Florida Hosp. v. AHCA

• Decision Date: 20 August 2002
• Docket Number: No. 1D01-1887.,1D01-1887.
• Citation: 823 So.2d 844
• Parties: FLORIDA HOSPITAL (Adventist Health, etc.), Appellant, v. State of Florida AGENCY FOR HEALTH CARE ADMINISTRATION, etc., Appellee.
• Court: Florida District Court of Appeals

823 So.2d 844

FLORIDA HOSPITAL (Adventist Health, etc.), Appellant, v. State of Florida AGENCY FOR HEALTH CARE ADMINISTRATION, etc., Appellee.

No. 1D01-1887.

District Court of Appeal of Florida, First District.

August 20, 2002.

J. Robert Griffin, Esq. of Tilton & Metzger, P.A., Tallahassee, for Appellant.

Gregory J. Philo, Esq. for the Agency for Health Care Administration, Tallahassee, for Appellee.

LEWIS, J.

Appellant, Florida Hospital, appeals a final order of appellee, the Agency for Health Care Administration (AHCA), which approved a recommended order from the Division of Administrative Hearings finding that appellant violated sections 395.002(15) and 395.0197(6), Florida Statutes (1997), by failing to report a hypoxic event that caused brain damage to a patient as a Code 15 occurrence. Appellant raises three arguments on appeal. We affirm the first issue without further discussion. In its second argument, appellant contends that AHCA's construction and interpretation of the term "brain damage" were impermissible because they were inconsistent with the plain meaning of the statutes. Finally, appellant argues that AHCA's construction and interpretation of the term "brain damage" were vague and unconstitutional as applied. We affirm, holding that AHCA's construction and interpretation of the term "brain damage" are consistent with the plain meaning of the statutes, are not vague and were not unconstitutionally applied to appellant.

On June 9, 1998, S.P., a 95 year-old patient at Florida Hospital, became comatose, cyanotic and unresponsive after she became disconnected from her ventilator machine. While an employee of Florida Hospital heard S.P.'s room alarm sound, the nurses' station alarm failed to sound. It could not be determined as to how long S.P. remained disconnected from the ventilator. The medical staff of Florida Hospital then provided S.P. with respirator assistance and immediately transferred her back to the cardiac care unit, which is where S.P. had been prior to the ventilator incident. While in the cardiac care unit, S.P. received intensive therapeutic care and massive blood transfusions.

From June 10, 1998 through June 11, 1998, the consulting neurologist indicated in his progress notes that S.P. had a guarded prognosis and was not receptive to outside stimuli. From June 12, 1998 through June 17, 1998, the progress notes indicated that S.P. was improving. S.P.'s neurologist then noted that S.P. was "at baseline, neurologically stable." In other words, S.P.'s neurological condition returned to the state that it had been prior to the ventilator disconnection.

Subsequent to the ventilator incident, appellant took several remedial measures to prevent any future incidents of this type. Appellant's Code 15 committee reviewed S.P.'s case to decide whether or not it warranted Code 15 treatment, which consists of reporting to AHCA within fifteen days of the incident. The Code 15 committee voted against such Code 15 treatment, believing that since S.P. recovered to her neurological baseline, no brain damage had occurred. Instead of filing the incident as a Code 15, appellant reported the occurrence as an adverse incident in its Annual Report of Incidents.

AHCA filed an administrative complaint against appellant alleging a violation of section 395.0197(6), Florida Statutes (1997), for failure to report a hypoxic event that caused brain damage to patient S.P. as a Code 15 occurrence. In December 2000, a formal hearing was held. The ALJ, in accepting AHCA's interpretation that S.P. had suffered brain damage, found that S.P. suffered transient or temporary brain damage and appellant should have reported the incident as a Code 15. The ALJ recommended that AHCA had justification pursuant to section 395.0197(10), Florida Statutes (1997), to levy a $5,000.00 administrative fine against appellant. AHCA accepted both the ALJ's findings of fact and conclusions of law. This appeal followed.

Pursuant to section 395.0197(6)(b), Florida Statutes (1997), appellant, as a licensed hospital facility, is required to report to AHCA within fifteen days of occurrence, any "adverse or untoward incident" that results in "brain or spinal damage to a patient." An "adverse or untoward incident" is defined as:

an event over which health care personnel could exercise control, which is probably associated in whole or in part with medical intervention rather than the condition for which such intervention occurred, and which causes injury to a patient, and which:

(a) Is not consistent with or expected to be a consequence of such medical intervention (b) Occurs as a result of medical intervention to which the patient has not given his or her informed consent;

(c) Occurs as the result of any other action or lack of any other action on the part of the hospital or personnel of the hospital;

(d) Results in a surgical procedure being performed on the wrong patient; or

(e) Results in a surgical procedure being performed that is unrelated to the patient's diagnosis or medical needs.

§ 395.002(2), Fla. Stat. (1997) (emphasis added).

The term "injury," for purposes of reporting to ACHA, is defined as an outcome caused by an "adverse or untoward incident" that results in:

(a) Death;

(b) Brain Damage;

(c) Spinal Damage;

(d) Permanent Disfigurement;

(e) Fracture or dislocation of bones or joints;

(f) Any condition requiring definitive or specialized medical attention which is not consistent with the routine management of the patient's case or patient's pre-existing physical condition;

(g) Any condition requiring surgical intervention to correct or control;

(h) Any condition resulting in transfer of the patient, within or outside the facility, to a unit providing a more acute level of care;

(i) Any condition that extends the patient's length of stay; or

(j) Any condition that results in a limitation of neurological, physical, or sensory function which continues after discharge from the facility.

§ 395.002(15), Fla. Stat. (1997) (emphasis added).

If an adverse or untoward incident, whether occurring in the licensed facility or arising from health care prior to admission in the licensed facility, results in:

(a) The death of a patient;

(b) Brain or spinal damage to a patient;

(c) The performance of a surgical procedure on the wrong patient;

(d) A surgical procedure unrelated to the patient's diagnosis or medical needs being performed on any patient, including the surgical repair of injuries or damage resulting from the planned surgical procedure, wrong site or wrong procedure surgeries, and procedures to remove foreign objects remaining from surgical procedures, the licensed facility shall report this incident to the agency within 15 calendar days after its occurrence.

§ 395.0197(6), Fla. Stat. (1997) (emphasis added).

The standard of review of an agency decision based upon an issue of law is whether the agency erroneously interpreted the law and, if so, whether a correct interpretation compels a particular action. See § 120.68(7)(d), Fla. Stat. (1997); Southwest Fla. Water Mgmt. Dist. v. Save the Manatee Club, Inc., 773 So.2d 594, 597 (Fla. 1st DCA 2000); Metro. Dade County v. Dep't of Envtl. Prot., 714 So.2d 512, 515 (Fla. 3d DCA 1998). In that the Legislature delegated to AHCA the power to enforce section 395.0197(6), Florida Statutes (1997), we note that we are required to be highly deferential to the agency's interpretation of such statute. As the supreme court recently affirmed in Verizon Florida, Inc. v. Jacobs, 810 So.2d 906, 908 (Fla.2002), an "agency's interpretation of the statute it is charged with enforcing is entitled to great deference." See also BellSouth Telecomms., Inc. v. Johnson, 708 So.2d 594, 596 (Fla.1998). However, a court need not defer to an agency's construction or application of a statute if special agency expertise is not required, or if the agency's interpretation conflicts with the plain and ordinary meaning of the statute. Doyle v. Dep't of Bus. Reg., 794 So.2d 686, 690 (Fla. 1st DCA 2001).

If the language of the statute is clear and unambiguous and conveys a clear and definite meaning, the statute should be given its plain meaning. M.W. v. Davis, 756 So.2d 90, 101 (Fla.2000); Aetna Cas. & Sur. Co. v. Huntington Nat'l Bank, 609 So.2d 1315, 1317 (Fla.1992); Holly v. Auld, 450 So.2d 217, 219 (Fla.1984). When necessary, the plain and ordinary meaning of words in a statute can be ascertained by reference to a dictionary. Seagrave v. State, 802 So.2d 281, 286 (Fla.2001).

On appeal, appellant argues, as it did before AHCA, that AHCA's interpretation of the term "brain damage" is impermissible and inconsistent with the statutes' plain meaning. According to appellant, the Legislature did not intend to include those injuries that result in a "limitation of neurological, physical, or sensory function which continues after discharge from the facility" pursuant to section 395.002(15)(j),...