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Greater Oversight Needed at Facilities for Individuals with Traumatic Brain Injury

Wednesday, August 22, 2012

August 15, 2012

Elizabeth Dudek, Secretary
Florida Agency for Health Care Administration
2727 Mahan Drive
Tallahassee, FL 32308

John H. Armstrong, State Surgeon General
Florida Department of Health
2585 Merchants Row Boulevard
Tallahassee, FL 32301

Re: Transitional Living Facilities (TLF)

Dear Secretary Dudek and Surgeon General Armstrong:

Disability Rights Florida is the federally funded protection and advocacy system for people with disabilities in Florida. We address concerns about the health, safety, abuse, neglect and rights of individuals in residential settings of all types. In this capacity, we have serious concerns about the level of the state’s regulatory control over Transitional Living Facilities (TLFs) as well as the state’s ability to ensure health and safety and to adequately prevent, detect and respond to allegations of abuse, neglect and rights violations of residents of TLFs. We urge that comprehensive action be promptly undertaken.

As you know, Disability Rights Florida has independent authority to investigate allegations of abuse, neglect and rights violations, as well as to monitor the state’s investigations. We advocate for the changes needed to ensure that the state has a comprehensive and effective system in place to license and exert sufficient oversight authority to assure the basic health and safety, as well as to prevent, detect and respond to abuse, neglect and rights violations of residents of facilities. We monitor the state’s performance of its obligations and we routinely comment on the rules that outline the state’s oversight authority of the facilities it licenses.

400.805, F.S. authorizes AHCA to issue licenses to TLFs and to adopt rules governing the physical plant and fiscal management aspects. 400.805 also authorizes DOH and AHCA to work together to adopt rules governing the services provided by TLFs. The statute authorizes unannounced inspections and fines for violations of statute and rule and incorporates all of the requirements of Part II of chapter 408. We see significant problems with both 59A-17, F.A.C. and 64I-1, F.A.C., the rules promulgated pursuant to this statute that set out the scope of AHCA and DOH’s current oversight authority. Copies are enclosed for your convenience. We urge that these problems be remedied through immediate and thorough revision of these licensing rules.

The Florida Institute for Neurologic Rehabilitation (FINR) is one of the state’s TLFs and is known for visible marketing across the country, acceptance of residents from other states, and high profile confirmed cases of abusive and neglectful treatment of individuals placed in the facility. Although not exhaustive, a review of some of this abuse and neglect was recently summarized by Bloomberg News reporter David Armstrong. See

Based on our review of these reported cases, other cases, the rules, and various public TLF inspection reports prepared by AHCA staff, we have become increasingly concerned that the scope of these rules are too limited to ensure resident health, safety, and prevention and detection of abuse, neglect and rights violations.

Unlike rules we typically see for the licensure, operation, and therefore inspection of residential facilities in Florida, 59A-17 and 64I-1 are silent across several key domains. Because TLFs are not regulated by federal law (unlike nursing homes, ICF/DD, and hospitals), the need for minimum state regulatory standards in each domain is paramount. Standards are needed to establish minimum regulatory controls over at least the following aspects of operation, health, safety and resident rights:

  1. Abuse and neglect
  2. Discipline, restraint and seclusion use
  3. Client rights (informed consent, communications, freedom of movement, religious observations, recreation, contact with courts, clothing and personal effects, dignity, privacy, ADA accommodations)
  4. Rights of parents and guardians
  5. Complaints and grievances as well as access to regulatory agencies and the Abuse Hotline
  6. Safety and transportation
  7. Emergencies & disaster planning
  8. Client treatment and treatment plans
  9. Training and education for residents
  10. Client records and confidentiality
  11. Admissions
  12. Administration; budget and finance
  13. Personnel qualifications, requirements and responsibilities
  14. Living space per resident, bedrooms and baths for residents
  15. Bedding and laundry
  16. Medications storage and administration

We understand and appreciate that AHCA and DOH have teamed up (along with DCF) to begin a closer examination of FINR and other Transitional Living Facilities. Unfortunately, we fear that meaningful improvement in these facilities cannot occur without significant changes to the scope of existing oversight authority in both agencies. We urge both agencies to address this concern immediately.

In closing, we request a response by August 31, 2012 and an opportunity to meet with you and key agency staff thereafter. Thank you in advance for your prompt consideration.


Robert E. Whitney
Executive Director



cc: Senate President, Mike Haridopolos
House Speaker, Dean Cannon
Jane Johnson, Office of Policy and Budget

Tags for this Post

agency for health care administration, background screening, department of health, legislature, restraint and seclusion, traumatic brain injury institutions,

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