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ARIZONA STATE LEGISLATURE
Forty-seventh Legislature – First Regular Session
JOINT SELECT COMMITTEE TO INVESTIGATE OPERATIONS
AND CONDITIONS AT THE ARIZONA VETERANS HOME
Minutes of Meeting
House Hearing Room 1 -- 3:00 PM
Chairman Nelson called the meeting to order at 3:11 p.m. and attendance was noted by the secretary.
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Senator Jack Harper, Chair |
Representative John Nelson, Chair |
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Senator Jim Waring, CoChair |
Representative Manual Alvarez |
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Senator Chuck Gray |
Representative John McComish |
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Senator Linda Gray |
Representative Ben Miranda |
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Senator Richard Miranda |
Representative Jonathan Paton |
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Senator Victor Soltero |
Representative Albert Tom |
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Senator Charlene Pesquiera |
Representative Bob Stump, CoChair |
Chairman Nelson outlined the agenda items and asked if each member had received copies of the Organization Chart (Attachment 1) and the Comparison Chart of Arizona Veterans’ Home Reports (Attachment 2).
Comparison of January Veterans Affairs Survey and February Department of Health Services Survey by Staff
Thomas Adkins, Legislative Research Analyst, House Counties, Municipalities and Military Affairs Committee, addressed the committee to explain and discuss the Comparison Chart of Arizona Veterans’ Home Reports (Attachment 2).
He stated that the twenty-five infractions in the left column were identified on the January Veterans’ Affairs (VA) Report and the fifteen infractions in the right column on the February Department of Health Services (DHS) Report. There are eight infractions which appear on both reports and are printed in red.
He further explained that the two reports ask different questions, measure different things, and use different measurements to determine compliance.
Senator Harper asked if the Veterans’ Home is disputing some of the claims from the 94-page DHS Report; Mr. Adkins replied that is his understanding, but that he does not know which ones. Chairman Nelson added that it was his understanding that the issue regarding the colostomy bag is in dispute.
Chairman Nelson asked General Maxon to address the committee regarding his current role and his plans to address the reports and the corrective actions to be taken.
Representatives of the Arizona Veterans Home Answer Questions Regarding Findings in the January Veterans Affairs Report and February Department of Health Services Report
Brigadier General Gregg Maxon, Acting Interim Director for Department of Veteran Services, addressed the committee to explain that the Governor had appointed him three weeks ago to Acting Interim Director for the Department, whose mission is to provide advocacy and services to Arizona’s Veterans’ community.
He explained that his intentions are to:
He stated that his recent observations of the Home are that it is well-run and well-kept, and he invited all members to come to observe the facility. He explained that there are some staffing problems, as there are 20-25 vacancies out of a staff of slightly over 200. There are also training issues, there are problems related to evening and weekend shifts, and the pay is as much as 20-30 percent behind comparable civilian positions. He stated that morale was very low.
Discussion of Measures to Correct Deficiencies Identified in the January Veterans Affairs Inspection and February Department of Health Services Inspection
General Maxon listed the following corrective actions that he intends to put in place:
Senator Harper asked if the Home uses registry nurses when it is short-handed; General Maxon explained that the Home has always used the registry.
Senator Harper asked if the Home has the same compensation per bed as other government-subsidized homes; General Maxon replied that he did not know the answer to that question.
Senator Harper asked if he was protesting the 94-page DHS Report; General Maxon replied in the negative, explaining that his focus is to move forward.
Mr. Paton asked if he was familiar with the Coppersmith, Gordon, Schermer and Brockelman document; General Maxon replied that he was familiar with it and the informal stages of negotiating the findings of the survey, but that finally did not dispute any of the findings. He now wishes to solve the issues, not to fight over them.
Mr. Paton asked if he agreed with the DHS report; General Maxon replied that he does not disagree with it, and that the assessment is tough but fair.
Mr. Paton asked if the Home has legal council to represent it; General Maxon replied that it does not have a staff attorney, but that the Attorney General’s office would provide council.
Mr. Paton asked what the role of Coppersmith et al is; General Maxon replied that the firm has experience in regulatory compliance issues and would handle those, and that it is not retained to represent and defend the Home.
Mr. Ben Miranda asked about the weekend salary adjustments and if there is a staff shortage on weekends which might tie the problems to weekend shifts; General Maxon replied that it is difficult to staff night and weekend shifts because the current policy provides no pay differentials for shifts.
Mr. Miranda asked about the types of training and the pay scale, commenting that $8-$10/hour is a low pay scale; General Maxon explained that certain license and certification processes must be fulfilled in order to even get a job at the Home.
Mr. Miranda asked about the surveys that are on-going right now; General Maxon replied that the surveys are not finding patient care issues, rather performance appraisals which are not done and dietary menus which do not match what the resident ordered. He further explained that DHS will re-inspect the Home and look at these issues, and that consultants are reviewing policies and procedures.
Mr. Miranda asked about the resident assistant at the Home; General Maxon replied that the communication is now very good with that person, and he added that the chaplain position will enhance that.
Mr. Miranda asked what can the Legislature expect from the General’s leadership, what do the veterans need, and how can the Legislature provide support; General Maxon replied that he wants the Home to be 100 percent self-supporting with a highly-motivated staff.
Chairman Nelson asked if there is a prioritization to the training and if repetition of training occurs beyond the initial training of a new hire; General Maxon replied that he was in agreement that recurrent training must occur.
Chairman Nelson asked what the weekend and late-night shift compensation would be; General Maxon replied that he is looking at shift differential, but that it may not be necessary. He stated that most issues occurred on the night shifts and that he has instructed his management staff to visit at odd hours to increase the professionalism of the night shift staff.
Chairman Nelson asked if the low turnover rate at the Home indicates job satisfaction; General Maxon replied that the first six months of employment are critical, and that if new staff stays that first period, then they generally stay long-term.
Mr. Paton asked for more details about the Coppersmith et al law firm; General Maxon explained the firm does provide legal advice to ensure that policies and procedures comply with regulatory requirements, but does not advise on policy.
Mr. Paton asked if the firm had attempted to mitigate the effects of a negative report; General Maxon replied that their duties are to clarify the issues.
Mr. Paton asked about the issue of money, specifically a surplus for next year of $4 million; General Maxon replied that he is not aware of that and that his figures show a $421,000 fund balance projected for the end of this year. Mr. Paton asked what the Home’s request was last year from the Governor’s budget; General Maxon replied that the Home was granted a spending authority of $13,262,000.
Mr. Paton asked if the Home has surveillance cameras; General Maxon replied in the affirmative.
Mr. Paton asked how many patient-care complaints were received last year; General Maxon did not know the answer, as that time-frame was before his arrival. He stated that he would find out the answer for the committee.
Mr. Paton asked about the Reuben Person complaint; General Maxon replied that the complaint was about bedsores which led to his death and that there was a $3 million administrative claim made which was turned over to the Attorney General’s office.
Mr. Paton asked about a verbal abuse complaint against a Home staff person; General Maxon stated that he was not aware of that specific instance but that such abuse is not tolerated. Mr. Paton asked if any disciplinary action is taken in the case of verbal abuse; General Maxon stated that he was not aware of such a case. Mr. Paton asked if there was training or a written standard designed to curtail verbal abuse of patients; General Maxon explained that the approach would be two-fold:
Mr. Paton asked how the Home handles substance abuse problems; General Maxon explained that such abuse is typically alcohol and reminded the committee that the patients are not inmates and are free to leave to go to a bar and have a few drinks. Mr. Paton asked if alcohol is allowed in the Home; General Maxon explained that some patients do have a doctor’s approval, and that the alcohol is kept locked and administered as if a medication.
Senator Linda Gray inquired about how the Home was dealing with Patient 21 who has an alcohol problem; General Maxon stated that he would defer to Mr. Mike Landry on that question.
Senator Harper asked if the law firm did protest the report about a colostomy incident; General Maxon replied that they were not protesting the DHS report. Senator Harper asked if the law firm looked at the video tapes before it wrote the protest of the 94-page report; General Maxon replied that he did not know.
Senator Chuck Gray asked if there were any individuals fired over this or if criminal charges should be filed; General Maxon replied that his charge is to go forward and he cannot speak about actions taken before he arrived as that would require speculation. Senator Gray asked who would go back and look for criminal negligence such as elder abuse or neglect or endangerment; General Maxon replied that the County Attorney’s office would be the one to do that.
Senator Gray stated that someone should investigate tying up the loose ends from the incidents before the General’s arrival, and that the General should be that person; General Maxon replied he would take whatever action is required, although any criminal investigation would be the responsibility of the County Attorney.
Senator Soltero asked how and where the Home ranks in providing care for residents; Chairman Nelson replied that DHS would most likely have a comparison of all the compiled documents.
Senator Waring asked if this was the only veterans’ resource in Arizona and if other veterans who do not use this resource are kept track of. He asked about the advantages of a veterans’ home versus private sector housing for veterans. General Maxon replied that the Department of Veterans Affairs may know about other vets, but that there are privacy issues to capturing that information. He added that he supports the Home environment because soldiers share a common bond which is continued at the Home and would be lost in a private setting.
Mr. Tom asked about the heating and air conditioning at the Home; General Maxon replied that the rooms have been retrofitted with bigger air ducts.
Senator Linda Gray asked why the VA survey was received so late; General Maxon replied that because the survey was confidential, there were legal issues which slowed it down. Senator Gray asked if a $10,000 fine was paid for the late reporting; General Maxon replied that it had not been paid and that it is actually a Federal Medicaid issue.
Chairman Nelson and Senator Gray asked if there was a freeze on new patients; General Maxon replied that there is and that it will be lifted 30-45 days after clearance. He also clarified that the Home is accepting new patients and that the freeze applies to admitting certain patients under certain programs.
Update from Governor's Veterans Home Review Team
Mike Landry, Assistant Deputy Directory of Operations for Department of Veteran Services, explained that his direct responsibility to manage the entire Home began on March 14, 2007; prior to that he had been in charge of engineering, dietary, and housekeeping areas, joining the staff in November, 2006.
Senator Linda Gray asked about Patient 21 returning intoxicated from Home outings; Mr. Landry said that that patient was discharged in late January/early February of this year, and since he was not an inmate, he was free to go outside the Home. There was not documentation to urge an intervention for his drinking problem.
Senator Linda Gray asked what the intervention process is now; Mr. Landry explained the Care Planning Process which is now in place but was not for Patient 21.
Mr. McComish inquired about the organizational structure of the Home; Mr. Landry replied that he was hired as Facilities Project Manager. Then, as of March 14, he was asked to run the Home and report directly to Dennis Burke in the Governor’s Office. He now oversees the Home and reports to Director Maxon. Further discussion ensued.
Mr. McComish stated his concerns with the problems reported in January which recurred in the February DHS survey; Mr. Landry explained that there was not enough time to respond to the January report, hence the problems were still seen a month later. He further explained that the Care Plans have since been corrected to address the problems such as smoking issues and the alleged abuse issues. Mr. Landry stressed that the call light is a lifeline for the patients and that audits are being run to address the call light problems and that new technology would be acquired which will also help.
Mr. McComish asked what other management changes have occurred besides Mr. Chorpenning’s departure; Mr. Landry replied that the positions of Home Administrator, Director of Nursing, and Social Services Manager are currently vacant due to resignation (Director of Nursing) and being asked to leave (Home Administrator and Social Services Manager).
Chairman Nelson asked who Mr. Chorpenning reported to; Mr. Landry stated that Mr. Chorpenning reported to Dennis Burke. General Maxon further clarified that Mr. Chorpenning was a member of the Governor’s Cabinet and reported to her. Further discussion ensued on the reporting structure of the other department heads. The Policy Advisor on the Governor’s staff is the point at which DHS and the Home both report. General Maxon explained that he reports through Dennis Burke to the Governor.
Chairman Nelson reiterated that he has requested an organization chart that would show the structure from the Governor down: who reports to whom?
Mr. Paton asked if General Maxon has access to the Governor if there are more problems; General Maxon replied in the affirmative.
Senator Harper asked Mr. Landry if he had knowledge of the Coppersmith law firm’s dispute of the 94-page DHS report; Mr. Landry replied in the affirmative. Senator Harper asked if the Coppersmith law firm had reviewed video tapes from the Home; Mr. Landry replied that he did not know, that the videos do not capture images from inside residents’ rooms in any event. Mr. Landry stated that the video surveillance hard drive overwrites every 30 days, but that he would attempt to provide them if they are available.
Senator Soltero asked how many staff vacancies there are right now; Mr. Landry replied that there are 35 total, with 21 in nursing and 14 other vacancies. He stated that the Home will use the registry to fill the nursing vacancies and contractors for the other administrative posts, but that these people are not state employees. Senator Soltero suggested that it is better to have full-time state employees in those positions.
Mr. Ben Miranda asked about the age and condition of the medical equipment in use at the Home; Mr. Landry said that he did not know but would obtain that information for the committee.
Chairman Nelson confirmed that General Maxon and Mr. Landry are the individuals who will speak for the Home.
Discussion and Requests for Additional Information
Senator Harper requested any video files or video discs of images from the Home that would be relevant to any points that are being contested by the Coppersmith law firm in reference to the 94-page DHS report.
Without objection, the meeting adjourned at 5:18 p.m.
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Jane Dooley, Committee Secretary
April 19, 2007
(Original minutes, attachments and audio on file in the Office of the Chief Clerk; video archives available at http://www.azleg.gov/)
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JOINT SELECT COMMITTEE TO
INVESTIGATE OPERATIONS
AND CONDITIONS AT THE ARIZONA VETERANS HOME
2
April 17, 2007
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