Kern County Grand Jury • 2023-2024

Report: North Kern South Tulare Hospital District

Published: April 02, 2024 40 pages
Ver PDF original

Findings and Recommendations 19 findings

F1
The District has a website with public information about the operations and services that the District provides. Unfortunately, it is not well maintained with up-to-date information and does not meet all the requirements of Cal Health and Safety Code §32139. Additionally, contact information is not available for each Board Member. The website fails to provide transparency to the public. Furthermore, the Grand Jury was denied access to contact information of Board Members, causing a delay in this investigation.
Related Recommendations (2)
R9
The Grand Jury recommends that the North Kern South Tulare Hospital District should: Develop and publish on the District’s website, and in binder form for each Board Member to use as a reference, a complete set of the Board Policies and Procedures Handbook. This should include procedures to approve contracts, monthly stipends for Board members, approved users of credit cards, timing for ethics and Brown Act Training, duties and responsibilities of Board Members, and for contracts requiring an RFP. This should be completed by June 1, 2024. (Findings 1, 2 and 3)
R11
The Grand Jury recommends that the North Kern South Tulare Hospital District should: Update and maintain the District’s website at least monthly to meet all the requirements of CA Health and Safety Code §32139, and include biographies, photos, and contact information of Board Members and administrative staff, allowing for better public access to the District and increasing transparency. This should be in place by June 1, 2024. (Findings 1 and 8)
F2
The Board delegates the routine operations of the District to the CEO. As per the District’s Bylaws, Board Members shall refrain from interfering in the day-to-day operations; however, they are responsible for implementing policies, retaining legal counsel, and making financial decisions in the best interest of the District. Members of the Board may approve contracts after discussion at public board meetings. Members of the Board or the Board President have no authority to sign contracts and agreements without approval of the Board, at an open board meeting, with public input. However, the Board President, without Board approval and public input, signed many contracts and agreements (Engagement Letters).
Related Recommendations (2)
R7
The Grand Jury recommends that the North Kern South Tulare Hospital District should: By June 1, 2024, place all future contracts over $25,000 on the Board’s agenda to be discussed and approved by the Board before being signed and implemented by the Board President and/or CEO. This allows the public to have input in actions of the Board. (Findings 2, 9, 10 and 17)
R12
The Grand Jury recommends that the North Kern South Tulare Hospital District should: Refocus and redirect goals toward patient care and staff morale. Excessive administrative staff turnover takes focus away from patient care. This should begin by June 1, 2024. (Findings 2 and 3)
F3
The Bylaws do not indicate the date of ratification nor the date of last revision. The Bylaws need to be reviewed and updated to reflect the current operation of the District, including the duties assigned to the officers and to the District administration with the use of an organizational chart. Discussions of updating the Bylaws have taken place at board meetings, with no action. As per Article XV, The Board of Directors will review these Bylaws at least biennially and alter them to conform to changes in the law and the standards of the Joint Commission on Accreditation of Healthcare Organization. Not having an organizational chart and defined roles and responsibilities for the administrative staff indicates a lack of public transparency and fails to provide structure for daily operations.
No recommendations for this finding
F4
Three newly appointed Board Members apparently communicated via phone and text messages in a wheel hub meeting and/or a serial meeting (see glossary) prior to the first day of service at the December 12, 2022 District Board Meeting. The minutes of that meeting do not reflect a swearing of the oath of office for the three new Board Members. Each new member took the oath of office with a notary public at different times, days earlier or days and months later. This would be a violation of the California Constitution, Government Code, and The Brown Act.
Related Recommendations (3)
R2
The Grand Jury recommends that the North Kern South Tulare Hospital District should: By June 1, 2024, the District should re-seat the Board Member who was removed in December 2022. (Findings 4 and 16)
R3
The Grand Jury recommends that the North Kern South Tulare Hospital District should: Seek a decision from the California Superior Court or an opinion of the California State Attorney General’s Office, not the opinion of a hired law firm, on the legal grounds to seat and/or remove Board Members. The process should be initiated by June 1, 2024. (Findings 4 and 16)
R5
The Grand Jury recommends that the North Kern South Tulare Hospital District should: Publish by June 1, 2024, the Code of Ethics Policy for Board Members that had been discussed at previous board meetings. (Findings 4, 5, 6 and 7)
F5
Reportedly, the Board President continued to text and/or call other Board Members prior to District Board Meetings to get the members’ positions and/or discussion of District business. Such conversations would be a Brown Act violation.
No recommendations for this finding
F6
Records of the Board Members completing the required FPPC and The Brown Act trainings were not made available to the Grand Jury or to the public, showing a lack of transparency and dedication to the duties of a Board Member. (See Appendix D)
No recommendations for this finding
F7
As per the retainer agreement, dated December 14, 2022, with the newly hired legal counsel, Commencing December 14, 2022, the firm will provide advice to [Named Board Member] and will handle any other matter and provide any advice as requested by the District. This appears to give personal legal counsel to the Named Board Member with the invoices paid by the Districts’ public funds. This gives the impression that the new legal counsel firm is engaged, first and foremost, to represent the Named Board Member, and then the District.
No recommendations for this finding
F8
In accordance with the District’s Bylaws, regular meetings shall be held on the fourth Thursday of each month. However, the District’s website indicates that for calendar year 2021, the Board held 28 meetings, of which 16 were special meetings. The website has also recorded 17 meetings (12 regular and 5 special) for the 2022 calendar year. In 2023, the District held at least 19 meetings (11 regular and 8 special). The question is, why so many back-to-back special meetings? Apparently, there was a lack of planning for the monthly agendas that led to using special meetings to handle the District’s business. Public transparency may be in question as to the justification for having so many meetings. Is the public being properly informed of the District's business before action is taken?
No recommendations for this finding
F9
The District’s meeting agenda and minutes for the meeting of July 12, 2023, indicated that the Board adjourned into closed session. Nevertheless, the report on actions taken from the closed session, as required by The Brown Act, to engage with (Accounting and Business Consulting Firm) for up to $178,000, was not on the agenda. There was no public information, RFP, or retainer letter provided for inspection prior to the consideration of this item. This item does not meet the requirements for a closed session according to The Brown Act. Such actions of the Board may have also violated Health and Safety Code, Division 23, Chapter 2, Article 2, Section 32138, and lacks public transparency.
Related Recommendations (1)
R4
The Grand Jury recommends that the North Kern South Tulare Hospital District should: Use the RFP with a “competitive means” process to award contracts for goods and services over $25,000, and seek public input before awarding contracts. This process needs to be included in the District’s procedures before June 1, 2024. (Findings 9 and 10)
F10
The Board President signed several contracts with vendors and expanded the scope of existing contracts without board approval or public comments. The public has the right to know before action is taken with vendor contracts that are over $25,000 and to review the purpose of such contracts.
No recommendations for this finding
F11
As per the District’s Bylaws, ARTICLE 1, SCOPE AND PURPOSE, Section 3. Purposes: (c.) To conduct educational and research activities essential to the attainment of its purpose. This District has done a great job of meeting this purpose by offering Certified Nursing Assistant Classes open to the public to help fill staffing shortages. (See Appendix B)
No recommendations for this finding
F12
The use of seven credit cards by employees leads to excessive spending; the monthly balance as of September 28, 2023, was $259,462.65. The use of paying routine expenses by credit card does not have the needed checks and balances with justifications for each expense. Not knowing the purpose of each charge leaves the public questioning how their funds are being used.
Related Recommendations (2)
R8
The Grand Jury recommends that the North Kern South Tulare Hospital District should: Curtail and re-evaluate the excessive use of credit cards. The lack of accountability of seven cards and the risk of misuse may outweigh the benefit of the card usage. The use of purchase orders has the advantage of tracking the monthly spending and allows for prior approval before spending. This should be incorporated into next year’s budget and spending procedures by July 1, 2024. (Finding 12)
R14
The Grand Jury recommends that the North Kern South Tulare Hospital District should: Re-evaluate and streamline the use of outside vendor contracts to a single contract per vendor including a defined description, scope of expected outcomes, and with a definite timeframe of completion. This should be completed by June 1, 2024. (Findings 12 and 17) NOTES: • The North Kern South Tulare Hospital District should post a copy of this report where it will be available for public review. • Persons wishing to receive an email notification of newly released reports may sign up at: www.kerncounty.com/government/other-agencies/grand-jury • Present and past Kern County Grand Jury Final Reports and Responses can be accessed on the Kern County Grand Jury website: www.kerncounty.com/government/other- agencies/grand-jury RESPONSE DEADLINE: • REQUIRED WITHIN 90 DAYS FROM: North Kern South Tulare Hospital District Board of Directors to 1 to 19 o
F13
The Grand Jury attended District Regular Board Meetings in person and via Zoom, with the following observations: meetings started on time with a quorum of the Board, staff members, and the public present. Legal counsel was live via Zoom to offer advice during the meetings and tracking the motions. Complete board meeting agendas and packets were available for the public. The meetings were conducted in an orderly manner with some discussions from Board Members and staff. The Grand Jury did not observe a sign showing that there was a meeting taking place on the front door of the building or outside of the meeting room door, as required. Two Board Members and staff members had their backs to the public, making it difficult to hear when they were speaking. The large TV monitor was not fully visible to the entire public, giving the impression that it is not important to attend meetings and participate in the District’s business. The CEO used the meetings to explain some of the plans he thinks would benefit the District and to meet the healthcare needs of the community. There was also discussion about hiring an additional law firm, developing an organizational chart, and creating guidelines for the CEO duties.
Related Recommendations (2)
R6
The Grand Jury recommends that the North Kern South Tulare Hospital District should: Re-arrange the board meeting room so that all Board Members can address the public directly (facing the public) and be heard by the public. The use of a public address system would be beneficial. Consider re-locating the TV monitor for better visibility for all that attend the meeting. This would be more welcoming for the public to attend. This should be in place by June 1, 2024. (Finding 13)
R13
The Grand Jury recommends that the North Kern South Tulare Hospital District should: Invite medical staff from both facilities to report to the Board and public at regular monthly meetings or on a regular basis, to discuss patient care, patient satisfaction, Centers for Medicare and Medicaid Services (CMS) complaints, and employee morale. This item should be placed on the June 2024 Board Meeting Agenda. (Finding 13)
F14
During a fact-finding visit to the District and its facilities, the Grand Jury noticed an empty lot belonging to the District that is not being utilized nor properly maintained. (See Appendix E). This is ideal for future growth.
No recommendations for this finding
F15
The Grand Jury observed and verified through interviews and videos of board meetings that the current HVAC system for the DDSNF needs repair and/or replacement. The use of portable fans and coolers creates a health and safety concern for the patients, staff, and visitors.
Related Recommendations (1)
R10
The Grand Jury recommends that the North Kern South Tulare Hospital District should: Dedicate funding for the replacement or upgrading of the HVAC system in the DDSNF. Eliminating the use of portable fans and cooling systems in summer months will mitigate the risk of a safety hazard and improve patient care. This should be included in the next budget by July 1, 2024. (Finding 15)
F16
The Grand Jury could not verify through Board meeting minutes and/or videos of meetings, or from the Kern County Elections Office, that all current Board Members took and subscribed to the Oath or Affirmation of Office before performing the duties of a Board Member. This lack of documentation questions the authority of the Board to act and violates California Government Code.
No recommendations for this finding
F17
The District has been spending in excess of $340,000 with (Accounting and Business Consulting Firm) without defined expectations, outcomes, and end dates. This has the potential to lead to out-of-control spending and being locked into future expenses.
No recommendations for this finding
F18
The Board did not follow District Bylaws by holding the yearly officer election at the December 2023 Board Meeting. This gives the impression that officers are elected for the duration of their tenure.
No recommendations for this finding
F19
The funds being spent on legal fees are not being properly monitored. COMMENTS: The Grand Jury appreciates the input provided by all witnesses and the cooperation of the administrative staff in preparing this report. The District is serving the community and fulfilling the health needs of its residents. The amount of public funds being spent on professional fees and services is out of control for a district this size. Approximately one sixteenth (1/16) of the total budget is for such fees. In addition, the contracts for the out-sourcing for account reconciliation and audit are not clear-cut. The amount of public funds being spent for this purpose is astronomical. Having memberships with both the Association of California Healthcare Districts (ACHD) and the California Special Districts Association (CSDA) will be helpful in updating District Bylaws and Board Policies, and for the completion of the FPPC requirements. The lack of transparency and unwillingness to provide District public documents to the Grand Jury, based on the advice of legal counsel, made completing this report more difficult than necessary. The Grand Jury used the subpoena process to request the District Bylaws and District Policies and Operating Procedures. The District produced two sets of bylaws, and the Grand Jury made the assumption that the longer version with 15 articles and duties for the CEO is the most recent. The Grand Jury received the Policies and Operating Procedures via email. These policies and procedures appear to be a generic, incomplete version taken from a consultant website. They were last updated as far back as 2004 and contain no signatures of acknowledgement of receipt from any District employee. These policies and procedures were not generated specifically for the North Kern South Tulare Hospital District. Not being provided with adopted District Board policies and procedures made it difficult to assess the effectiveness of the Board in meeting their goals. Board Members have no set duties and do not fully understand their roles and responsibilities. It is time for the Board of Directors to know that the people have entrusted them with overseeing the District’s best interests. Instead of blaming previous Board and/or administrative staff for lapses, they shall act as the District’s present governing body, guiding the District’s long-term goals and policies, and assisting with strategic planning and decision-making. The day-to-day operations of the DDSNF and GNC should be left with the management and administrative staff. More focus should be on patient safety, quality of care, treatment, and services provided District wide. Stop the BLAME GAME! The Board Members must curtail the excessive spending and provide the oversight functions needed to direct the District into the future!
Related Recommendations (1)
R1
The Grand Jury recommends that the North Kern South Tulare Hospital District should: Establish protocols regarding the use of General Counsel and any outside counsel. This is to be completed before July 1, 2024. (Finding 19)

Comments 13