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Agenda 07/09/2013 Item #16E9 7/9/2013 16.E.9. EXECUTIVE SUMMARY Recommendation to approve and authorize the Chairwoman to execute a Settlement Agreement with the Florida Department of Health to settle an administrative case captioned Florida Department of Health v. Collier County (DOAH Case No.: 13-001087) with County agreeing to pay a $2,000 administrative fine and receive a reprimand; however with no admission of liability. OBJECTIVE: To settle the administrative case of the Florida Department of Health v. Collier County. CONSIDERATIONS: Collier County received notice of an Administrative Complaint from the Florida Department of Health on or about December 5, 2012. The Complaint stems from a medical transport incident involving Naples Community Hospital in the City of Marco Island on October 2, 2011. Collier County filed a response denying the allegations in the Complaint and requesting an Administrative Hearing before an Administrative Law Judge. On October 2, 2011, at 8:48 a.m. Collier County EMS was notified of a patient transport from the Marco Healthcare Center, an extension of the NCH Healthcare System, in reference to dizziness. The hours of operation for Marco Healthcare Center are from 8:00 am to 7:30 pm, 7 days a week. NCH Healthcare System, which at the time operated its own ambulance service (NCH Ambulance Services) from Marco Healthcare Center, was immediately contacted. The NCH Ambulance Services Transport Manager advised that NCH was transferring the patient and that Collier County EMS transport was not needed. The NCH Transport Manager also confirmed that Collier County EMS was not needed via text message to Chief Walter Kopka. Collier County EMS also immediately contacted the Marco Healthcare Center staff who advised NCH Ambulance Services would be handing the patient transfer, and that it was not requesting any further services from Collier County EMS. In addition, the patient was in-patient status at NCH. Marco Healthcare Center is a NCH Healthcare System owned facility. At all relevant times, NCH Healthcare System owned and operated its own transport service, NCH Ambulance Services (ALS License Number ALS 1104). NCH Healthcare System was required by local ordinance to provide transports from its facilities. (NCH voluntarily relinquished their transport license in November 2011.) At all relevant times, Collier County believed that NCH would transport the patient based on the express representation of the NCH Transport Manager and in compliance with their COPCN. However, NCH did not immediately transport the patient due to medical care being delivered by a physician and staff at Marco Healthcare Center. Collier County denies any liability or violation of Florida law. The County and the Department of Health have reached a Settlement Agreement pending approval by the Board of County Commissioners. The Department requires the County to pay an administrative fine ($2,000) and Packet Page-1246- 7/9/2013 16.E.9. receive a reprimand; however there is no County admission of liability and no finding of any liability. The County believes that it is in the best interest of the County to settle this administrative case due to the extensive resources required to litigate the case. The cost to litigate the case will far exceed the administrative fine. FISCAL IMPACT: Collier County will be required to pay an administrative fine in the amount of $2,000 to the Florida Department of Health. Funds are available within EMS Fund (490) operating cost center(144610). GROWTH MANAGEMENT IMPACT: No Growth Management Impact. LEGAL CONSIDERATIONS: This item has been reviewed and approved by the County Attorney as to form and legality and requires majority vote for approval.—JAK RECOMMENDATION: For the Board of County Commissioners to approve and authorize the Chairwoman to execute a Settlement Agreement with the Florida Department of Health to settle an administrative case captioned Florida Department of Health v. Collier County (DOAH Case No.: 13-001087) with County agreeing to pay a $2,000 administrative fine and receive a reprimand; however with no admission of liability. Prepared by: Walter Kopka, Chief, Collier County EMS Attachments: Proposed Settlement Agreement 13-1087/63 Packet Page -1247- 7/9/2013 16.E.9. COLLIER COUNTY Board of County Commissioners Item Number: 16.16.E.16.E.9. Item Summary: Recommendation to approve and authorize the Chairwoman to execute a Settlement Agreement with the Florida Department of Health to settle an administrative case captioned Florida Department of Health v. Collier County(DOAH Case No.: 13-001087) with County agreeing to pay a $2,000 administrative fine and receive a reprimand; however with no admission of liability. Meeting Date: 7/9/2013 Prepared By Name: CrotteauKathynell Title:Legal Secretary,County Attorney 7/1/2013 3:44:34 PM Approved By Name: SummersDan Title:Director-Bureau of Emergency Services, Date: 7/1/2013 4:19:34 PM Name: KopkaWalter Date: 7/1/2013 5:07:29 PM Name: PriceLen Title:Administrator, Administrative Services Date: 7/1/2013 5:42:39 PM Name: GreeneColleen Title:Assistant County Attorney,County Attorney Date: 7/2/2013 10:10:20 AM Name: PryorCheryl Title:Management/Budget Analyst, Senior,Office of Manag Date: 7/2/2013 11:03:57 AM Name: KlatzkowJeff Title: County Attorney Packet Page-1248- 7/9/2013 16.E.9. Date: 7/2/2013 11:15:05 AM Name: OchsLeo Title: County Manager Date: 7/2/2013 12:25:37 PM Packet Page-1249- - 7/9/2013 16.E.9. STATE OF FLORIDA DEPARTMENT OF HEALTH BUREAU OF EMERGENCY MEDICAL OVERSIGHT DEPARTMENT OF HEALTH, Petitioner, V. Case No. 2011-17540 COLLIER COUNTY EMS, Respondent. SETTLEMENT AGI IEMENT Collier County EMS, referred to as the "Respondent," and the Department of Health, referred to as "Department," stipulate and agree to the following Agreement and to the entry of a Final Order of the Bureau of Emergency Medical Oversight, referred to as "Bureau," incorporating the Stipulated Facts and Stipulated Disposition in this matter. Petitioner is the state agency charged with regulating emergency medical services pursuant to section 20.43, Florida Statutes and Chapter 401, Florida Statutes. STIPULATED FACTS 1. At all times material hereto, Respondent has been licensed as an AIR- ALS service provider in the State of Florida. 2. The Department charged Respondent with an Administrative Complaint that was filed and properly served upon Respondent, alleging violations 1 Venice Ambulance Service,2012-11091 EMS Licensure Settlement Agreement eff.04-10-2013 Packet Page -1250- 7/9/2013 16.E.9.of Chapter 401, Florida Statutes, and the rules adopted pursuant thereto. A true and correct copy of the Administrative Complaint has been furnished with this Settlement Agreement. 3. Respondent neither admits nor denies the allegations contained in the Administrative Complaint. STIPULATED CONCLUSIONS OF LAW 1. Respondent admits that, in its capacity as a licensed AIR-ALS service provider, it is subject to the provisions of Chapters 401, Florida Statutes, and the jurisdiction of the Department and the Bureau. 2. Respondent admits that the facts alleged in the Administrative Complaint, If proven, would constitute violations of Chapter 401, Florida Statutes, as alleged in the Administrative Complaint. 3. Respondent agrees that the Stipulated Disposition in this case is acceptable to Respondent. STIPULATED DISPOSITION 1. Fine - The Bureau of Emergency Medical Oversight shall impose an administrative fine of two thousand dollars ($2,000.00) against the license of Respondent, to be paid by Respondent to the Florida Department of Health and mailed to the attention of Kimberly Moore, Section Administrator, Department of Health, Bureau of Emergency Medical Oversight, Investigation Section, 4052 Bald Cypress Way, Bin A22, 2 Venice Ambulance Service,2012.11091 EMS Licensure Settlement Agreement eft.04-10-2013 �p Packet Page-1251- C./ 7/9/2013 16.E.9. Tallahassee, FL 32399-1722, within twenty-one (21) days from the date of receipt of this Agreement. 2. Reprimand - The Bureau of Emergency Medical Oversight reprimands Collier County EMS for violation of Chapter 401, Florida Statutes. STANDARD PROVISIONS 1. Enforceability — It is expressly understood that this Agreement is a legal and binding document and is fully enforceable against all parties in any court of competent jurisdiction. The signatories hereto are vested with the authority to execute this Agreement on behalf of their respective principals, and as designated representatives, to fully bind such principals. 2. Future Conduct - In the future, Respondent shall not violate Chapter 401, Florida Statutes, or the rules promulgated pursuant thereto, or any other state or federal law, rule, or regulation relating to its providing of AIR-ALS service. 3. Purpose of Agreement - Respondent, for the purpose of avoiding further administrative action with respect to this cause, executes this Agreement. Respondent expressly waives all further procedural steps and/or judicial review of this subject matter. The parties hereby agree to waive all claims, rights, charges, recoveries, and amounts with respect to the subject matter of Case Number 2011-17540. 4. Waiver of attorney's fees and costs - The parties hereby agree they will bear their own attorney's fees and costs resulting from prosecution or defense of this matter. Respondent waives the right to seek any attorney's fees or costs from the Department and the Bureau in connection with this matter. 3 Venice Ambulance Service,2012-11091 EMS Licensure Settlement Agreement off.04-10-2013 Packet Page-1252- `CJ — — — - - 7/9/2013 16.E.9. - SIGNED this day of , 2013. ATTEST: DWIGHT E. BROCK,Clerk BY: FOR COLLIER COUNTY EMS Name Approved as to form and legality Title Date Assistant County Attorney APPROVED this day of , 2013. FOR BUREAU OF EMERGENCY MEDICAL OVERSIGHT By: John C. Bixler, Administrator Emergency Medical Services Florida Department of Health 4052 Bald Cypress Way, Bin #A22 Tallahassee, FL 32399-1722 4 Venice Ambulance Service,2012-11091 EMS Licensure Settlement Agreement eff 04-10-2013 Packet Page-1253- 7/9/2013 16.E.9. STATE OF FLORIDA DEPARTMENT OF HEALTH BUREAU OF EMERGENCY MEDICAL OVERSIGHT DEPARTMENT OF HEALTH, Petitioner, vs. Case No. 2011-07540 COLLIER COUNTY EMS, Respondent. ADMINISTRATIVE COMPLAINT The DEPARTMENT OF HEALTH (Petitioner), by and through the undersigned attorney,files an Administrative Complaint against COLLIER COUNTY EMS(Respondent) and states: NATURE OF ACTION 1. Pursuant to §401.411, Florida Statutes, this is an action to impose an administrative fine of$3,000.00 and reprimand Respondent's Advanced Life Support(ALS) certificate. JURISDICTION AND VENUE 2. The Petitioner has jurisdiction pursuant to Chapter 120, Florida Statutes(Fla. Stat.), and Rule 28-106, Florida Administrative Code (F.A.C.). 3. Venue lies pursuant to Rule 28-106.207, F.A.C. PARTIES 4. Petitioner is a state agency established in §20.43, Fla. Stat., and is charged 1 Packet Page-1254- 7/9/2013 16.E.9. with regulating emergency medical services pursuant to Chapter 401, Fla. Stat. 5. At all times material hereto,Respondent is an ALS provider, license number ALS 1102. 6. Respondent's address of record is 8075 Lely Cultural Parkway, Suite 445, Naples, FL 34113. STATEMENT OF FACTS 7. At all times material hereto, Walter Kopka was the interim-chief of Collier County EMS. 8. At all times material hereto, Naples Community Hospital (NCH) owns and operates Marco Island Health Center(MIHC)located at 40 Heathwood Drive,Marco Island, FL 34145. MIHC is one of three NCH Walk-In Centers. 9. At all times material hereto, MIHC's hours of operation are 0800 to 1930 hours, seven days a week, including holidays. 10. On or about October 2, 2011 at approximately 0814 hours, Robert Rowe arrives at MIHC with his friend Paul Anderson(Anderson). Anderson is complaining about dizziness. 11. At approximately 0846 hours, Collier County 911 (a.k.a. Collier County Sheriffs Office Communication Center) receives a call from MIHC requesting an ambulance for an emergency transport of an 80 year-old male, complaining of dizziness. 12. At approximately 0848 Medic Rescue 50 (MR50) from Marco Island Fire Rescue Station 50 is dispatched to NCH MIHC. Seconds later, MR50 is instructed by Collier County 911 dispatch to stand down because NCH Ambulance Service will handle 2 Packet Page -1255- 7/9/2013 16.E.9. the call. 13. At approximately 0903 hours,Collier County EMS Battalion Chief 80 advises dispatch that NCH MIHC transport will handle the transport. 14. At approximately 0911 hours, Collier County 911 dispatch center receives a second call from MIHC,this time from a registered nurse,advising that they need a ground ambulance transport immediately because their in-house paramedic has not reported for duty. Collier County 911 dispatch advises that ambulance is on the way. 15. At approximately 0917 hours,NCH Ambulance Service employee,paramedic Laurie McKenney(McKenney), reports for duty at MIHC. 16. At approximately 0919 hours,Collier County 911 dispatch center dispatches Marco Island Fire Rescue Tower 50(T50)and Medical Rescue 90(MR90)to MIHC.MR90 is advised to standby in station. 17. At approximately, 0921 hours,T50 arrives at MIHC. 18. At approximately 0932 hours, upon evaluation of Anderson, T50 requests Medflight due to the critical condition of the patient. 19. At approximately 0938 hours, MR90 arrives at MICH and advises dispatch that there is only one patient. 20. At approximately 0940 hours, Medflight is placed on standby and NCH Ambulance Service transports Henderson to NCH downtown. A paramedic from MR50 assists McKenney with patient care during transport. 21. Pursuant to§401.45, Fla.Stat.(2011),a person may not be denied treatment or transport from any licensee for any emergency medical condition 3 Packet Page -1256- 7/9/2013 16.E.9. COUNT I RESPONDENT VIOLATED SECTION 401.411(g), FLORIDA STATUTES (2011), BY FAILING TO CONFORM TO THE MINIMAL PREVAILING STANDARDS OF ACCEPTABLE PRACTICE 22. Petitioner re-alleges and incorporates paragraphs 1 through 21 as if fully set forth herein. 23. At all times material hereto, Collier County EMS maintains an ALS ground ambulance service provider license and Its Certificate of Convenience and Public Necessity (COPCN) requires it to meet all the requirements of applicable laws and rules and provide "emergency services on a twenty-four (24) hour basis" encompassing the entire county. 24. At all times material hereto, Collier County and the City of Marco Island entered into an "Interlocal Agreement"to establish an ALS engine and rescue apparatus, Apiikk licensed and equipped by Collier County EMS, at Marco Island Station 50 (Station 50). The agreement requires the City of Marco Island to provide one firefighter/paramedic or firefighter/EMT to the Collier County EMS and respond to all 911 medicaVfire emergencies as directed by Collier County EMS fire/EMS protocol from Station 50. 25. On or about October 2,2011,the NCH's ALS ground transport ambulance at MICH was out of service when it opened for business at 0800 hours. Despite dispatching Medic Rescue 50 to MIHC, Collier County EMS Battalion Chief 80 (BC80) contravened dispatch orders by directing the dispatch center to stand-down MR50; therefore, terminating its response to MIHC. 26. Thirty-one minutes later, MIHC calls Collier County 911 requesting an ALS 4 Packet Page-1257- 7/9/2013 16.E.9. transport for Henderson. This time,T50 and MR90 are dispatched to MIHC. Immediately following the dispatch, Collier County 911 instructs MR90 to standby in their station. 27. Forty-six (46) minutes after the original 911 call, T50, after evaluating Henderson, requests Medflight to airlift the critically ill patient. 28. Due to the actions of Collier County EMS, the transport of Henderson is delayed approximately fifty-four (54) minutes after the original 911 call was made. Had Henderson been transported soon after the initial 911 call was made he would have arrived at NCH downtown emergency room well prior to the"actual"transport departure time and possibly changed the outcome of Henderson's condition. 29. Based on the foregoing, Respondent violated §401.411(1)(a), Fla. Stat. (2011), by failing to conform to the minimal prevailing standards of acceptable practice of a ALS ground transport provider. COUNT II RESPONDENT VIOLATED SECTION 401.45(1), FLORIDA STATUTES, BY FAILING TO PROVIDE TREATMENT AND TRANSPORT AS REQUIRED BY ITS ADANCED LIFE SUPPORT LICENSE AND CERTIFICATE OF PUBLIC CONVENIENCE AND NECESSITY 30. Petitioner re-alleges and incorporates paragraphs 1 through 29 as if fully set forth herein. 31. Pursuant to §§401.45(1), Fla. Stat., a person may not be denied treatment from any emergency medical condition that will deteriorate from failure to provide such treatment at any general hospital. 32. Respondent's actions on October 2nd departed from the minimum prevailing standards of acceptable practice under law and caused undue delay in transporting a 5 Packet Page-1258- 7/9/2013 16.E.9. critically ill patient. 33. Based on the foregoing, Respondent violated§401.45(1),Fla.Stat.,by failing to timely treatment and transport as required by law. CONCLUSIONS OF LAW 34. Respondent violated§401.411(1)(g),Fla.Stat.(2011),by failing to conform to the minimal prevailing standards of acceptable practice. 35. Respondent violated§401.45(1)(a),Fla.Stat.(2011), by failing to comply with §401.45, Fla. Stat. 36. Pursuant to §401.411(1)(a), Fla. Stat., a licensee may be disciplined for violation of§§401.411(1)(g) and 401.45(1). 37. All classifications of EMS licensure held by Respondent are subject to any final order which issues in this case, as provided by §401.411(2). Aft CLAIM FOR RELIEF WHEREFORE, Petitioner respectfully requests that the following sanctions be imposed against Respondent: a. Make factual and legal findings in favor of Petitioner on Counts I and II. b. Pursuant to §401.411(1), reprimand Respondent's ALS provider license. c. Pursuant to §401.411(7), administratively fine Respondent $2,000 for such violations. d. Provide such other relief as may be proper. Respectfully submitted on this 5 day of , 2011 6 Packet Page -1259- 7/9/2013 16.E.9. THOMAS F. CONGDON Assi neral Counsel Thomas F. Congdon Assistant General Counsel Fla. Bar No. 0620408 Florida Department of Health Office of the General Counsel 4052 Bald Cypress Way, Bin#A02 Tallahassee, FL 32399-1703 Telephone: (850)245-4005 Facsimile: (850)413-8743 • Email: thomas_congdon©doh.state.fl.us CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing has been furnished by U.S.Certified Mail to Collier County EMS,do Chief Walter Ko ka,8075 Lely Cul ral Park ay, Suite 445, Naples, FL 34113 on this J day of , 2012. T omas F. Congdon Assistant General Counsel 7 Packet Page-1260-