HospitalInspections.org

Based on review of facility By-Laws, review of facility records, review of emails, and interviews, the facility failed to comply with agreements/arrangement for its operations when hospital staff and the contracted emergency department (ED) providers failed to receive funds for services furnished on more than one occasion.

The findings include:

Review of the facility By-Laws, under article 7.2, showed CEO [chief Executive Officer] job duties included, "SECTION 7.2 AUTHORITY AND DUTIES
7.2.1 The Board shall empower the CEO to be responsible for the Hospital's management. The specific authority and duties of the CEO shall be the following:
7.2.1.1 to establish effective operations;
7.2.1.2 to establish information and support systems;
7.2.1.3 to recruit and maintain staff;
7.2.1.4 to conserve physical and financial assets..."

Review of the CEO job description identified the CEO under the Administration department and showed it was the CEO responsibility to provide leadership, assume responsibility and accountability for the overall strategic planning of rural hospital...Assures consistent compliance with quality, risk, financial, and other expectations that are in accordance with expectations and directives..."

Review of the current staffing schedule revealed three nurses on the current schedule had either resigned or been terminated related to the facility's failure to meet payroll.

A copy of an email was presented to the complaint survey showing the Vice President (VP) of Human Resources sent an email on 08/16/2024 to the hospital staff regarding [name of hospital] corporate payroll. The email was addressed to "Team" and stated "...regrettably, funding for the [name of hospital] payroll was not fully funded...without 100% funding the company was unable to release today's payroll."

A copy of the social media post sent out by Registered Nurse (RN) #1 prior to their termination was presented to the survey on 08/20/2024. The social media post informed media that staff were "fed up and speaking out on [name of hospital] for not paying staff." According to the social media post, "...this had become a habit yet again leaving people without the ability to pay bills or feed their kids." The social media post reported checks that had been received prior also showed deductions for dental, vision, and life insurance even though dental, vision, and life insurance had been canceled months ago because of non- payment to the insurance company.

During an interview with the CEO on 08/20/24 at 8:30 AM, the CEO stated payroll had been delayed on more than one occasion for staff due to a delay in funds. The CEO went on to say he attended a conference...last week and was not available "to calm things down." When asked if the Governing Body/Advisory Board was aware of the payroll issue, the CEO provided an email sent out on 08/18/2024 at 8:56 AM, which stated the facility delayed payroll however there was no evidence found to show the Advisory Board had ever met to resolve the issue.

During an interview on 08/20/24 at 9:30 AM, with the Director of Nursing (DON) she stated RN #1 was terminated after posting personal information on social media regarding facility failure to meet payroll and two additional nurses turned in immediate resignations. The DON stated agency staff are expected to be called in today to assist once the CEO gives approval. The DON stated managers were exhausted from working double shifts to provide coverage. According to the DON, the ED manager was not available for her assigned job duties today because the ED manager worked night shift to provide coverage for staff who gave immediate resignation, leaving the facility understaffed.

A telephone interview was conducted on 08/20/2024 at 10:50 AM, with the Vice President (VP) of Human Resource (HR) located at the cooperate office in Florida. According to the VP of HR, RN #1 broke facility policy when the nurse posted a copy of the memo that was sent out to staff regarding delay in payroll. The VP of HR stated RN #1 was terminated because of the social media post and two additional nurses, Licensed Practical Nurse (LPN) #1 and RN #2, turned in their immediate resignation, stating the unfortunate mishap with payroll posed a burden. When asked if staff would be paid today, as stated in a memo, the VP of HR stated funds were not available today as of 11:08 AM. When asked how the facility would be paying Agency staff, the VP of HR stated the CEO had not made a request for Agency staff coverage as of 08/20/24 at 11:08 AM.

A telephone interview on 8/20/2024 at 11:30 AM, with the contracted agency, who provided nursing staff to assist with staffing shortage, revealed the hospital had not made arrangement for 08/20/24 6:00 PM to 6:00 AM coverage as of 11:30 AM on 08/20/24.

An interview on 08/20/24 at 11:40 AM, with the ED Provider, revealed the facility failed to pay contracted ED Providers. According to the ED Provider "...more staff are expected to walk out if Administration does not make payroll." The ED Provider stated the facility averages seeing 30 patients a day in the ED however, the providers plan to give seven-day notice if Administration does not make payroll.

During a telephone interview conducted on 08/20/2024 at 12:30 PM, the Chief of Staff/President of Medical Staff stated she was not aware of payroll concerns or the social media post stating the facility did not have funds to meet payroll for employees. The Chief of Staff had not spoken with the CEO regarding payroll and had not been informed of staff walking out or being terminated related to the facility's failure to meet payroll.

Random staff interviews were conducted on 08/20/2024 with staff, a certified nurse aide (CNA) at 12:50 PM, RN #3 at 1:00 PM, LPN #2 at 1:10 PM and the ED tech at 1:15 PM, and all confirmed there had been a delay in payroll on more than one occasion. The staff interviewed stated a memo was sent out on 08/16/2024 stating there would be a delay in payroll and staff should receive pay by 8/20/2024 or before, however no one had been paid as of 8/20/2024 at 1:15 PM.

During an interview on 8/20/2024 at 1:25 PM, with the Medical-Surgical Supervisor, she stated she had been working double shifts to provide coverage for 3 nurses who resigned. The Supervisor stated the staffing schedule had been revised to provide coverage, but staff were exhausted. The Supervisor was aware of the concern regarding deductions coming out of paychecks for dental, vision and life insurance even though the insurance coverage had canceled benefits sometime in April of 2024 due to non-payment. According to the Supervisor, staff were told [name of insurance company] would reimburse the deductions made from each paycheck. The Supervisor was not aware of any staff who had received reimbursement.