Tracking down the troubles: some KVHD history

Thanks Dave.

Here is a portentous piece of Public relations fluff that has many interesting facts for certain people to look at and for the community to see how a management company hired an unqualified individual for two top priority jobs: First as the Clinical Nursing officer and then CEO.


And they brought on our current numbers man, Chet Beedle, CFO, who is still with us. (or against us)

I will make comments to direct your attention to certain issues and items that are still biting us right now. I will highlight some statements to look at as well.
It was a long article, Dolly, so I have just taken the most pertinent excerpts.

Popular hospital CEO rakes new assignment
By Dolly Ogawa

Published on Wednesday, July 2, 2003 10:00 PM PDT

CEO David Green had been at Kern Valley Hospital for exactly 3 years on June 25, the day he left for his new position in the city of El Centro in the San Joaquin Valley.

In those three years he accomplished a lot."When I came here the hospital had a lot of turmoil regarding financial issues. I think we've settled a lot of that and have a direction we're going in and we have solidified the nursing staff, especially with Pam (Pamela Ott, former Director of Nursing), coming on board. Now with the board appointing Pam as the interim CEO at this point it helps further solidify this team."

Green feels that the whole staff and management team, which he describes as a tremendous pool of talent and experience, is the best the hospital has ever had and possibly the best anywhere.We have many nurses that have transferred here from LA and Orange County. "Whatever brought them here we've got the cream of the crop and the people from here are very good at what they do because they've been doing it for a long time."

(Then we fired the cream of the crop? We probably should have fired the mold on top of the crop.)

"I believe the skilled nursing center we have here is second to none in the state. You walk down the hall you don't smell anything, here you have a significant number of not just nurses but CNAs that care about the people. We don't sacrifice quality up here because we have people who know what they 're doing."

(We sacrificed quality and management then made scapegoats out of some quality personnel)


The hospital's main challenge has been a tremendous debt burden. "Although we've been able to make a go of it, it's been up and down. They tried to deal with managed care in the late 90s and lost a significant amount of money. Managed care doesn't work out for any rural health care service. The hospital was struggling when Cal Mortgage who guarantees funding for hospitals insisted they needed more support. BRIM Healthcare was hired in 2000. BRIM is a company that has backup regional support for the CEO.
Carol Bradshaw was the chief nursing officer. When she left they found someone from Paradise and she left last winter. Then they were lucky enough to find Pamela Ott, when she moved to this area to be close to her grandchildren. "Lucky us," Green said. "She had been in this type of environment before."

Ott said, "We have competent people taking care of you here, whereas in large hospitals down below they have registry nurses and you can't always trust their abilities."

(Ouch, that comes back to bite us right now. Oh, there are traveling nurses looking for a place to stay. Mr. Jamison, do you have any open rooms?)

In a small community it was so easy for rumors to spread. There have been a lot of misunderstandings.
(Rumors became more like fact and finally evolved into urban legend; see post below)

Green's replacement, Pamela Ott, was found by "Divine Destiny." It was a miracle to find just the right person so easily and so quickly. Her daughter told her how beautiful it was up here.When Green had to replace the chief nursing officer, he put a small ad in the Bakersfield paper. In all his 28 years in this business he'd never seen this happen. It is so hard to replace the chief nursing officer, he insisted. It takes months. From the ad he received two responses. One was from Pamela Ott. He couldn't believe it as he read her credentials.

(Actually I couldn’t believe it when I read her credentials either. They are posted on the blog.)

Something had to be wrong (and it certainly was) and then he talked to her on the phone. She was so nice! It was unbelievable. He thought that once she came up here and saw what the job entailed he'd lose her on that round. No. It was divine destiny, as she said. She was perfect for the job.

When Green scheduled an interview with all of the management staff she was taken with the people. "I love rural health care because you can make a difference in the community. You can help people stay in their beautiful environment without having to leave to get health care. So it's pretty special for me.

(It's all been so special. The SNF disaster, the fired employees, the lawsuits, the collusion with some board members, the finger pointing, the measure M fiasco, the conflict of interest, the scapegoating; Gosh, rural healthcare really is so much fun)

I thought this is great after so many years working of being an administrator, to have the opportunity to work as a chief nursing officer and work with --someone who has the same vision for rural health care."Green said during her interview, "You could do my job." Little did she know that he would be leaving and that she would be doing his job. It is an interim position.

The Board of Directors will be making the final decision and they are taking their time. Pamela also wants to have some time to see the scope of the job by doing it.

Thanks Dave, the board, Brim, and Cal Mtg. and Goldman Sachs?

UPDATED:short staffed not uncaring, leads to trouble

(UPDATE) This blog from last year tells a story that cannot be denied: short staffing and likely not chemical restraints may have lead to the possible early demise of some KVHD nursing home residents. Since the government, public health, didn't follow up on the weight loss and dehydration issues, they cited the hospital with, along with short staff, the medications were the unlikely cause. I would rather they who died were not starved, or neglected, but that is what the facts look like.)

I think it boils down to this: How can you run any sort of business without the proper amount of staff? But the big question is did the short staffing cause the problems in the SNF in the first place?

KVHD is short on everything, except cheap talk. Doctors, nurses, nurse's aids, and obviously knowledge and money are in short supply.

Here's a recent article about another nursing home situation that sounds oh too familiar.

Compass Health and administrators at Mission View are trying to increase profits
by reducing staff and employing people who were not properly trained or
qualified, leading to Williams’ death.
Attorneys for Cameron, Greg Coates
and Michael Thamer, argue that the nursing facility took short cuts in care
that resulted in unsanitary and hazardous living conditions and left residents
unsuper vised. They also said there was an increase in accidents and injuries
suffered by residents and nursing staff and other signs of inadequate care.

To read more on this go to:

http://www.scnursinghomelaw.com/2008/01/articles/nursing-home-cases-in-the-news/family-files-wrongful-death-suit-against-nursing-home/

The following stories illustrate and comment on what happened at the KVHD nursing facility during the time the hospital was investigated.

Short staffing, pay cuts, and administration caused the problems.

A nurse’s story from the skilled nursing facility

She had just gotten her credentials to be a certified nurse’s aid in August of 2007. Her career started at the KVHD Skilled Nursing Facility at the same time as the new Director of Nursing Gwen Hughes came on board.

Though she had compassion for all the residents she cared for, she had no time to do the things she wanted to do to make the lives of the patients a little better.

“We were always short staffed and running around trying to just take care of the patients. I wanted to read their mail to them and talk them, but I never had time.”

The young aid said she was in charge of 14 patients by herself and working 12 hour shifts, while only being given half hour lunch breaks. The pace, she said, was too much.

She said she received no formal training from the nurses or the staff, and relied upon the other aids to tell her what she needed to do. “They told me this is what we do and this is the way we do it”

The aid said she didn’t know any better than what she was told, it was her first job in healthcare.

One of the first things that changed when Hughes took over, the aid said, was that they were ordered to take all the patients into the dining room to eat.

“There were some of them in pain and I didn’t want to move them, but they kept telling me that it was good for their health, because being in bed constantly could cause pneumonia. It made sense but I still felt sorry for the people. They have a right to eat where they want to.”

She said, the aids stuck together during this time, and were concerned about the changes being made to the protocol, and the changes being seen in some patients. (these are just aids mind you. What concern did the administration and the board have?)

“One woman used to talk to me and tell me stories, she wasn’t completely lucid, but she knew what was going on.”

Then over a period of a couple months, the aid said that the patient began to be “lethargic” and show signs of weakness.

“She began drooling and I didn’t know what the heck was the matter with her. I thought it might be part of a natural process.”

Running from patient to patient was how the aid described the situation.
“We were very short staffed; two aids per hall and that was a good day.”

Asked if she told the Department of Health Services about the problems, she said, “I kept telling them we were short staffed. Then I finally just quit, we were all so stressed out.”

In the exit survey, from April 2007, one of the findings was that the Skilled Nursing Facility was short staffed.

Citing other problems, the document lends to the argument itself that short staffing was the main issue as well as leadership and training.

The document said there were patients not getting enough hydration and some left in soiled or wet garments.

Medications were not given on time as well. You would have to have enough people available to get those meds to the residents on time.

Apparently, DHS never interviewed the again about her experiences at KVHD.

The aid also mentioned that there were discrepancies in the paperwork that was given to DHS compared to what they had actually completed.

"The other aids would get together and we would do all of our paperwork. But it wasn't updated for some reason when DHS came in."

After quitting KVHD, the aid still went on to nursing school. She said she is learning a lot about what happened in the past and why it shouldn't have happened.

"I'm now working at a nursing home and we have three patients to take care of; no more."

The federal laws require one hour and 58 minutes per patient to take care of their daily needs, bathing, eating, and things that make their life better, a little time to talk and listen.

Obviously, this young aspiring nurse, could not have accomplished the requirements for care. In 12 hours, with a break, she had 14 patients; so how could the hospital been meeting that law?

Regarding the investigation of the KVHD skilled nursing facility, she told me that she doesn't understand why the doctor and pharmacist are being indicted.

She said in school they are taught that doctors need to "trust" and "rely upon" the nurses who spend more time with the patients and know them better.
"In nursing school they teach us that an RN has to be really careful assessing patients. If the doctors agree with your judgement call they rely on you. The RN is the doctor there. They call in the prescripti0ns to the doctor who phones in the prescription. Basically, the nurses write the prescriptions."

The nurse's aid said after her experience with the KVHD hospital SNF, she was glad to be gone. "I would never want to work in a place like that again. It was terrible; I hated it. But I did care about the patients."

Another nurse, an LVN, who is a witness in the indictments against, Gwen Hughes, Dr. Pormir, and Debbie Hayes, shed some light on what had happened in a letter to the editor after she was fired during the crisis in 2007.

Her career with the KVHD began just before the hospital was taken over by a management company called BRIM, sent in by Cal Mtg. to make sure they got their payments on the bond debt, which was in question for a time.

"Looking back at this administration, one of the first official functions was cutting the pay of all the nursing staff. This began the decline of quality of staff personnel."

She went on to say that when she started her employement in the SNF at KVHD, there was a director of nursing who she thought had the right qualities. "Staff and residents were happy and yearly state surveys came and went without a problem."

The LVN, who had hoped to retire from KVHD, said everything changed when the management company and it's team arrived and they lost the DON, Todd Elkins.
"We lost him as soon as the present administration began; butting heads with the CEO, speaking out for his nursing staff over the pay cut."

She describes things going downhill all the way to the point of losing her job over speaking out.
"Last friday, (5/4/07) I believe I was unjustly dismissed from my position. Strong words, you might think, but I have all the proof necessary to back up my words. I am in fact one of the scapegoats of the administration."

Scapegoats are plenty at this hospital even now. We still have remnants of the BRIM management company style and technique existing today. As well as the CFO.

And we still have not done anything about the debt.

Do you think I'm making them angry by asking for relief for this hospital? Is that such a bad thought? There is relief going to huge corporations, why wouldn't this board and CFO not want to try and negotiate an agreement?

You know why.