ARIZONA STATE LEGISLATURE
Joint Select Committee to Investigate Operations and Conditions at the Arizona Veterans’ Home
Minutes of the Meeting
Wednesday, April 4, 2007
9:00 a.m., Senate Hearing Room 109
Members Present:
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Senator Jack Harper, Chairman |
Representative John Nelson, Chairman |
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Senator Jim Waring, Cochairman |
Representative Bob Stump, Cochairman |
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Senator Chuck Gray |
Representative Manuel Alvarez |
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Senator Linda Gray |
Representative John McComish |
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Senator Richard Miranda |
Representative Ben Miranda |
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Senator Charlene Pesquiera |
Representative Jonathan Paton |
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Senator Victor Soltero |
Representative Albert Tom |
Staff:
Chad Nitsch, Senate Government Committee Research Analyst
Thomas Adkins, House Counties, Municipalities, and Military Affairs Analyst
Chairman Harper and Chairman Nelson called the meeting to order at 9:05 a.m. and the attendance was noted.
REVIEW OF EVENTS RELATING TO THE ARIZONA VETERANS’ HOME
Chad Nitsch, Senate Government Committee Research Analyst, presented a timeline relating to events at the Arizona Veterans’ Home (Attachment A) and answered questions posed by the Committee members.
Mr. Nitsch presented the following timeline:
Representative Miranda asked Mr. Nitsch when it was first discovered that there were issues at the Veterans’ Home other than the information received from the survey.
Mr. Nitsch stated he believed there were reports in January, 2007 but could not verify that as fact.
Representative Miranda asked Mr. Nitsch if the investigation was still a work in progress.
Mr. Nitsch affirmed that the investigation was still a work in progress.
PRESENTATION BY STAFF AND DEPARTMENT OF HEALTH SERVICES OF THE NCI-447 REPORT ON 2/12/2007 (Continued on Page 9)
Susan Gerard, Director, Department of Health Services, testified regarding the NCI-447 Report (Attachment B) and answered questions posed by the Committee members.
Director Gerard submitted the following timeline entitled “Department of Health Services Overview of the Office of Long-Term Care and Licensing Surveys” (Attachment C):
Ms. Gerard stated on the weekend of the survey there were no problems with receiving information and if anyone needed assistance, she was available with the Licensure staff and could have provided additional information.
Ms. Gerard said in regards to the report that was submitted to CMS on March 9, 2007, since DHS is contracted with CMS to do the work, the reports are confidential until the entire process is complete. However, DHS also has state statutes which state that DHS reports are public record.
Ms. Gerard stated in regards to the fines, they are paid by the nursing facilities and are returned to the General Fund or CMS if it is a federal fine.
Senator Waring asked Ms. Gerard what steps were taken to correct the situation as soon as possible.
Ms. Gerard stated the Veterans’ Home staff and management responded quickly to make the corrections that were recommended. Her staff stayed through the weekend and did not leave until they were comfortable that all of the immediate jeopardy issues were corrected.
Senator Waring asked if she was given an explanation by her staff as to how this could have happened.
Ms. Gerard stated the real problem was on the night shift and with management.
Senator Waring asked how often DHS does a survey of the facility.
Ms. Gerard said DHS is required by law to do a survey of every skilled nursing facility once a year. They also go into facilities if there is a Level 1 complaint.
Senator Waring asked if it is difficult to make a complaint.
Ms. Gerard stated anyone is able to make a complaint through writing, calling, e-mailing, or faxing DHS.
Senator Miranda asked how early action was taken once the survey was done.
Ms. Gerard stated action was taken immediately.
Senator Miranda asked Ms. Gerard if any evaluations that are done are a result of how residents or staff feels about how the facility is being run.
Ms. Gerard stated every facility is required to post a patient’s bill of rights and provide that kind of information when someone enters a facility. DHS also has information about a facility’s grade on their website. Ms. Gerard added, staff is also interviewed as part of their annual survey.
Senator Miranda recommended an evaluation form might be beneficial.
Ms. Gerard said there is an ombudsman program but she is not sure if this facility has one.
Senator Miranda asked Ms. Gerard to comment on competitive salaries at the facility.
Ms. Gerard stated she does not know much about the salaries at the Veterans’ Home but she does know how difficult it is to maintain competitive salaries at the state mental hospital. Ms. Gerard added industry wide it is difficult to compete with hospitals.
Representative Nelson asked Ms. Gerard if she agrees with the findings in the report.
Ms. Gerard said she does and DHS has reached an agreement with the facility on their enforcement actions and their plan of correction.
Representative Nelson asked Ms. Gerard to comment on some of the specific situations her staff found at the facility that resulted in the finding of substandard care.
Ms. Gerard stated Deborah Piluri, Team Leader, Long Term Care Licensing, Department of Health Services, would be better suited to answer the question.
Ms. Piluri stated there were four or five instances that helped to identify substandard care. For example, on more than one occasion, staff had not hooked up a colostomy appliance to a resident who required one and this same resident stated he was unable to participate in therapy because he had to wait for staff to change him.
Representative Nelson referred to an e-mail on February 11, 2007 to Jeanine L’Ecuyer and January Contreras. Ms. Gerard stated her inspection team had trouble obtaining documents. Representative Nelson asked Ms. Gerard if the Governor’s office ever asked for more details in regards to this problem and if they inquired about the problem obtaining the documents.
Ms. Piluri stated because the veterans’ hospital is a federally run component it is difficult to obtain documents and finish up the investigation.
Representative Nelson asked Ms. Gerard when her first communication was with the Governor’s office.
Ms. Gerard stated Mary Wiley, who is the Director of Licensure at DHS, called her on the evening of February 9, 2007, to tell her there were problems. She then called Alan Stephens to inform him.
Representative Nelson asked Ms. Gerard when the Governor’s office received a copy of the DHS report.
Ms. Gerard stated a copy of the CMS report was hand delivered on March 12, 2007.
Representative Nelson asked Ms. Gerard what was found during an inspection by the Veterans Administration in January, 2007.
Ms. Gerard said they have been unable to obtain a copy of that report.
Representative Nelson asked Ms. Gerard how many complaints DHS has received about negligent care or abuse at the Veterans’ Home.
Ms. Gerard stated from January 1, 2004 to February, 2007 there have been eighteen complaints and thirty-nine allegations, referring to a handout distributed to the Committee members entitled “Arizona State Veterans Home Complaints Received” (Attachment D).
Representative Nelson asked Ms. Gerard if DHS is currently investigating the death of a patient from bed sores and infection.
Ms. Gerard stated DHS is investigating but it was not reported until the publicity of the survey.
Representative Nelson asked if Ms. Gerard would be able to provide a copy of the corrective action plan.
Ms. Gerard stated she would and provided a copy to the Committee members entitled “Arizona Department of Health Services Division of Licensing Long Term Care Licensing Enforcement Meeting Agreement Form” (Attachment E).
Representative Nelson asked Ms. Gerard when the previous survey of the Veterans’ Home occurred and what was found.
Ms. Gerard said the previous survey occurred in February, 2006.
Ms. Piluri added there were thirteen deficiencies discovered, none of which were of high severity and there was only one quality of care issue that was cited.
Representative Stump asked Ms. Piluri to define the term “immediate jeopardy.”
Ms. Piluri stated immediate jeopardy is any situation that has caused serious injury or any situation that has the potential to cause serious injury.
Senator Linda Gray asked Ms. Gerard when DHS received the complaint regarding the resident that had died.
Ms. Gerard stated it was received on March 27, 2007.
Senator Linda Gray asked Ms. Gerard if the complaint had been filed with anyone else prior to her office.
Ms. Gerard said she only knew what she read in the paper and that the resident’s son had spoken to people in the Veterans Administration Department regarding his father’s care and stated that there was supposed to be an investigation.
Senator Linda Gray asked what happens to a resident once they are not alert orientated.
Ms. Gerard stated if that is the case they rely on medical charts and the resident’s family to assist with the survey.
Alan Stephens, Chief of Staff, Operations, Office of Governor Napolitano, answered questions posed by the Committee members.
Representative McComish asked Mr. Stephens what he did when he first found out about the problems at the Veterans’ Home.
Mr. Stephens stated he spoke with Director Gerard and was told that the issues of immediate jeopardy and the areas where patients were in danger were immediately addressed.
Representative McComish asked when the Governor was notified regarding the problems at the Veterans’ Home.
Mr. Stephens said the Governor was notified on March 23, 2007 but he should have made her aware as soon as he found out on February 12, 2007.
Representative McComish asked who advised the Governor on March 23, 2007.
Mr. Stephens stated Dennis Burke notified her on March 23, 2007.
Representative McComish asked how Mr. Burke came to be involved.
Mr. Stephens said he had a meeting with Mr. Burke and Director Gerard regarding the chronology he had requested from DHS on March 23, 2007.
Representative McComish asked when Mr. Burke first became aware of the situation.
Mr. Stephens stated Mr. Burke became aware of the report during the discussion they had at that time.
Representative McComish asked when he became aware of the VA inspection and if he was aware of what the results were.
Mr. Stephens said he found out about the VA inspection during the meeting on March 23, 2007 through the chronology Director Gerard prepared and he has not seen the VA report.
Representative Miranda asked Mr. Stephens if it is his understanding that training is still something that needs to be done and if the other corrective actions have been addressed.
Mr. Stephens stated it was his understanding on February 12, 2007 that people were moving very rapidly because it was indicated there was a very high degree of cooperation with Veterans Services.
Representative Miranda asked if any major issues had come to his attention at the Veterans’ Home prior to February 12, 2007.
Mr. Stephens stated nothing came to his attention prior to February 12, 2007.
Senator Linda Gray asked Mr. Stephens if he had asked for a copy of the VA findings.
Mr. Stephens said he had not requested a copy but he believed the Governor’s office did.
Senator Linda Gray asked if he knew when the Governor’s office made the request for the VA findings and what response they received.
Mr. Stephens stated he asked DHS about the report when he found out about it and it was indicated that they did not have it.
Representative Paton asked Mr. Stephens at what point something becomes so severe that the Governor is notified that there is a problem.
Mr. Stephens reiterated he should have notified the Governor on February 12, 2007 and he did not because he was told DHS was taking care of the immediate issues and there would be a plan to focus on the long term issues.
Representative Paton asked Mr. Stephens what prompted the Governor to take action.
Mr. Stephens said once the Governor learned what was happening she immediately asked for an investigation and appointed Dr. Kirschner to focus on the issues that had occurred at the Veterans’ Home. Mr. Stephens added it is important to look at the protocol that DHS has laid out in the event these types of situations occur.
Representative Paton asked Mr. Stephens if it was the media release that prompted this to go to the Governor’s level.
Mr. Stephens stated it was a combination of things that prompted this to go to the Governor. Once he became aware that the report was finalized on March 22, 2007, he asked for a chronology, met with Director Gerard, and then the Governor was notified.
Representative Paton asked Mr. Stephens if it is his duty to inform the Governor of problems with state agencies, especially if the problems are serious.
Mr. Stephens reiterated he should have notified the Governor on February 12, 2007 and he was operating under the belief that the immediate issues were being addressed.
Senator Harper asked Mr. Stephens how long he has known the Governor.
Mr. Stephens stated he has known the Governor for almost twenty years.
Senator Harper asked Mr. Stephens if he has worked for the Governor in any other capacity.
Mr. Stephens said he has not worked for the Governor in any other capacity.
Senator Harper asked Mr. Stephens if the Governor has ever worked for him.
Mr. Stephens stated in 1990 he was accused in the AzScam issue and the Governor represented him. Mr. Stephens added he was found innocent.
RECESSED
Senator Harper recessed the meeting at 10:25 a.m. until Thursday, April 5, 2004, at 2:00 p.m.
RECONVENED
Senator Harper and Representative Nelson reconvened the meeting on Thursday, April 5, 2004, at 2:02 p.m.
PRESENTATION BY STAFF AND DEPARTMENT OF HEALTH SERVICES OF THE NCI-447 REPORT ON 2/12/2007 (Continued on Page 19)
Senator Harper stated House and Senate rules would still be in effect during the Committee hearing.
Alan Stephens, Chief of Staff, Operations, Office of Governor Napolitano, continued his testimony.
Mr. Stephens stated he came to testify voluntarily as a member of a co-equal branch of state government to help the Committee get to the bottom of a significant public policy issue affecting the state.
Mr. Stephens commented on Senator Harper’s inquiry into matters of public record that occurred sixteen years ago.
Representative Paton asked Mr. Stephens to confirm the reason that he did not take this matter to the Governor was because the DHS staff was highly skilled and taking care of the situation.
Mr. Stephens stated that was correct.
Representative Paton asked why the Governor appointed her own investigative team after the story broke in the Arizona Republic if DHS was taking care of the situation.
Mr. Stephens stated through a series of e-mails and discussions with Director Gerard and others as to what had taken place that weekend, he was told there was going to be a report. On March 9, 2007, DHS sent a letter to Veterans’ Services, which he became aware of on March 23, 2007, that listed a series of recommendations and discussions about what sanctions would be recommended to the Center for Medicare and Medicaid Services (CMS) regional office. This led to the CMS letter, which he became aware of on March 23, 2007, which assessed a fine of $10,000 and other sanctions, including the sanction of denial of payment for new admissions effective as soon as the notice requirements are met.
Mr. Stephens added had he seen that letter or had known that sanction was going to be requested that may have changed his view considerably and is an example of miscommunication on the issue.
Mr. Stephens stated that revelation, which he and the Governor became aware of on March 23, 2007, was the kind of issue that she reacted to very quickly and resulted in the establishment of the Committee.
Representative Paton asked Mr. Stephens to give a timeline of the corrective measures the Governor took as soon as she found out about this letter.
Mr. Stephens stated once the Governor was aware of the decision by CMS, she requested a copy of all documents. She then worked to establish a Committee to look into how the care at the Veterans’ Home would be maintained and to make recommendations about how the process can be handled better on all fronts. Mr. Stephens added the Governor also met with a number of staff members, including Patrick Chorpenning, who resigned as Director of the Veteran’s Home and was replaced with Brigadier General Richard Maxon as Interim Director.
Representative Paton asked if the Governor made a recommendation to hire a law firm to represent the Veterans’ Home.
Mr. Stephens stated the Governor wanted to make sure the Veterans’ Home was equipped with the best team possible in assisting with the request made by the Licensing Survey Team at DHS of a permanent long-term corrective action by March 26, 2007.
Representative Paton asked Mr. Stephens what is the purpose of the law.
Mr. Stephens said the law firm specializes in working with healthcare facilities that are undergoing similar kinds of corrective actions. Mr. Stephens added the State retained this firm a couple of years ago regarding issues with the State hospital.
Representative Paton asked Mr. Stephens who was defending the Veterans’ Home in the six weeks prior to the DHS investigation leading up to this point.
Mr. Stephens stated the Veterans’ Home staff was preparing the corrective action plan.
Representative Paton stated Beth Schermer, who works for the law firm that was retained to represent the Veterans’ Home, met with the Governor on March 15, 2007. Representative Paton asked Mr. Stephens if he knew what the nature of the meeting was about.
Mr. Stephens said he did not know what the meeting was in regards to but would find out and report back to the Committee.
Representative Paton asked if anyone had made an effort to contact the Governor in regards to the problems at the Veterans’ Home.
Mr. Stephens stated based on the information he had from the Director, the specialists in the field were very experienced and the matters were being taken care of quickly.
Representative Paton asked if it is true that the Governor assembled a team to investigate once she found out about the issues at the Veterans’ Home.
Mr. Stephens stated the Governor gave several directives to staff to provide help to the Veterans’ Home in terms of responding to the corrective action plan.
Representative Paton asked Mr. Stephens if he is aware of several letters written to the Governor and other agencies by Randy Persson in regards to his father, who was a resident at the home, having untreated bed sores (Attachment F).
Mr. Stephens said he is not aware of those letters.
Representative Paton asked if Mr. Stephens was aware, that according to Mr. Persson’s father’s death certificate, the cause of death was sepsis due to a systemic infection of unknown etiology (Attachment G).
Mr. Stephens said he was not aware of the cause of death.
Representative Paton asked if this is a proper way to treat our veterans.
Mr. Stephens stated this is not the proper way to treat our veterans.
Representative Paton asked Mr. Stephens to find out what the disconnect was in regards to the Governor not responding to Mr. Persson’s letters.
Mr. Stephens said he would look into this issue.
Representative Paton stated when the Governor finally responded to Mr. Persson’s letters she stated that she was going to appoint Dr. Kirschner to head a team to review the quality of the care at the Home. Representative Paton asked what this team will do that the DHS team and the corrective action plan will not accomplish.
Mr. Stephens stated the team’s charge is to look at the various issues presented in the review during the weekend of February 2, 2007 and any systemic issues at the Veterans’ Home that need to be addressed.
Mr. Paton asked who brought the report to the Governor’s attention.
Mr. Stephens stated Dennis Burke brought the report to the Governor’s attention.
Mr. Paton asked Mr. Stephens if Mr. Burke did not become aware of this situation until March 23, 2007.
Mr. Stephens said he had a brief conversation with Mr. Burke during the week of February 12, 2007 and told him about the DHS review and that he was told all the immediate issues were addressed.
Mr. Paton stated in a March 30, 2007 article on azcentral.com, Mr. Stephens was quoted as saying that he and the Governor’s staff were not aware of the gravity of the situation and the blame for that lays at the feet of Director Gerard. Representative Paton asked Mr. Stephens if he still agrees with that statement.
Mr. Stephens said there could have been better communication on all sides. In terms of the Governor’s office receiving documents that indicated that there could be a long lasting effect on the finances of the Home which would affect the care. This was something he did not know and would have dealt with the issue differently if that would have been known.
Senator Linda Gray asked Mr. Stephens if the Veterans Affairs (VA) report and findings were included in the documents that the Governor requested after she found out about the issues at the Veterans’ Home.
Mr. Stephens said that report was not included because DHS did not have those documents.
Senator Linda Gray asked Mr. Stephens whom he requested a copy of the VA findings from.
Mr. Stephens stated he requested a copy from the Department of Health.
Senator Linda Gray asked if anyone else asked for a copy of the VA findings from another agency.
Mr. Stephens said he did not know.
Senator Linda Gray asked if the Governor’s office has more authority than DHS in trying to obtain a copy of the VA findings.
Mr. Stephens said he did not know and informed the Committee that Brigadier General Maxon is prepared to talk about that report.
Senator Linda Gray stated Mr. Stephens commented previously that the Governor’s office does not have more authority than the Department of Health in trying to obtain the VA report.
Mr. Stephens stated DHS, as well as other state agencies and the Governor’s office are a part of state government. It is an issue of the state asking the federal government for a report and, in this case the Governor’s office, falls in the same range as another state agency.
Senator Linda Gray said she finds that quite surprising.
Representative Miranda requested any e-mails that are being utilized for questions be shared with the Committee.
Representative Nelson requested a 15 minute recess for the purpose of delivering a packet documents from Michael Haener, Deputy Chief of Staff, Office of Governor Napolitano, to the Committee members (Attachment H).
RECESSED
Senator Harper recessed the meeting at 2:32 p.m. until the sound of the gavel.
RECONVENED
Senator Harper reconvened the meeting at 2:57 p.m.
Representative Miranda stated he has some concerns regarding questions in reference to individual cases that may be subject to litigation because it may compromise both sides of this issue. Representative Miranda added the pivotal issue is to determine if the issues at the Veterans’ Home are systemic and how to resolve those issues. His only question in regards to the timeline would be specific to whether or not there was a timely response.
Representative Paton asked Mr. Stephens when he received the report.
Mr. Stephens stated he received the chronology and was aware that the report was finished on March 23, 2007.
Representative Paton stated the log shows Andrea Schoenecker, an assistant at DHS, dropped off the document that he is referring to on March 13, 2007 to January Contreras. Representative Paton asked Mr. Stephens why it took ten days for him to receive the document.
Mr. Stephens replied, what was received was the statement of deficiencies, in summary, in an e-mail he received on February 12, 2007. Mr. Stephens stated he thought he was going to receive a report with a series of recommendations and timelines that had been sent to the Veterans’ home and the federal government on March 9, 2007, which the Governor’s office did not receive.
PUBLIC TESTIMONY
Gerri Hofius, representing her brother Guy White, testified regarding the care her brother received while under the care of the Arizona Department of Veterans Services (ADVS) and answered questions posed by the Committee members.
Ms. Hofius stated ADVS was her brother’s guardian and conservator for twenty-two years but as of October 18, 2006 she became his guardian.
Ms. Hofius said she was previously told by ADVS she would never qualify to be a guardian because if he was to hurt somebody as a result of his condition she could be found liable. Ms. Hofius added she was also told that the VA would never see her as a payee for benefits.
Ms. Hofius stated ADVS does not pay attention to the veterans’ health. For example, she asked to go with her brother to a VA doctor’s appointment but was not allowed. It was only because he was taken to Thunderbird Hospital for an emergency that she found out he was taking between seventeen and twenty-three medications. When she asked why he was on so many medications she was told it was none of her business because she was not his guardian and that she was not welcome to any more visits at the veterans’ hospital. If she did show up on her own she would be arrested which is not true.
Ms. Hofius said if anything comes out of her testimony, it is to stick up for veterans and not to listen to ADVS.
Ms. Hofius stated after weeks of trying she finally was able to meet with Patrick Chorpenning in late 2005. She presented him with a packet of information with all of the medications her brother was taking and research she had done on the internet. She discovered that the medications caused her brother to have problems even though she was told the VA would never prescribe anything that would hurt someone. Ms. Hofius said Mr. Chorpenning played it down and told her the internet does not give accurate information.
Ms. Hofius said it is still not known what is wrong with her brother and when she asked Mr. Chorpenning how her brother can be helped. Mr. Chorpenning told her that ADVS would look into it. To this day she has not received any information.
Ms. Hofius added her brother was under the care of ADVS when it was overhauled in the late 1990’s because of misappropriating veterans’ funds.
Senator Waring asked Ms. Hofius how long ADVS was her brother’s guardian. Mr. Hofius stated ADVS was her brother’s guardian for twenty-two years.
Senator Waring stated he was concerned that the Department was trying to talk people out of taking responsibility for their own relatives and at the same time asking the legislature to take more money from the veterans to manage their care.
Ms. Hofius stated Mr. Chorpenning did tell her the judges always like to see a family member be a guardian but reiterated the VA would never see her as a payee for her brother’s benefits.
Ms. Hofius said she has been told her brother does not qualify for social security benefits but when she went to meet with social security she was told that not only does he qualify but had been receiving benefits from 1972 through 1975 and stopped receiving them because he did not show up for an appointment. She figured he has lost roughly $300,000 by not receiving benefits.
Senator Waring stated Ms. Hofius should have received a more balanced and accurate view of what was happening with her brother and is frustrated by that.
Senator Waring said Mr. Chorpenning must have had the best intentions and worked very hard. He devoted his life to veterans’ care and it is unfortunate his career ended this way. His efforts for veterans should be applauded.
Senator Linda Gray asked Ms. Hofius who told her that she was not allowed to visit her brother at the hospital.
Ms. Hofius said Gary Werner and Jeff Flake, her brother’s current case manager, told her this. When she finally was able to go to a doctor’s visit her brother’s primary caregiver told her the she was informed that her brother did not have any family members living in Arizona. Ms. Hofius stated, her brother has three siblings that have lived in Arizona for fifty years.
Representative Miranda asked Ms. Hofius if she believes part of the problem relates to inadequate funding of the facilities.
Ms. Hofius stated she does not believe that is part of the problem because if a person is being paid they should do their job without any excuses. Ms. Hofius added she believes it is not a money issue but an issue of attitude.
Representative Miranda stated it is important to look at salary schedules and under-staffing issues in the facilities and eliminate those as explanations for some of the issues that have arisen.
Rochelle Witten testified regarding her father’s experience at the Veterans’ Home.
Ms. Witten stated her father was admitted to the Arizona State Veteran Home on February 9, 2007, the day the DHS inspection team declared it in immediate jeopardy and presumed that the corrections were starting to be made from that point forward.
Ms. Witten added her father is a World War II veteran and had a severe stroke on January 7, 2007 and is paralyzed on his right side. He is totally dependent on the care that is given at the Veterans’ Home.
Ms. Witten said the doctor assigned to her father is hardly there and unable to meet with him because he rotates between ten nursing homes and could have an emergency at any moment. She expressed concern since this is her father’s primary caregiver.
Ms. Witten stated she asked for a psychiatric evaluation for her father, this apparently happened but no one in her family was notified. She found out after the fact that her father was asked a series of questions even though he cannot speak and his comprehension is compromised. This resulted in him being prescribed an anti-psychotic without the family being consulted.
Ms. Witten added the psychologist was supposed to do a follow up and the family requested that they be notified but they do not know if a follow up was done and the family was not notified.
Ms. Witten cited an example of lack of communication, when her father had an infected boil and needed to go to the VA Hospital. Her brother was contacted regarding this but was not told an ambulance transported him. This ended up costing $500.
Ms. Witten stated communication with the family is improving and the social worker assigned to her father is very helpful.
Ms. Witten stated at their one and only care plan meeting, she requested assistance for him to get back into bed after he was finished eating. She was told something would be done but no one followed through with this request and he fell out of his wheelchair.
Ms. Witten added when her father was transferred from Good Samaritan Rehabilitation Center, the Occupational Therapist recommended that he continue to receive muscle stimulation on his right shoulder. She brought this up in the care plan meeting and was told he would be evaluated at the VA Hospital and treated. This did not happen and he cannot use his right shoulder.
Ms. Witten concluded, the staff in the unit where her father resides are compassionate and respectful but they are stretched and under paid.
Representative Paton asked Ms. Witten if she has noticed if conditions at the Veterans’ Home are better.
Ms. Witten said the staff are on their toes in terms of when she makes requests.
Ms. Witten added there are still some systemic problems such as the activities for daily living are not always being checked resulting in each individuals’ care being forgotten.
Representative Paton asked Ms. Witten if she saw changes once the news broke.
Ms. Witten stated she did notice changes when the news broke.
Representative Miranda asked Ms. Witten to elaborate on the under-staffing and salary schedules of the Veterans’ Home staff.
Ms. Witten said she is not certain about the pay rate but the under-staffing was obvious. At one point her father waited twenty to twenty-five minutes for someone to respond to the call button.
Senator Soltero asked Ms. Witten if she felt her father is in a safe and secure environment.
Ms. Witten stated she believes her father is in a safe environment but there are needs that he has that are sometimes not met and that could become dangerous.
Senator Soltero asked Ms. Witten if she notices any areas that need improvement at the Veterans’ Home to write them down and share them with the Committee members so they can pass them along to those who are in charge. Hopefully, this will place extra attention on those areas and will eventually create a home that is acceptable for the veterans.
Representative Nelson asked Ms. Witten if, in her conversations with staff, the ratio of patients to staff was discussed and whether or not the facility was overcrowded.
Ms. Witten stated that topic did not come up in her conversations with staff.
Representative Nelson stated from a management standpoint, his concern would be if the Veterans’ Home is operating on the basis of only what the patients pay and if there are too many patients for the staff, resulting in some reduction over a period of time to make sure that the level of service is kept up for the patients that are there. Representative Nelson asked Ms. Witten to comment on this.
Ms. Witten said the Veterans’ Home has not been able to balance the number of patients with the number of staff and she does not know if staff should be cut and beds kept empty or if more staff should be hired.
Representative Nelson stated if this was a for-profit hospital there are things that would happen because cash in cash out is what keeps the facility operating and with private businesses, if there are problems, staff is laid off if there is not enough money to support the institution. From a management standpoint, this is something that somebody should have looked at and at least made some decisions as to where they cut the patients coming in until they had the staff to deal with them. Feedback is needed on this because something has happened to bring this up. Obviously the VA thinks this is a major issue because they are not accepting any more patients until this issue is resolved, and this is going to have an impact on the revenue stream. The problems need to be worked out and prevent this from reoccurring. As an oversight group they have a responsibility and owe the veterans the care they deserve, even if it takes a reduction in the number of beds that are being used to provide that quality of service.
Representative Nelson said he will talk to some of the other people that are working on this problem to see if this is an issue and if there should be some guidelines because there is a surplus of money in that funding category at this point in time.
Senator Miranda stated he did make a request for information from the Veterans’ Home regarding what the competitive salaries are versus for-profit homes and if there is a standard ratio of patients to staff.
Senator Harper stated the Committee would try and get back to that issue before the end of the meeting.
PRESENTATION BY STAFF AND DEPARTMENT OF HEALTH SERVICES OF THE NCI-447 REPORT ON 2/12/2007 (CONTINUED)
January Contreras, Policy Advisor, Health/Human Services, Office of Governor Janet Napolitano, answered questions posed by the Committee members.
Representative McComish asked Ms. Contreras to describe her duties as a policy advisor.
Ms. Contreras stated she works closely with the leadership of Arizona Health Care Cost Containment System (AHCCCS) and DHS and deals with the issues of Medicaid, insurance coverage, and public health. She also is responsible with being informed on national policies and making recommendations as to how to move forward in those areas.
Representative McComish asked Ms. Contreras when she began her current position.
Ms. Contreras stated she began in July of 2006.
Representative McComish asked if she has visited the Veterans’ Home and if so what her observations were.
Ms. Contreras stated she has not visited the Veterans’ Home.
Representative McComish stated on the same day that Director Gerard notified Ms. Contreras that the DHS inspection team called immediate jeopardy she e-mailed Jeanine L’Ecuyer stating “don’t think this is going to hit but you never know” (Attachment H). Representative McComish asked Ms. Contreras what she meant by this statement.
Ms. Contreras stated her primary concern was patient care at the Veterans’ Home and part of her job is to also make sure the appropriate person is aware of any incidents that might involve the media. This did qualify in that respect and she let Ms. L’Ecuyer know.
Representative McComish asked Ms. Contreras when she received the report that was discussed earlier and what light she can shed on this issue.
Ms. Contreras stated the log shows the report was delivered to the Governor’s office on March 13, 2007. She did not receive the report immediately but when she did receive it she read through it and found it was consistent with the prior reports from DHS regarding the most egregious situations were.
Representative McComish asked Ms. Contreras when she read the report that was delivered on March 13, 2007.
Ms. Contreras said she read the report on March 19, 2007.
Representative McComish asked Ms. Contreras if a hand delivered report would alert her that it was something more important than normal and something that the Governor should be alerted to.
Ms. Contreras stated the report was important and she did call DHS to request the report prior to March 13, 2007 but it did not come immediately. She does receive many hand delivered documents that are placed into the same area and that is obviously part of the problem. Ms. Contreras added the report was important for the purpose of looking at long term issues involved. The short term issues had been addressed by DHS. What she was looking for in the report was the corrective action plan and the report did not have that plan in order for her to assess the long term issues that needed to be addressed. She did know that all of the immediate issues were taken care of and the residents were in a safe environment and receiving the care that they needed.
Representative McComish asked Ms. Contreras if she provided the report to Ms. L’Ecuyer or Mr. Stephens.
Ms. Contreras stated she did not provide the report to Ms. L’Ecuyer but once she read through the report on March 19, 2007, and know the major problems had been identified and were being corrected, she discussed it with Mr. Stephens on that date.
Representative McComish asked Ms. Contreras what action she took concerning the long term plan, once she identified that the short term issues were being addressed.
Ms. Contreras said at that point she needed to see what the corrective action plan looked like and the specific steps that the Veterans’ Home was going to be taking.
Representative McComish asked Ms. Contreras what she did to obtain the corrective action plan.
Ms. Contreras stated this is what she discussed with Mr. Stephens on March 19, 2007 and spoke to Director Gerard later that week regarding the process of when the corrective action plan would be done.
Senator Linda Gray asked Ms. Contreras, after being notified that there were immediate jeopardy concerns for the Veterans’ Home, as a policy advisor to the Governor on health issues, why she did not see first hand what was going on.
Ms. Contreras said immediate jeopardy is a very specific term the Licensure staff uses and applied it at the time to a situation where more than one resident was allowed to smoke without the proper supervision. This was something that could be addressed immediately at the home because the proper staff was there.
Senator Linda Gray asked Ms. Contreras if she believed that there is still plenty of staff there to get everything done right.
Ms. Contreras stated the adequate staff that she was referring to is from the DHS Licensure staff and that they did have the team they needed to address the issues and she trusts their report.
Representative Stump stated he understands the designation immediate jeopardy is equivalent to immediate danger and there have been nine circumstances in the state this year. Representative Stump asked Ms. Contreras if her understanding of the definition is different.
Ms. Contreras stated she does not know the technical definition but it does sound similar. It is a situation where the DHS Licensure staff feels like they are going to be at the facility taking care of the residents until the problem is fixed. When she worked with AHCCCS she saw incidents where there was immediate jeopardy and residents were removed from the home and DHS Licensure staff will not leave until that takes place.
Representative Paton asked Ms. Contreras, in light of Ms. Witten’s testimony, if she thinks it would be a good idea to visit the Veterans’ Home and see what is going on for herself.
Ms. Contreras said the DHS Licensure staff has the expertise to make sure residents in every nursing home are receiving the care that they need and she felt very comfortable knowing what the observations were from the people who know best what needs to happen in a nursing home.
Representative Paton asked Ms. Contreras if she is saying that she does not plan on visiting the Veteran’s Home in light of some of the testimony that there are still some problems there.
Ms. Contreras said she has had conversations with Dr. Kirschner about his plans for moving forward and she does expect that a visit would happen at some point.
Representative Paton stated he hopes Ms. Contreras would take some of the comments from this Committee and report to the Governor to make sure they are being implemented and that there is not a lack of communication again between the Governor’s office, DHS, and the Veterans’ Home.
Ms. Contreras said Representative Paton’s comments are well taken and the Governor’s office is working to make sure communication errors are avoided.
Representative Nelson asked Ms. Contreras if there is an organization chart for the hospital and the Governor’s office that shows the lines of communication and the lines of authority.
Ms. Contreras stated that could be provided.
Representative Miranda stated he would be interested in obtaining the funding sources available at the facility and the legislation that went through last year.
Representative Nelson said some of that information is in the budget and if there is another source he will try to get that data.
Senator Harper stated he will try to get staff to put together a presentation for a future meeting.
Representative Tom asked Ms. Contreras if DHS staff would research the issue of a lack of air conditioning and heating in the residents’ rooms.
Ms. Contreras stated she will follow up with the Licensure staff regarding that request.
Jeanine L’Ecuyer, Deputy Chief of Staff, Communications, Office of Governor Janet Napolitano, answered questions posed by the Committee members.
Representative Stump asked Ms. L’Ecuyer, in light of e-mails she received from Director Gerard (Attachment H), what her definition is of a serious situation and if she still believes Director Gerard fully conveyed to her the seriousness of the situation.
Ms. L’Ecuyer said she does believe the seriousness was conveyed because the e-mail from Director Gerard in mid-February talked about immediate jeopardy and made clear that the immediate jeopardy had been abated.
Representative Stump asked Ms. L’Ecuyer what her initial response was to an e-mail she received from Michael Murphy that stated “Story is going to pop on azcentral in about 30 minutes” (Attachment H).
Ms. L’Ecuyer said she does not recall but does recall receiving the e-mail on March 23, 3007.
Representative Stump asked Ms. L’Ecuyer when she notified Mr. Stephens of the CMS letter regarding the $10,000 fine against the Veterans’ Home.
Ms. L’Ecuyer stated she notified her Chiefs of Staff on March 23, 2007, the same day she saw the letter.
Representative Stump stated in an e-mail exchange between Mr. Stephens and Mr. Murphy, Mr. Stephens said that he did not receive the letter (Attachment H).
Ms. L’Ecuyer stated she may not have given Mr. Stephens a copy of the letter but they were all surprised because no one was aware that a fine had been levied against the Veterans’ Home.
Representative Stump stated Ms. L’Ecuyer had mentioned the press discovering what was occurring at the Veterans’ Home was a concern.
Representative Stump asked why this was a concern but notifying the Governor was not.
Ms. L’Ecuyer said she was not concerned as much that the media would find out but that the story was appropriately handled.
Representative Stump asked Ms. L’Ecuyer if she has regular access to the Governor.
Ms. L’Ecuyer stated she does.
Representative Stump asked Ms. L’Ecuyer when she first discussed the crisis at the Veterans’ Home with the Governor.
Ms. L’Ecuyer stated she first spoke to her on the afternoon of March 23, 2007.
Representative McComish stated in a March 30, 2007 article, Ms. L’Ecuyer was quoted as saying the blame lies at the feet of Gerard. Representative McComish asked Ms. L’Ecuyer if she still agrees with that statement, if it is accurate.
Ms. L’Ecuyer stated she does not recall that quote and assignation of blame is a side issue and the important issue is the care of the veterans.
Representative McComish commented the care of the veterans is the most important issue but assignation of blame is sometimes necessary in order to build on the care for the veterans.
Representative McComish stated Ms. L’Ecuyer was also quoted as saying Director Gerard did not make the seriousness clear. Representative McComish asked Ms. L’Ecuyer if she still stands by the statement, if it is accurate.
Ms. L’Ecuyer said she does.
Representative McComish asked Ms. L’Ecuyer if it is true that she said she was looking into the reasons why the Governor was not notified earlier.
Ms. L’Ecuyer stated that is not accurate and what she said was Dr. Kirschner would look into that.
Representative McComish asked Ms. L’Ecuyer if one of the reasons the Governor was not notified earlier was because she did not have the information earlier.
Ms. L’Ecuyer stated by simple logic that is correct.
REQUESTS FOR ADDITIONAL INFORMATION RELATED TO THE ARIZONA VETERANS’ HOME
Senator Waring requested information regarding when the new veterans’ home in southern Arizona would be coming on line and funding information for the new home. Senator Waring also requested information regarding in-home care for veterans provided by the government.
Representative Miranda reiterated his request for an organizational chart, funding sources, and prior legislation affecting the home. Representative Miranda also requested information regarding turnover rates and if the availability of equipment is problematic.
Senator Harper stated at the end of the day the Committee is here for the veterans and to make sure they have the best care possible.
There being no further business, the meeting was adjourned at 4:30 p.m.
Respectfully submitted,
Bill Ritz
Committee Secretary
(Audio recordings and attachments on file in the Secretary of Senate’s Office/Resource Center, Room 115).
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Joint Select Committee to Investigate Operations and Conditions
at the Arizona Veterans’ Home
April 4, 2007
Page 10
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