HospitalInspections.org

Based on interview and observation, the governing body failed to discharge its oversight responsibilities over the operation of the hospital effectively. The governing body failed to pay employee wages, failed to pay vendors for services rendered, and vendors have stopped providing services. Providers of medical services have not been paid and the services have ceased. The governing body failed to provide a safe setting for patients in that there is no adequate staff to care for the patients, and no supplies and medications needed to provide safe care to patients.


An interview with Personnel #17 on 8/2/2018 at 1:10 PM, revealed, "We have a staffing and supply crisis due to our underlying financial crisis. I know people have not received their checks. We have had a decrease in reimbursement and we have had an increase in our collections efforts and a decrease in our workforce to try to bring everything within our budget. We had a mismatch in funds and we distributed check to certain departments. We focused on ER, Radiology and lab. Other departments were not paid. The inpatient nurses are the next round of checks to be distributed. We have focused on areas we cannot live without. Moving forward we will be looking at agencies and possible current applicants. We are trying to see if any staff are willing to stay. The radiology group had agreed to stay until next week, but then left after a $13,000.00 payment was kicked back. We worked out an agreement and it should be resolved by next week."









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Based on observation and interview, the hospital failed to protect and promote the rights of the patients. The hospital failed to ensure that patients receive care in a safe environment.



The hospital called a Code Yellow, an internal disaster as designated by the Regional Advisory Council, on 8/1/2018 and 8/2/2018. The Regional Advisory Council (RAC) is a group set up through the Governor's Emergency Management group that helps coordinate emergency and trauma responses within an assigned geographic area. So when a facility goes on diversion, they notify the RAC to ensure that ambulance don't take patients to that particular ER, so there are no ambulances coming to the hospital. The hospital leadership stated that it would remain in place until the staffing issues are resolved.


1.) the hospital failed to pay employees for a two week period which resulted in employees not showing up for work. Respiratory and radiology services were unable to be provide services to patients.


2.) the hospital failed to pay invoices for medical supplies which resulted in lack of supplies for patient care.


4.) the hospital called a Code Yellow (internal emergency) due to lack of staffing which stopped ambulances from bringing patient to the hospital.


Cross Reference:

Tag 142
TAG 144

Based on observation and interview, the hospital does not have a well-organized nursing service, in that, the nursing services was only able to have minimal staffing in the ER and no Inpatient nurses were available should the ER need to admit a patient. The Chief Nursing Officer (CNO) failed to effectively oversee the nursing service operation including determining the types and numbers of nursing personnel and staff necessary to provide safe and appropriate nursing care for all areas of the hospital.

Cross Reference Tag 386 Organization of Nursing Services 482.23(a)



Based on observation and interviews, the nursing service does not have adequate number of registered nurses and other personnel to provide safe and appropriate nursing care to all patients as needed, in that the Inpatient unit has been closed down due to not being able to provide nurses for that unit. The ER only has 2 nurses available per shift and the nurses scheduled to work on 8/2/2018 did not show up due to nonpayment of wages.

Cross Reference Tag 392 Staffing and Delivery of Care 482.23(b)

Based on observation and interview, the hospital Radiologic Services ceased on 7/31/2018 because of non payment of past due services. The Radiologist ceased services and the radiology technicians were also not paid and called in to advise they were not coming in to work.

Tag 529 Scope of Radiologic Services CFR 482.26(a)


An interview with Personnel #4 on 8/2/2018 at 11:11 AM revealed, "Last night they had a hemorrhagic stroke that they had to ship without a read on the CT scan. Tonight they have no staff...The hospital breaks all kinds of laws. Yesterday there was no radiology tech because they are afraid they won't get paid."


Tag 546 Radiologic Responsibilities CFR 482.26(c),(c)(1)

Based on observations and interviews, the laboratory did not have the reagents to run laboratory tests to meet the needs of its patients.


On 8/2/2018, during an interview with Personnel #3 and #4 the following was revealed, "the laboratory had no reagents to run CMP, Amylase, lipase, D-Dimer or serum HCG. They were out of reagent to run Troponins but got that back during the week. They were not paying their invoices for lab services. Quest has not been picking up for about 2 months. They will get behind and then when they pay, services will resume. I am concerned if they can stay afloat.. Last week it was the reagent for the CBC, but we got some in and can now do them again."


Cross Reference Tag 582

Based on observation and interview, the hospital failed to ensure that the patients receive care in a safe environment in that;

1.) the hospital failed to pay the staff for the last pay period and the staff are not coming in to work.

2.) the hospital called a Code Yellow on 8/1/2018 which was reinstated on 8/2/2018 and the Administration stated that it would remain during the weekend due to staffing issues.

3.) the hospital failed to pay vendors for supplies and services and vendors have ceased doing business with the hospital.

A. Quest lab stopped providing services to the hospital two months ago due to non payment of invoices.

B. The Radiologist stopped providing services to the hospital since last Monday due to non payment of invoices.

C. Other suppliers that supply reagents for the lab and IV tubing, etc. have not been paid and supplies are running out at the hospital. The hospital is having to go to a sister hospital to borrow supplies.


Findings include:


During a tour of the hospital on the morning of 8/2/2018, the only department that had employees working was the ER. In the ER, there was a registration clerk, an ER tech, 2 RN's, ER MD, and respiratory tech. No patients were in the department at that time of the tour. Equipments had outdated Biomed safety inspection tags. A LifePak 15 Tag ID 223640 was due for Biomed Check 4/18. Ventilator DFW50612 was due for Biomed Check 4/18.


An interview was held with Personnel #3 at 9:55 AM on 8/2/2018 in the ER. Personnel #3 stated that she has called Safe Harbor due to the working conditions that she is working in. Safe Harbor is defined by the Texas Board of Nurse Examiners as a nursing peer review process that a nurse may initiate when asked to engage in an assignment or conduct that the nurse believes in good faith would potentially result in a violation of Board Statutes or Rules. Personnel #3 stated that they have no Radiology Techs, no Radiologist to read x-rays, and no respiratory technicians. he Lab has no reagent to run CMP, Amylase, and lipase if patients need those tests. The hospital called a Code Yellow, internal disaster as designated by the Regional Advisory Council (RAC) - a group set up through the Governor's Emergency Management group that helps coordinate emergency and trauma responses within an assigned geographic area. So when a facility goes on diversion, they notify the RAC to ensure that ambulance don't take patients to that particular ER, so there are no ambulances coming to the hospital. The Code Yellow was called due to the staffing crisis. Call lights are down in the ER and have been for awhile. Equipment was not checked by biomed timely in that 17 pieces of equipment had expired safety inspection tags. Personnel #3 stated that Supervisors were aware but nothing was done. Personnel #3 stated, they check the patients that present to the ER, stabilize as much as possible, and transfer the patients out. The Lab was out of reagent to run Troponins tests if patients need it based on presenting symptoms. No language line for translation for about 6-9 months. The nurse have been using Google translator to communicate to the patients that do not speak English. No employee insurance. The insurance premiums for staff were not paid for May, June, and July. Insurance premiums were pulled from their pay checks but the hospital did not pay the premiums and now the providers where they received services are turning their bills over to collection. Last weekend, theer were inpatients and the hospital gave direction to open the floor with just 1 RN as that was all they could get to come in to work the Inpatient unit. The nurse refused and the patient was kept in the ER with Inpatient status. A patient transfer last night was delayed because the first hospital called would not accept the patient without a read on the CT. Personnel #3 has submitted her 2 week notice.


An interview was held on 8/2//2018 at 1110 AM with Personnel #4 . Personnel #4 stated, at the beginning of the year payroll began to be later and later, the last pay was held until Monday. Sometimes employees were paid with personal checks, checks coming from different accounts. The hospital was not paying their invoices for lab services. Quest has not been picking up specimens for testing for about 2 months. Half of the hospital staff has not been paid. The ER staff was paid, but registration staff were not paid. Dietary has not been paid. Respiratory has not been paid...The dietary supplies have not been paid. The hospital has gone without IV tubing, and the tubing they had was expired and Psersonnel #4 refused to use it. There was no reagent in the lab to run a D-Dimer, Troponin, Amylase, Lipase or serum Hcg. Last week it was the reagent for the CBC. Personnel #4 stated, 4 years ago we had cardiology, pulmonology, surgery, renal, cath. lab, and the 3rd and 4th floors stayed full. Slowly they stopped paying the bills and the ER physician group left, and they were all board certified.The inpatient nurses have not been paid and now they would not come in to take care of inpatients. Last night there was a hemorrhagic stroke that had to be transferred without a read on the CT scan. The hospital has received an influx of resignation letters from employees.


An interview was held in the ER with Personnel #6 on 8/2/2018 at 1046. Personnel #6 stated that respiratory has been paid, but the director switched to PRN status because he had to have a job where he could depend on having health insurance. The hospital paid him for his hours worked but not for the 80 hours of PTO. One of the employees has a special needs child and their insurance claims are getting kicked back unpaid. They have had numerous investors come through, but nothing comes of it. Two weeks ago, we had a code in the ER, 2 nurses, a doctor, and a respiratory therapist worked the code. While the code was going on, there was no security personnel and people were wandering around the ER and in the hospital. The security has been on and off because of not being paid.The equipments has not been checked for months. There were respiratory medications, but the supplies have been out of date for months. Personnel #6 stated, staff don't feel safe using the ventilators so staff just bag the patients until EMS gets here to transfer them out.I am unable to calibrate the ABG machine.

Based on observation and interviews, the hospital failed to ensure patients receive care in a safe setting, in that


1.) the hospital failed to pay employees for a two week period which resulted in employees not showing up for work. Respiratory and radiology services were unable to be provided services to patients.


2.) the hospital failed to pay invoices for medical supplies which resulted in lack of supplies for patient care.


4.) the hospital called a Code Yellow (internal emergency) due to lack of staffing which stopped ambulances from bringing patient to the hospital.


Findings:


On morning of 8/2/2018, the hospital had no inpatients. The only department operational was the emergency room. At approximately 9:45 AM, there were no patients in the emergency room (ER). The staff present was the ER doctor, charge nurse, RN, ER technician, and registration clerk.


An interview was held with Personnel #3 at 9:55 AM on 8/2/2018 in the ER. Personnel #3 stated that she has called Safe Harbor due to the working conditions that she is working in. The Texas Board of Nursing defines Safe Harbor as a nursing peer review process that a nurse may initiate when asked to engage in an assignment or conduct that the nurse believes in good faith would potentially result in a violation of Board Statutes or Rules. Personnel #3 stated that they have no Radiology Techs, no Radiologist to read x-rays, and no respiratory technicians due to nonpayment of wages. The Lab has no reagent to run CMP, Amylase, and lipase. The hospital called a Code Yellow, an internal disaster, yesterday so there are no ambulances coming to the hospital. The Code Yellow was called due to the staffing crisis. Call lights were down in the ER and have been for awhile. Equipment were not checked by biomed timely, 17 pieces of equipment had expired biomed inspection tags. Personnel #3 stated that Supervisors were aware of the situations but nothing is being done about it. Personnel #3 stated, they check the patients that present to the ER, stabilize as much as possible, and transfer out those with more concerning problems. The lab was out of reagents to run Troponin levels on patients requiring it. No language translator line for about 6-9 months. The nurse have been using Google translator to communicate to the patients that do not speak English. No employee insurance. Insurance premiums were not paid for May, June, and July. The insurance premiums were pulled from the employees pay checks but the hospital did not pay the premiums, and now the providers where employees received services are turning their bills over to collection. Last weekend, there were patients admitted as inpatients and the hospital gave direction to open the floor with just 1 RN as that was all they could get to come in to work the InPatient unit. The nurse refused to come in and the patient was kept in the ER with Inpatient status. Personnel #3 stated, a patient transfer last night was delayed because the first hospital called would not accept the patient without a read on the CT.


An interview was held on 8/2//2018 at 1110 AM with Personnel #4 . Personnel #4 stated, at the beginning of the year payroll began to be later and later, the last pay was held until Monday. Sometimes employees were paid with personal checks, checks coming from different accounts. The hospital was not paying invoices for lab services. Quest has not picked up specimens for testing for about 2 months. Half of the hospital staff has not been paid. The ER staff was paid, but registration staff were not paid. Dietary has not been paid. Respiratory has not been paid. The dietary supplies have not been paid for. The hospital has gone without IV tubing, and the tubings for patient care were expired and Personnel #4 refused to use it. There was no reagent in the lab to run a D-Dimer, Troponin, Amylase, Lipase or serum Hcg for patients. Last week it was the reagent for the CBC. Personnel #4 stated, 4 years ago the hospital had cardiology, pulmonology, surgery, renal, cath. lab, and the 3rd and 4th floors stayed full. The hosptal stopped paying the bills and the ER physician group left, and they were all board certified. The inpatient nurses have not been paid, so they would not come in to work. Last night there was a hemorrhagic stroke that had to be transferred without a read on the CT scan. The hospital has received an influx of resignation letters from employees. I don't know if this can be fixed.



An interview was held in the ER with Personnel #6 on 8/2/2018 at 1046. Personnel #6 stated that respiratory has been paid, but the director switched to PRN status because he had to have a job where he could depend on having health insurance. The hospital paid him for his hours worked but not for the 80 hours of PTO. One of the employees has a special needs child and their insurance claims are getting kicked back unpaid. There have been numerous investors come through, but nothing comes of it. Two weeks ago, there was a code in the ER, 2 nurses, a doctor, and respiratory therapist all worked the code. While the code was going on, there was no security and people were wandering around the ER and in the hospital. The security has been on and off because of not being paid. The safety checks for the equipments were out of date. There were respiratory medications, but the supplies have been out of date for months. Staff don't feel safe using the ventilators so staff just bag the patients until EMS gets here to transfer patients out.

Based on observation and interview, the hospital does not have a well-organized nursing service, in that, the nursing services was only able to have minimal staffing in the ER and no Inpatient nurses were available should the ER need to admit a patient. The CNO failed to effectively oversee the sursing service operation including determining the types and numbers of nursing personnel and staff necessary to provide safe and appropriate nursing care to patients in all areas of the hospital.


Findings include:


On 8/2/2018 at 10:00 AM, the ER had two nurses to provide care to patients presenting to the ER. No Inpatient nurses were available should patients need to be admitted. For the past week, patients have been kept in the ER because there were no Inpatient nurses available due to nonpayment of wages. The nurses stated that they were not receiving any communication from Administration about pay, insurance, staffing, shortage of supplies, etc.


An interview was done with Personnel #3 on 8/2/2018 at 10:20 AM in the ER. Personnel #3 stated, she normally works 3 days per week, she has worked 4 ½ days this week. The hospital was short of staff on Sunday and had a call in on Tuesday. She was paid on Monday instead of the previous Friday, the hospital is current on the pay they owe her, but she is unsure if she will get paid next payday. She has put in her 2 weeks' termination of employment notice. She filed Safe Harbor. The Texas Board of Nurse Examiners defines Safe Harbor as a nursing peer review process that a nurse may initiate when asked to engage in an assignment or conduct that the nurse believes in good faith would potentially result in a violation of Board Statutes or Rules. The hospital is currently unable to run CMP, amylase, lipase test is patients need it. The doctors are frustrated. Call lights are nonfunctional. There is no TPA. She is worried about the equipment because it has not been checked by biomed in over a year. She has made her supervisor aware and nothing has happened. The hospital has not received an ambulance in a while. The hospital was placed on Code Yellow for an internal disaster as required by the Regional Advisory Council (RAC) - a group set up through the Governor's Emergency Management group that helps coordinate emergency and trauma responses within an assigned geographic area. So when a facility goes on diversion, they notify the RAC to ensure that ambulance don't take patients to that particular ER, at 2:00 PM yesterday as a solution to the safe harbor/staffing crisis. The hospital transfer a lot because there was no staff to read CT scans. The recent transfers have been because of lack of radiologist. This the second or third time they have not had radiological services. The hospital had been transferring patients because Troponin test as indicated by the patient's presenting symptoms could not be performed due to lack of reagents. The hospital language translation line has been gone for 6-9 months. The nurses have been translating through Google translate on their phones. They have a few people that speak Spanish. The hospital tried to open the floor for an admit with 1 nurse, felt it was unsafe, so held the patient in the ER. The nurses call in and there is no one to cover ER. The transfer of a patient last night was delayed because the first hospital called would not accept the patient without a read on the CT scan.


An interview was done with Personnel #3 on 8/2/2018 at 11:11 AM in the ER. Personnel #3 stated, the hospital has gone without IV tubing, and the tubing on stock was expired and staff refused to use it. There is no reagent in the lab to run a D-Dimer, Troponin, Amylase, Lipase or serum Hcg when needed by patient's condition. Last week, there were no reagnets to run CBC test. The hospital have not paid the inpatient nurses and now the nurses would not come in if patients are admitted as inpatient. Last night they had a hemorrhagic stroke that was transferred without a read on the CT scan. EMS knows thatthe hospital is under code yellow. The hospital has received an influx of resignation letters.

Based on observation and interviews, the nursing service does not have adequate number of registered nurses and other personnel to provide safe and appropriate nursing care to all patients as needed, in that the Inpatient unit has been closed down due to not being able to provide nurses for that unit. The ER only has 2 nurses available per shift and the nurses on 8/2/2018 did not show up for work due to nonpayment of wages.


Finding include:


During a tour of the hospital on the morning of 8/2/2018, the only department that had employees working was the ER. In the ER, there was a registration clerk, an ER tech, 2 RNs, an ER MD, and respiratory tech. No patients were in the department at that time of the tour. By 10:00 AM, the RNs for the night shift had called in and were not coming to work due to nonpayment of wages. Nurses were called but would not fill these positions due to the non payment of wages.


An interview was held with Personnel #3 at 9:55 AM on 8/2/2018 in the ER. Personnel #3 stated that she has called Safe Harbor due to the working conditions that she is working in. The Safe Harbor Rule (SHPR) is a nursing peer review process that can be initiated by a nurse when asked to participate in a conduct that has the potential to result in one or more violations of Texas Board of Nursing rules and statutes. Personnel #3 stated that they have no Radiology Techs, no Radiologist to read x-rays, and no respiratory technicians. The Lab has no reagents to run CMP, Amylase, and lipase tests for patients. The hospital called a Code Yellow, an internal disaster designation by the Regional Advisory Council (RAC), yesterday so there are no ambulances coming to the hospital. The Code Yellow was called due to the staffing crisis. The RAC is a group set up through the Governor's Emergency Management group that helps coordinate emergency and trauma responses within an assigned geographic area. So when a facility goes on diversion, the facility notifies the RAC to ensure that ambulance don't take patients to that particular ER. Patient's call lights are nonfunctional in the ER and have been for awhile. Equipment is not checked for safety by biomed, 17 pieces of equipment have expired safety check tags. Personnel #3 stated that Supervisors are aware but nothing was done. Personnel #3 stated, they are check the patients that present to the ER, stabilize as much as possible, and transfer them out. There were no reagents to run Troponins for patients whose condition requires it. No language translation line for about 6-9 months. The nurses have been using Google translator to communicate to the patients that do not speak English. No employee insurance. The hospital did not pay for the insurance premiums for May, June, and July. Insurance premiums were pulled from the employees pay checks but the hospital did not pay the premiums, now the providers where the employees received services are turning their bills over to collection. Last weekend, patients were admitted as inpatients and the hospital gave direction to open the floor with just 1 RN. The nurse refused to come in and the patient was kept in the ER with Inpatient status. The patient transfer last night was delayed because the first hospital called would not accept the patient without a read on the CT.


An interview was held on 8/2//2018 at 1110 AM with Personnel #4 . Personnel #4 stated, at the beginning of the year payroll began to be later and later, the last pay was held until Monday. Sometimes employees were paid with personal checks, checks coming from different accounts. The hospital was not paying their invoices for lab services. Quest has not been picking up specimens for testing for about 2 months. Half of the hospital staff has not been paid. The ER staff was paid, but registration staff were not paid. Dietary has not been paid. Respiratory has not been paid. The dietary supplies have not been paid for. The hospital has gone without IV tubings, and the tubings on stock was expired and staff refused to use it. There was no reagents in the lab to run a D-Dimer, Troponin, Amylase, Lipase, or serum Hcg for patients. Last week there was no reagents for the CBC test. The hospital has cardiology, pulmonology, surgery, renal, cath. lab, and the 3rd and 4th floors stayed full 4 years ago. Slowly, the hospital stopped paying the bills and the ER physician group left, and they were all board certified. The hospital have not paid the inpatient nurses and now the nurses would not come in to work if patients are admitted to the hospital. Last night, there was a patient with a hemorrhagic stroke and had to be transferred to another hospital without a read on the CT scan. The hospital has received an influx of resignation letters from employees.

Based on observation and interview, the hospital Radiologic Services ceased providing services on 7/31/2018 because of non payment of services previously provided to patients at the hospital. The Radiologist ceased providing services for nonpayment of wages. The radiology technicians were also not paid and called in to advise they were not coming in to work.


Findings included:


On 8/2/2018 at approximately 10:10 AM, there were no radiology techs on duty at the hospital. No radiology services were being provided at the hospital. Patients were evaluated and transferred out if they needed further service. The radiology tech for the night shift had already called in that they would not be coming in for the night shift.


An interview with Personnel #4 on 8/2/2018 at 11:11 AM revealed, "Last night they had a hemorrhagic stroke that they had to ship without a read on the CT scan. Tonight they have no staff...The hospital breaks all kinds of laws. Yesterday there was no radiology tech because they are afraid they won't get paid."


An interview with Personnel #11 on 8//2/2018 at 11:41 AM revealed, "On Tuesday I had to beg to get a reading on a CT so I could get a patient transferred. There is no radiologist. I have had a hospital decline a transfer because I did not have a read on a x-ray."


An interview with Personnel #17 on 8/2/2018 at 1:15 PM revealed, "The radiology group had agreed to stay until next week, but then left after a $13,000.00 payment was kicked back. We worked out an agreement and it should be resolved by next week."

Based on observation and interview, the hospital failed to have a radiologist to supervise the radiology services and interpret the required radiologic tests as determined by the medical staff.


Findings include:


On the morning of 8/2/2018, a tour of the ER services were performed. At approximately 10:10 AM, the ER was staffed with a registration clerk, 2 ER RNs, an ER tech, and an ER Physician. There was no radiology tech available for the ER.


An interview with Personnel #3 on 8/2/2018 at 10:10 AM revealed, "They transfer a lot because they have no one to read CT scans. The recent transfers have been because of lack of radiologist. This is the second or third time they have not had radiology."


An interview with Personnel #4 on 8/2/2018 at 11:11 AM revealed, "Last night they had a hemorrhagic stroke that they had to ship without a read on the CT scan. Tonight they have no staff."


An interview with Personnel #11 on 8/2/2018 at 11:41 AM revealed, "On Tuesday I had to beg to get a reading on a CT so I could get a patient transferred. There is no radiologist. I have had a hospital decline a transfer because I did not have a read on a x-ray."

Based on observation and interview, the hospital failed to have adequate laboratory services available directly or through a contractual agreement with a certified laboratory, in that the hospital failed to pay vendors for supplies and services, and vendors have ceased doing business with the hospital.


A. Quest lab stopped servicing the hospital two months ago due to non payment of services provided.


B. Other suppliers which supply reagents for the lab and IV tubings, etc. have not been paid and supplies are running out at the hospital. The hospital is having to go to a sister hospital to borrow supplies.


Findings include:


On morning of 8/2/2018, the hospital had no inpatients. The only department operational was the emergency room. At approximately 9:45 AM, there were no patients in the emergency room (ER). The staff present was the ER doctor, the charge nurse, an RN, an ER technician, and registration clerk.


On 8/2/2018, during an interview with Personnel #3 and #4 the following was revealed, "the laboratory had no reagents to run CMP, Amylase, lipase, D-Dimer or serum HCG. They were out of reagent to run Troponins but got that back during the week. They were not paying their invoices for lab services. Quest has not been picking up for about 2 months. They will get behind and then when they pay, services will resume. I am concerned if they can stay afloat.. Last week it was the reagent for the CBC, but we got some in and can now do them again."

Based on observation and interviews, the hospital failed to have adequate number of respiratory therapists to meet the qualifications specified by the medical staff, consistent with State Law, in that, respiratory therapists were not paid by the hospital and did not report to work or called in to notify that they would not be in.

Findings include:

On morning of 8/2/2018, the hospital had no inpatients. The only department operational was the emergency room. At approximately 9:45 AM, there were no patients in the emergency room (ER). The staff present was the ER doctor, charge nurse, RN, ER technician, and registration clerk. Only one respiratory therapist per shift was working. Personnel #1 stated that the policy stated that there was to be two respiratory therapist per shift.

An interview was held in the ER with Personnel #6 on 8/2/2018 at 10:46 AM. Personnel #6 stated "respiratory has been paid, but the director switched to PRN status because he had to have a job where he could depend on having health insurance. They paid him for his hours worked but they owe him for 80 hours of PTO and they did not pay that. One of my co-workers has a special needs child and their claims are getting kicked back unpaid. There are still people here today that did not get paid for last time. We stopped having any administrative voice a year ago. They have had numerous investors come through, but nothing comes of it. I can't tell you how long it has been since I have seen the owners. Two weeks ago we had a code in the ER, 2 nurses, the doctor, and respiratory all worked the code. While the code was going on there was no security and people were wandering around the ER and in the hospital. The security has been on and off because of not being paid. The equipment is out of date; it has been months since the ventilators have been checked. We have respiratory medications, but the supplies have been out of date for months. I don't feel safe using the ventilators so we just bag the patients until EMS gets here to transfer them out. I am unable to calibrate the ABG machine. The therapist has already called in for tonight. This does not feel safe."