RBC | After a Feb. 9 meeting brought forth commissioners’ issues with the public health department, the HT requested public records from Rio Blanco County in an attempt to verify “major concerns” regarding the relationship between the department and the county’s two hospitals.
While other complaints weren’t specific, commissioners and the county attorney all expressed direct opinions on the hospital matter.
“I think we oughta be a supporting role for our hospitals, and we shouldn’t be mandating policies … I’m not sure that’s exactly how they feel right now,” Commissioner Jeff Rector stated.
Commissioner Gary Moyer said, “I feel we’ve been misled as to what the relationship has been with these other partners,” and Commissioner Ty Gates stated, “There’s been instances that the administration feels was overreaching maybe, or could be taken as throwing them under the bus.”
County Attorney Todd Starr told Harvey, “You don’t have a good read of your relationship with either hospital,” noting that “hospital administrators expressed grave concern about their relationship with public health,” the week prior to the meeting.
Public Health Director Alice Harvey responded she was unaware of any concerns, and that nothing had been brought directly to her department.
The HT submitted a Colorado Open Records Act request Feb. 12, and received a total of 30 text messages and seven emails 10 days later, Feb. 22. The HT was charged $385, equivalent to 11 hours of county employee time.21-02-22RespoonsiveDocuments
As some of the records related to outbreaks, we are including this information for reference. COVID outbreaks reported at healthcare facilities during November and December 2020 included the following, according to public reports from the CDPHE:
- Walbridge Wing outbreak reported Nov. 20, resolved Dec. 18; nine staff positive, eight residents positive, one confirmed resident death.
- Rangely District Hospital (RDH) outbreak reported Nov. 30, active, 25 staff positive.
- Pioneers Medical Center (PMC) outbreak reported Dec. 9, active, 27 staff positive, one attendee positive.
The CDPHE completed a survey on only one of those entities – PMC – after receiving an anonymous complaint. The HT contacted the CDPHE for further information and was told complaint specifics are not available for public review.
The survey was completed Dec. 16 and found five deficiencies at PMC.
“Due to the nature of the survey findings,” the report reads, “an Immediate Jeopardy was declared on 12/9/20 at 4:35 p.m. The facility failed to ensure healthcare personnel (HCP) who were symptomatic for COVID-19 were excluded from work … document review and interviews revealed multiple instances in which HCP who reported symptoms consistent with COVID-19 or a positive test result for COVID-19 were allowed to work and potentially spread a highly contagious infectious disease.”
CDPHE’s Records Manager Michael Lastoczy provided the full survey report to the HT, and clarified the “immediate jeopardy” designation.
“It means their actions were putting a resident’s life at risk,” he said.
Additionally, the survey put the facility out of compliance with the Centers for Medicare and Medicaid Services condition of participation for Infection Prevention and Control and Antibiotic Stewardship Programs.
The facility was directed to devise a plan to address the situation, and after the plan was submitted by PMC, immediate jeopardy was removed Dec. 11 at 9:51 a.m. “However, deficient practice with condition level findings remained.”
Other deficiencies cited in the report included:
- “The facility failed to employ methods to prevent and control the transmission of COVID-19 … specifically the facility did not ensure healthcare personnel who were symptomatic or positive for COVID-19 were excluded from work.” Interviews in the report reference numerous employees, including patient financial services technicians, directors, the facility compliance officer, an employee health specialist, the Chief Nursing Officer and the CEO.
- The hospital was cited for failing to report the outbreak to public health in accordance with their own facility policy “in order to establish a plan to manage and investigate the potential outbreak.”
Between Nov. 1 and Dec. 3, 24 healthcare providers (HCP) tested positive, and one was designated a probable case. Nine of those people worked in the Wing, but because some staff was “flexed” between facilities, “this created the potential for facility HCP to be exposed to COVID-19 positive HCP in the long-term care facility.” See below for correlating correspondence from our CORA request.
- The hospital’s screening process was also cited. “Based on document review and interviews, the facility failed to ensure a process was in place to screen all healthcare personnel for symptoms of COVID-19.”
- Finally, the facility “failed to ensure staff responsible to oversee the health of healthcare personnel (HCP) at the facility were educated on public health guidance and facility processes … to prevent the transmission of COVID-19. The failure created the potential for the spread of COVID-19 at the facility.”
PMC’s plans of correction for each citation are included in the full report, with an alleged compliance date of Jan. 11. The plans were approved Jan. 20 and were signed by Chief Nursing Officer Karen Iacuone. The full CDPHE report is available at https://www.theheraldtimes.com/ht-receives-public-records-from-county/rio-blanco-county/.
PUBLIC RECORDS: OUTBREAK REPORTING
The first chronological public record we received from our open records request is a Nov. 18 email from PMC’s Rachel Gates to county commissioners which states, “Liz Sellers would love to have a cup of coffee and visit about concerns that were shared.” The following day, Moyer responded he would be there. PMC told the HT this meeting did not take place.
On Nov. 20, the COVID-19 outbreak at the Walbridge Wing was reported to the CDPHE.
Next, the HT received an email exchange between Public Health Director Harvey and CDPHE Epidemiologist Brianna Merritt.The exchange occurred Nov. 25, five days after the Walbridge Wing outbreak was first reported, and five days prior to the RDH outbreak being reported.
Harvey asked about publishing the outbreaks on the county website after public requests for the information. “Our priority is of course working with the businesses/organizations themselves and then reporting to you, but is this something you think we should consider?”
Merritt responded that the matter was up to the county’s discretion. “It may open some transparency, but also not completely necessary.” The county ultimately did not publish outbreak information on their website, but was required to continue to report outbreaks to the CDPHE, where the information is available to the public on the CDPHE website.
On Dec. 2, Harvey emailed Merritt again, to ask if releasing any outbreak information publicly could involve a HIPAA violation, as she had been told by County Attorney Todd Starr.
Merritt’s response: “All outbreaks are required to be reported to CDPHE and go to the public facing (CDPHE) website, this is not a HIPAA violation. Your attorney can reach out to the CDPHE attorney if they have more questions or concerns.” Harvey then forwarded the info to the county commissioners, the county attorney and county employee Vicky Edwards.
On Dec. 4, an email exchange took place between Starr and all three county commissioners with the title “Bad contact with A. Harvey.” This email was excluded from the CORA based on “attorney-client privilege.”
Five days later, a hospital infection preventionist and the public health department both emailed the state “to inquire if there was a requirement for the facility to report clusters of respiratory illness or positive COVID-19 tests as outbreaks,” according to the CDPHE report. The state responded the same day confirming providers were to report known or suspected outbreaks.
PUBLIC RECORDS: TEXT MESSAGES
Text message threads received in response to our request occurred between Jan. 18 and Feb. 9. Due to the way the messages were cropped, it is difficult to determine who is doing the texting, but extrapolating from the content, some conversations about public health likely went on between commissioners outside of the public eye.
You can view all of the documents we received at https://www.theheraldtimes.com/ht-receives-public-records-from-county/rio-blanco-county/.
One thread references a Jan. 26 executive session that took place with both PMC CEO Liz Sellers and RDH CEO Kyle Wren. The executive session was called “for the purpose of receiving legal advice on specific legal questions,” according to the agenda.
On Jan. 27, an unidentified commissioner asked Commissioner Rector if he had emailed the “PH statute to the hospitals.” We were unable to determine which public health statute this is in reference to.
On the following day, one commissioner texted Rector again. “Hey bud, need to visit with you about public health.”
An email on that same day, Jan. 28, was also excluded from our CORA due to “attorney-client privilege.” The email was sent from Starr and Edwards to the commissioners with the title “Re: Qualifications Statute Public Health.”
On Feb. 4, Starr sent an email to Sellers, Wren and Moyer. “The BoCC has asked that I reach out to you again communicating the Board’s displeasure at the way the County has allowed the relationship with each of your entities to deteriorate and to reaffirm the county’s commitment to get this set right.”
Starr then states that though he understands the hospitals could not assist in “taking over the Public Health functions on an interim basis,” they could perhaps take over testing and vaccination functions. “I believe we have a stable of volunteers that we could provide to assist with this function,” the email reads.
“Finally, I wish to confirm that if the BoCC goes public with its concerns about the Public Health Department we could state in public that one of the reasons for the Commissioner’s displeasure with county staff is the poor relationship with the hospitals.”
FEB. 9 MEETING
On Feb. 9, the commissioners scheduled an executive session with public health “for the purpose of receiving legal advice on specific legal questions and determining positions that may be subject to negotiations: developing strategy for negotiations: and instructing negotiators.” Harvey and other public health employees asked the meeting be kept public due to the personnel issues to be discussed. You can find our report on that meeting at https://www.theheraldtimes.com/county-beat-board-addresses-friction/rio-blanco-county/.
HOSPITAL BOARD INVOLVEMENT
On Tuesday, the HT attempted to ask PMC board members some questions about the situation during their regular meeting, but audio trouble prevented a direct conversation. Instead, the HT emailed questions to each board member and received the following response from PMC’s Rachel Gates:
Q: Did any board members attend a Nov. 2020 meeting between the CEO and one or more county commissioners to discuss “concerns”?
Q: For Ms. Sellers, specifically: did the November “coffee date” referenced in county emails take place?
Q: Did any board members attend a 5 p.m. Jan. 26 meeting between hospital CEOs and the county commissioners? I believe this was listed as an exec session “to discuss legal matters.”
Q: Did the board as an entity have any other communication with the commissioners or county attorney Todd Starr during the months of Nov., Dec., or Jan.?
Q: Has the hospital board discussed or expressed “grave concerns about public health” during a public meeting in the last three months? What were those concerns regarding?
Q: Were there concerns expressed by or to the board related to any of the following: public health outbreak reporting, HIPAA violations, Dec. complaint filed against PMC and the subsequent survey that put the facility in immediate jeopardy, or something else?
Q: Did the board approve the following messaging from County Attorney Todd Starr emailed to hospital CEOs Feb. 4, “I wish to confirm that if the BoCC goes public with its concerns about the Public Health Department we could state in pubic (sic) that one of the reasons for the Commissioners’ displeasure with county staff is the poor relationship with the hospitals.”
Q: Is the board aware of/does the board support County Attorney Starr’s Feb. 4 query to have the hospital take over the testing and vaccination functions of public health?
We will review past board minutes to confirm.
The HT also submitted questions to RDH CEO Kyle Wren, but did not receive a response by press time.
By HT STAFF – firstname.lastname@example.org