Admin leave
Hospital CEO letter may conflict with nursing home rules
A May 2, Weston County Hospital District board meeting drew a sizable crowd to protest the decision of the new hospital CEO to place his second-in-command on administrative leave, and citizens’ concerns deepened after Chair Dottie Briggs, with COO Piper Allard’s permission, read to the public the letter CEO Randy Lindauer wrote to Allard, notifying her that he had decided to place her on administrative leave.
In the letter, Lindauer also requested Allard’s resignation but offered her a conditional severance package that would require her to allow the hospital to identify her as the facility’s nursing home administrator. However, it also prohibited her from having any contact with the employees she would be required to supervise under the conditions of her administrator’s license.
As a condition of Allard’s resignation, Briggs said, reading the letter, Lindauer is “prepared to offer” a severance package equivalent to six months of Allard’s current salary. During those six months, Allard “will not be required to come to the building,” but she “shall cooperate with the designee of my (Lindauer’s) choosing to create a smooth transition of duties and responsibilities” that are currently hers (Allard’s). The letter also directed that Allard will “continue as the licensed nursing at-home administrator and cooperate with the Manor to consult on an ad hoc basis to ensure compliance and continuity in our healthcare operations.” Allard was also supposed to complete non-disparagement and non-disclosure agreements, and restrict contact with nearly all hospital employees.
“Other than the provision of health care services to you and your family, all communications with Weston County Health Services will be directed through Karen Paul, our interim Chief Human Resources officer at her number and her email,” the letter also stated.
Rules governing health care facilities, however, indicate that some amount of contact and communication must take place between administrators and their staff members for the administrator to fulfill his or her duties.
Under Chapter 5 of the Board of Nursing Home Administrators’ rules, there are 32 duties that administrators must carry out. These duties include providing staff “with adequate information” to attain long-term and short-term goals to ensure that facility programs and resident care are maintained and improved, “demonstrating desired supervisory techniques and resident and family interaction” to “set an example of good resident relations and care for staff,” delegating responsibility and authority to staff to run the facility and coordinating department activities “to assure departments work together toward the achievement of goals and activities by developing an information and communication system.”
The rules also state that an administrator must “communicate with staff to solve problems by the utilization of the appropriate communication techniques such as staff meetings, department head meetings, counseling and coordination of written information” and “maintain a safe and productive working environment for staff in order to provide quality care through the use of regular inspections, allocation of resources for facility maintenance and construction and periodic evaluations of staff morale and productivity.”
The News Letter Journal asked Lindauer whether the hospital would comply with Wyoming and federal policies if Allard accepted the terms laid out in his letter to her, and he said in an email on May 13 that he is waiting to hear back “today” from the Nursing Home Administrators Licensing Board, which he said was called “over a week ago.”
“If they had a problem, I am sure they would have called or shown up,” he said.
Emily Cronbaugh, the executive director of Wyoming’s Department of Administration and Information’s Professional Licensing Boards, told the News Letter Journal they first heard from Lindauer on May 13 and did not indicate the agency had been contacted by anybody else regarding the situation at WCHS prior to the communication from Lindauer on May 13.
Regulations 101
Under Wyoming Statute 33-22-108(a)(vi), the Board of Nursing Home Administrators must “receive, investigate, and take appropriate action with respect to, any charge or complaint filed with the board to the effect that any individual licensed as a nursing home administrator has failed to comply with the requirements of such standards,” Cronbaugh told the News Letter Journal in an email on May 10.
According to the Board of Nursing Home Administrators’ online roster, which was last updated on April 15, Allard’s license, which was issued on Nov. 1, 2023, is active and expires on Dec. 31, 2024. The record also indicates that there has been no disciplinary action.
“To date, no such charge or complaint has been filed with the Board regarding the license of Ms. Allard,” Cronbaugh said in her email, which also noted that her department licenses individuals, not facilities.
Kim Deti, a Wyoming Department of Health public information officer, said in an email on May 9 that the department will not directly discuss a facility personnel issue. However, she directed the News Letter Journal to specific sections of rules that govern nursing homes.
According to federal regulations published in the State Operations Manual Appendix PP – Guidance to surveyors for Long Term Care Facilities, a facility has to be administered “in a manner that enables it to use its resources effectively and efficiently to attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident.” Those resources include staff.
The facility must have a governing body that is legally responsible for establishing and implementing policies for management and operation of the facility, the regulations state. The governing body must appoint an administrator who is licensed by the state, “responsible for management of the facility” and “reports to and is accountable to the governing body”; and the facility has to decide how often and by what means the administrator reports to the governing body, what types of problems and information are reported to the governing body, how the administrator reports information regarding the facility’s management and operation, and how the administrator and the governing body are involved in the facility wide assessment, which analyzes what resources are needed to care for residents.
According to the Wyoming Department of Health rules and regulations, a nursing home administrator has a license from the Wyoming Board of Nursing Home Administrators and “operates, manages, supervises, or is in charge of” a nursing care facility. The nursing care facility’s governing body, which is the “individual(s), group, or corporation that has the ultimate authority and responsibility” for resident care and personnel policies, “shall appoint” a “full-time, on premise, administrator qualified by education, training and experience as established by the Wyoming Board of Nursing Home Administrators.”
The administrator “shall enforce the rules and regulations relative to the level of health care and safety of residents and for the protection of their personal and property rights” and “plan, organize, and direct” those responsibilities that the governing body delegates to them. An employee of the facility “shall be authorized in writing to act on the administrator’s behalf during his/her absence.”
The governing body, “through the Nursing Home Administrator, shall be responsible for implementing and maintaining written personnel policies and procedures that support sound resident care and personnel practices.” That includes annual evaluations of employees.
Also, the administrator “or his/her designated representative” must provide “all pertinent information” regarding diseases or conditions.
The facility’s director of nursing services must bring to the administrator any patient care problems that require changes in policy, staffing changes. The administrator has to be on a pharmaceutical services committee, which meets quarterly and develops policy and procedures for drug therapy and use.
In response to emailed questions from the NLJ, Lindauer defended the terms he offered to Allard and said it is not unusual to utilize the license of an individual who has been placed on leave.
“It is (common practice) when you put someone on Administrative Leave in her capacity as the one carrying the license,” he said.
The terms laid out in his letter to Allard required her to resign her position, however, so they would be applied after she was no longer on administrative leave. It does appear that the state licensing agency may grant a temporary administrator license for up to six months, but those conditions also don’t seem to apply to the current situation at WCHS.
The Wyoming Board of Nursing Home Administrators may, after considering the matter “on an individual basis,” grant a temporary license for up to six months to an individual who does not meet all the licensing requirements “but who is of good character” and meets the educational requirements, if the administrator’s position “unexpectedly becomes vacant.” That temporary license can be renewed once.
For licensure of a nursing care facility, Wyoming’s Department of Health’s Office of Health Quality considers any initial and annual renewal licensure survey deficiencies or life safety code deficiencies, compliance with laws and standards regarding communicable and reportable diseases that the Department of Health requires, complaint investigations and resolutions, and “the effectiveness of the quality management program,” which is a program that the nursing care facility develops and implements to evaluate and improve resident care and services.
Attempts to reach other officials
Wyoming Attorney General Bridget Hill said in an email on May 9 that she could not answer the News Letter Journal’s questions because the questions require legal analysis and the attorney general’s office only represents the agencies of state and state elected officials, under state statute.
David Johnson, the deputy assistant secretary for health at the U.S. Department of Health and Human Services’ Office of the Assistant Secretary for Health’s Office of Regional Health Operations, said in an email on May 9 that he was not able to comment.
“This appears to be a decision made by those associated with this facility/organization, and would recommend reaching out to them or others that may have more direct insight on this matter or in this subject area,” Johnson said in his email.
Allard said in a Facebook message on May 13 that she is still on administrative leave and unable to comment.