided at Northpointe.

601264. The administrator himself had warned the resident's

6020granddaughter, after the November 18 and 19 hallucinatory

6028incidents, that there was a possibility that she would have to

6039be discharged to another facility, if the behavior did not

6049alleviate. Therefore, he was aware of the need to consider

6059transferring the resident to another facility such as a skilled

6069nursing facility. The Respondent simply failed to act quickly

6078enough on this issue. The Respondent, in light of the above

6089Findings of Fact, violated Rule 58A-5.0181(5), by failing to

6098discharge Resident No. 1 when her needs exceeded the

6107capabilities of the Respondent's facility and when she no longer

6117met the criteria for assisted living facility residence. She

6126was thus placed in imminent danger due to a lack of adequate

6138supervision, which constituted a Class I deficiency, for

6146purposes of Section 429.19(2)(a), Florida Statutes (2008).

6153Count VI

615565. Given the above Findings of Fact, based upon

6164persuasive evidence, the Respondent has committed a negligent

6172act which affected the health and safety of Resident No. 1. See

6184§ 429.141(a), Fla. Stat. (2008). The Respondent has also

6193committed one or more Class I deficiencies for purposes of

6203Section 429.14(1)(e)1., Florida Statutes (2008). The Respondent

6210facility is subject to revocation by committing the Class I

6220violations, pursuant to Section 408.815(1)(c), Florida Statutes

6227(2008).

622866. In light of the gravity of the violations proven,

6238substantial or maximum penalties are recommended to be imposed.

6247Although revocation is legally available, the interest of the

6256many other residents of the facility in continued placement

6265there should be strongly considered. It is also true that, as

6276serious as this situation was, it was an isolated occurrence and

6287not reflective of a pattern of care as to other residents.

6298Accordingly, it is recommended that revocation be withheld,

6306subject to the Respondent submitting quarterly corrective action

6314plans, to be accompanied with quarterly inspections or surveys

6323by the Petitioner, to ensure compliance and correction, for a

6333period at the discretion of the Agency, not to exceed two years,

6345and contingent upon timely payment of the monetary penalties

6354imposed, based upon a schedule determined at the discretion of

6364the Petitioner Agency.

6367RECOMMENDATION

6368Having considered the foregoing Findings of Fact,

6375Conclusions of Law, the evidence of record, the candor and

6385demeanor of the witnesses and pleadings and arguments of the

6395parties, it is, therefore,

6399RECOMMENDED that a final order be entered by the Agency for

6410Health Care Administration, as to Count VI, imposing the

6419referenced alternative to revocation, under the conditions and

6427in the manner referenced in the last paragraph of the

6437Conclusions of Law above; that as to Count I, a fine of

6449$5,000.00 be imposed; that Count II found to be dismissed; that,

6461as to Count III, that a $10,000.00 fine be imposed; as to Count

6475IV, that a $10,000.00 fine be imposed; and as to Count V that a

6490$10,000.00 fine be imposed.

6495DONE AND ENTERED this 29th day of January, 2010, in

6505Tallahassee, Leon County, Florida.

6509S

6510P. MICHAEL RUFF

6513Administrative Law Judge

6516Division of Administrative Hearings

6520The DeSoto Building

65231230 Apalachee Parkway

6526Tallahassee, Florida 32399-3060

6529(850) 488-9675 SUNCOM 278-9675

6533Fax Filing (850) 921-6847

6537www.doah.state.fl.us

6538Filed with the Clerk of the

6544Division of Administrative Hearings

6548this 29th day of January, 2010.

6554COPIES FURNISHED :

6557Richard Joseph Saliba, Esquire

6561Mark H. Hinely, Esquire

6565Agency for Health Care Administration

6570Fort Know Building 3

65742727 Mahan Drive, Mail Stop 3

6580Tallahassee, Florida 32308

6583Kerry Anne Schultz, Esquire

6587Fountain, Schultz & Associates, P.L.

65922045 Fountain Professional Court, Suite A

6598Navarre, Florida 32566

6601Richard J. Shoop, Agency Clerk

6606Agency for Health Care Administration

66112727 Mahan Drive, Mail Stop 3

6617Tallahassee, Florida 32308

6620Justin Senior, General Counsel

6624Agency for Health Care Administration

6629Fort Knox Building, Suite 3431

66342727 Mahan Drive, Mail Stop 3

6640Tallahassee, Florida 32308

6643Thomas W. Arnold, Secretary

6647Agency for Health Care Administration

6652Fort Knox Building, Suite 3116

66572727 Mahan Drive

6660Tallahassee, Florida 32308-5403

6663NOTICE OF RIGHT TO SUBMIT EXCEPTIONS

6669All parties have the right to submit written exceptions within

667915 days from the date of this Recommended Order. Any exceptions

6690to this Recommended Order should be filed with the agency that

6701will issue the Final Order in this case.

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Date
Proceedings
PDF:
Date: 04/29/2010
Proceedings: Agency Final Order
PDF:
Date: 04/29/2010
Proceedings: Respondent's Response to Petitioner's Exceptions to Recommended Order filed.
PDF:
Date: 04/29/2010
Proceedings: Agency Final Order filed.
PDF:
Date: 01/29/2010
Proceedings: Recommended Order
PDF:
Date: 01/29/2010
Proceedings: Recommended Order cover letter identifying the hearing record referred to the Agency.
PDF:
Date: 01/29/2010
Proceedings: Recommended Order (hearing held September 10, 11 and 30, and October 31, 2009). CASE CLOSED.
PDF:
Date: 12/11/2009
Proceedings: Respondent's Proposed Recommended Order filed.
PDF:
Date: 12/09/2009
Proceedings: Agency's Proposed Recommended Order filed.
Date: 11/10/2009
Proceedings: Transcript (Volumes I-VII) filed.
PDF:
Date: 10/22/2009
Proceedings: Petitioner's Exhibit List (exhibits not available for viewing) filed.
PDF:
Date: 10/22/2009
Proceedings: Respondent's Exhibit List (exhibits not available for viewing) filed.
PDF:
Date: 10/22/2009
Proceedings: Deposition of C. Mulloy filed.
Date: 10/21/2009
Proceedings: CASE STATUS: Hearing Held.
PDF:
Date: 10/09/2009
Proceedings: Order Re-scheduling Hearing (hearing set for October 21, 2009; 9:30 a.m., Central Time; Pensacola, FL).
Date: 09/30/2009
Proceedings: CASE STATUS: Hearing Partially Held; continued to October 21, 2009; 9:30 a.m.; Pensacola, FL.
PDF:
Date: 09/28/2009
Proceedings: Notice of Filing (of deposition of Dr. F. Salib) filed.
PDF:
Date: 09/22/2009
Proceedings: Petitioner's Motion for Rebutal Witness to Appear Via Telephone filed.
PDF:
Date: 09/15/2009
Proceedings: Notice of Hearing (hearing set for September 30, 2009; 9:00 a.m., Central Time; Pensacola, FL).
Date: 09/10/2009
Proceedings: CASE STATUS: Hearing Partially Held; continued to date not certain.
PDF:
Date: 09/09/2009
Proceedings: Notice of Filing (of certificate of deposition of C. Mulloy and objection/exhibit log) filed.
PDF:
Date: 09/09/2009
Proceedings: Deposition of Norma Endress filed.
PDF:
Date: 09/09/2009
Proceedings: Notice of Filing (of Deposition of N. Endress) filed.
PDF:
Date: 09/09/2009
Proceedings: Deposition of Melinda Palmer filed.
PDF:
Date: 09/09/2009
Proceedings: Deposition of Rebecca Mary Yokom filed.
PDF:
Date: 09/09/2009
Proceedings: Deposition of Michelle Carter filed.
PDF:
Date: 09/09/2009
Proceedings: Deposition of Aracelis Pollack filed.
PDF:
Date: 09/09/2009
Proceedings: Deposition of Tonja Neal filed.
PDF:
Date: 09/09/2009
Proceedings: Deposition of Rochelle Pitts filed.
PDF:
Date: 09/09/2009
Proceedings: Deposition of Patricia Denison filed.
PDF:
Date: 09/09/2009
Proceedings: Deposition of Carol Mulloy filed.
PDF:
Date: 09/09/2009
Proceedings: Notice of Filing (of Depositions [8]) filed.
PDF:
Date: 09/09/2009
Proceedings: Response to Petitioner's Motion in Limine filed.
PDF:
Date: 09/08/2009
Proceedings: Response to Motion to Strike Respondent's Responses to the Petitioner's First Request for Admission and First Set of Interrogatories filed.
PDF:
Date: 09/08/2009
Proceedings: Notice of Filing (deposition transcripts of Carol Mullor, Patricia Denison, Rochelle Pitts, Tonja Neal, Aracelis Pollack, Michelle Carter, Rebecca Mary Yocum, and Melinda Palmer, depositions not attached).
PDF:
Date: 09/08/2009
Proceedings: Notice of Filing (deposition transcripts of Norma Endress; deposition not attached).
PDF:
Date: 09/08/2009
Proceedings: Petitioner's Motion in Limine filed.
PDF:
Date: 09/08/2009
Proceedings: Deposition (Dr. I. Jack Abramson) filed.
PDF:
Date: 09/08/2009
Proceedings: Deposition (Sarah Hines) filed.
PDF:
Date: 09/08/2009
Proceedings: Deposition (Brenda Golden) filed.
PDF:
Date: 09/08/2009
Proceedings: Notice of Filing (Deposition Transcripts of Brenda Golden, Sarah Hines, and Dr. I. Jack Abramson).
PDF:
Date: 09/08/2009
Proceedings: Respondent's Response to Petitioner's Request for Production of Documents filed.
PDF:
Date: 09/08/2009
Proceedings: Motion to Strike Respondent's Affidavit of Carol Malloy filed September 4, 2009 filed.
PDF:
Date: 09/08/2009
Proceedings: Motion to Strike Respondent's Responses to the Petitioner's First Request for Admission and First Set of Interrogatories filed.
PDF:
Date: 09/08/2009
Proceedings: Petitioner's Amended Request for Official Recognition filed.
PDF:
Date: 09/04/2009
Proceedings: Notice of Filing; Affidavit of Carol Malloy filed.
PDF:
Date: 09/04/2009
Proceedings: Deposition of James Chaney filed.
PDF:
Date: 09/04/2009
Proceedings: Deposition of Mohamad Mikhchi filed.
PDF:
Date: 09/04/2009
Proceedings: Deposition of Anne Shearer filed.
PDF:
Date: 09/04/2009
Proceedings: Deposition of Brenda Wilson filed.
PDF:
Date: 09/04/2009
Proceedings: Respondent's Response to Petitioner's Request for Production of Documents filed.
PDF:
Date: 09/04/2009
Proceedings: Notice of Filing (Deposition Transcripts of B. Wilson, A. Shearer, M. Mikhchi, and J. Chanry).
PDF:
Date: 09/03/2009
Proceedings: Respondent's Northpointe Retirement Community, Inc.'s Responses to Petitioner's First Set of Interrogatories filed.
PDF:
Date: 09/03/2009
Proceedings: Notice of Service of Respondent's Responses to Petitioner's First Set of Interrogatories filed.
PDF:
Date: 09/03/2009
Proceedings: Respondent's Response to Petitioner's First Request for Admissions filed.
PDF:
Date: 09/03/2009
Proceedings: Notice of Videotape Deposition (of C. Mulloy) filed.
PDF:
Date: 09/02/2009
Proceedings: Amended Respondent's Preliminary Witness List filed.
PDF:
Date: 09/02/2009
Proceedings: Amended Respondent's Preliminary Expert List filed.
PDF:
Date: 09/01/2009
Proceedings: Amended Notice of Taking Depositions Duces Tecum (of F. Salib) filed.
PDF:
Date: 09/01/2009
Proceedings: Joint Pre-hearing Stipulation filed.
PDF:
Date: 08/31/2009
Proceedings: Petitioner's Request for Official Recognition filed.
PDF:
Date: 08/31/2009
Proceedings: Notice of Taking Depositions Duces Tecum (of F. Salib) filed.
PDF:
Date: 08/28/2009
Proceedings: Answer to Amended Administrative Complaint filed.
PDF:
Date: 08/28/2009
Proceedings: Notice of Appearance (of K. Shultz) filed.
PDF:
Date: 08/28/2009
Proceedings: Amended Notice of Videotape Deposition (of I. Abramson) filed.
PDF:
Date: 08/24/2009
Proceedings: Agency's Supplemental Witness List filed.
PDF:
Date: 08/24/2009
Proceedings: Respondent's Preliminary Expert Witness List filed.
PDF:
Date: 08/24/2009
Proceedings: Respondent's Preliminary Witness List filed.
PDF:
Date: 08/20/2009
Proceedings: Agency's Preliminary Expert Witness List filed.
PDF:
Date: 08/20/2009
Proceedings: Notice of Videotape Deposition filed.
PDF:
Date: 08/19/2009
Proceedings: Pre-hearing Stipulation filed.
PDF:
Date: 08/14/2009
Proceedings: Agency's Preliminary Witness List filed.
PDF:
Date: 08/12/2009
Proceedings: Notice of Taking Depositions Duces Tecum (of B. Golden) filed.
PDF:
Date: 08/12/2009
Proceedings: Order Granting Continuance and Re-scheduling Hearing (hearing set for September 10 and 11, 2009; 10:00 a.m., Central Time; Pensacola, FL).
PDF:
Date: 08/10/2009
Proceedings: Objection to Motion for Continuance filed.
PDF:
Date: 08/06/2009
Proceedings: Motion for Continuance filed.
PDF:
Date: 08/05/2009
Proceedings: Motion for Continuance filed.
PDF:
Date: 07/27/2009
Proceedings: Petitioner's Motion to Amend filed.
PDF:
Date: 07/27/2009
Proceedings: Letter to Judge Ruff from M. Mikhchi regarding request for approval for filing status as a qualified representative filed.
PDF:
Date: 07/22/2009
Proceedings: Notice of Taking Deposition Duces Tecum (4) filed.
PDF:
Date: 07/22/2009
Proceedings: Notice of Taking Depositions Duces Tecum (3) filed.
PDF:
Date: 07/22/2009
Proceedings: Notice of Taking Deposition Duces Tecum (5) filed.
PDF:
Date: 07/16/2009
Proceedings: Notice of Withdrawal of Counsel filed.
PDF:
Date: 07/16/2009
Proceedings: Notice of Appearance as Additional Counsel (filed by R.Saliba) filed.
PDF:
Date: 07/07/2009
Proceedings: Petitioner's Notice of Service of Discovery on Respondent filed.
PDF:
Date: 06/29/2009
Proceedings: Notice of Hearing (hearing set for August 17 and 18, 2009; 10:00 a.m., Central Time; Pensacola, FL).
PDF:
Date: 06/18/2009
Proceedings: Notice of Appearance as Additional Counsel (filed by M. Hunley) filed.
PDF:
Date: 06/18/2009
Proceedings: Joint Response to Initial Order filed.
PDF:
Date: 06/12/2009
Proceedings: Initial Order.
PDF:
Date: 06/12/2009
Proceedings: Notice of Appearance (MaryAlice David) filed.
PDF:
Date: 06/11/2009
Proceedings: Administrative Complaint filed.
PDF:
Date: 06/11/2009
Proceedings: Request for Formal Hearing Pursuant to Section 120.57 Fla. Stat. 2006, and 28.106.2015, Florida Administrative Code filed.
PDF:
Date: 06/11/2009
Proceedings: Notice (of Agency referral) filed.

Case Information

Judge:
P. MICHAEL RUFF
Date Filed:
06/11/2009
Date Assignment:
06/12/2009
Last Docket Entry:
04/29/2010
Location:
Pensacola, Florida
District:
Northern
Agency:
ADOPTED IN TOTO
 

Counsels

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Related Florida Statute(s) (6):

Related Florida Rule(s) (4):