Note: This is an HTML'IZED version of a copy of the report by the Fedilis Group Inc. on the "Ghost Employee" scandal at the department. The firm was hired in May 2000 by Jerry Regier, Acting Director of the Oklahoma State Department of Health. The report was made public on 9/21/00.

In conducting a management analysis of the Oklahoma State Department of Health, (Health Department), voluminous Health Department records were reviewed and numerous interviews were conducted with management and staff personnel. The information received during the course of these interviews includes personal observations, admissions against interest, relevant employee and management statements and employee perceptions of management in their assigned work area.

There were also allegations made, by the interviewed employees, concerning mismanagement and misfeasance in which the basis of knowledge can be generally characterized as gossip. Information of this type is not included unless there is a separate basis for corroboration and belief. In further selecting information to be included in this report the management review team weighed its operational significance, its impact on Health Department personnel and services, and the need for current management to take corrective measures.

The information presented is based upon interviews with employees, a review of agency documents and public source information.

This report supercedes and replaces the previous preliminary report prepared for Secretary Regier. The previous preliminary report should not be relied upon for the information contained therein as this report contains additional clarifying and corroborative material. This document sets forth a summary of information developed from May 9, 2000, to August 15, 2000.

The following is a report, which sets forth identified ongoing issues that are being addressed by Health and Human Services Secretary Jerry Regier (Secretary Regier), who is currently serving as the Acting Director of the Oklahoma State Department of Health (Health Department).

Based upon the management review team’s interview of Health Department management and staff employees, a review of Health Department payroll and personnel records, and other analyses conducted, it was apparent that problems, which have been ongoing for years within the Health Department, but which only recently came to light, were directly attributable to the previous management of this agency. During the past several years, upper management practices fostered an environment tolerant of ineffective and inefficient performance by both management and staff employees in addressing the mission and objectives of the Health Department. Certain Health Department managers, identified later in this report, allowed the agency to be corrupted in its mission to provide reliable, quality inspections of long term-care nursing facilities. Their practices allowed favored employees to receive full pay for less than full-time effort and other employees to be hired and retained in positions that appear to be unnecessary, unneeded and created to curry favor. The sum total of these actions by top management officials created a "Culture of Intimidation" for staff throughout the Health Department.

The primary issue identified to date derives from and reflects endemic management and employee irregularities which are the direct result of a corruption of the relationship between special health services providers and individuals charged with the responsibility of ensuring the health and safety of the senior citizens of Oklahoma. This problem came to light publicly on May 2, 2000, with the arrest of then Acting Commissioner Brent VanMeter and nursing home operator Jim Smart on Federal Bribery charges. Since that event and the appointment of Secretary Regier, employees of the Health Department have provided information, which reveals how upper management corruptly manipulated and controlled the Health Department to serve personal agendas and that of friends and associates. As demonstrated in this report, the efforts of personnel assigned to survey nursing homes and respond to individual complaints were thwarted.

Another issue identified, which does not directly impact the health and safety of individuals, but is a major affront to the tax paying citizens of Oklahoma is the previous practice at the Health Department of persons being on the payroll without any apparent duties. Upper management at the Health Department was fully aware of the practice and made no effort to end the abuse. In certain instances upper management actually helped in the preparation and approval of time and effort (time sheets) of these non-performing employees. These employees received yearly salaries of approximately $20,000 -$50,000 for periods of up to fifteen (15) years. Specific examples of this practice are set forth in this report. Secretary Regier continues to direct efforts at uncovering and ending any ongoing abuses of this nature. The Secretary has implemented policy directives to prevent this practice in the future and also improve payroll, time and attendance accountability. Mr. Regier has also forwarded information to appropriate investigative agencies and sent the Oklahoma Public Employees Retirement System corrected certified time and attendance records which may impact future annuity payments for certain employees.

Health Department employees, the majority of whom are dedicated and hardworking, advised they had to perform their responsibilities in an untenable work atmosphere. These employees were justifiably embarrassed by the difficulties brought upon this agency by management failings. Because of their lack of trust and confidence in the previous upper management team and a fear of possible retribution, they did not report their observations and suspicions of corruption and wrongdoing. Even in this early period of new management, which now includes the oversight of a fully informed Board of Health, it is apparent that employee trust is being renewed. In establishing a new direction and mission at the Health Department, management will have the resources of the vast majority of employees who are dedicated individuals that continue to serve the Health Department and the public during this transitional period of time.

On May 2, 2000, a federal complaint was filed and an arrest warrant was issued charging Brent VanMeter, Deputy Commissioner of the Health Department, with receiving a bribe from James Robert Smart, an operator of long term care facilities in Oklahoma.

Also on that date Oklahoma State Governor Frank Keating appointed Jerry Regier, Secretary of Health and Human Services, as the Acting Director of the Oklahoma Department of Health. The Oklahoma Board of Health called an emergency meeting and confirmed the Governor’s appointment. Subsequent to his appointment and confirmation by the Oklahoma Board of Health, Secretary Regier implemented several management initiatives in order to institute an effective management team at the Health Department. The initiatives included the following actions:

• The suspension and subsequent firing of Deputy Commissioner Brent VanMeter.

• The suspension and subsequent firing of:

Barbara Alstatt, Secretary to Deputy Commissioner Brent VanMeter

Evelyn Battle, Chief, Long Term Care

Judith Cochran, Process Review Coordinator

Karen Verner, Coordinator

Linda Lopez, Health Resource Development Service

Linda Wilkerson, RN, and Director of Surveys

• The suspension of two classified employees:

Jerry Taylor, Director of Certification and Enforcement, who was reinstated.

Leslie Henkuzens, South Coordinator, who subsequently retired.

• Ordered a scrambling of the schedule for annual surveys of nursing homes.

• Met with different staff groups to provide direction, build morale and seek feedback:

Executive Staff

Senior Staff

Surveyors

All Headquarters Staff

County Health Administrators

• Released Board sub-committee investigative report, which had been completed on May 2, prior to the public eruption of the scandal.

• Hired management consultants from the Fidelis Group to reinterview management and staff employees and report findings of mismanagement and proposed corrective actions.

• Ordered posting of Complaint Hotline at Long Term Care Nursing Homes.

• Ordered a review of the complaint backlog and implemented a process to address these complaints. Initiated the computerization of the complaint process, which had previously consisted of a paper log-in system.

• Established the Integrity Task Force to investigate complaints on the backlog list, which resulted in 100% of the backlog reviewed and addressed.

• Assigned temporary managers to four nursing homes and removed the Jiles management team as a service provider.

• Assigned a temporary manager to the Sayre nursing home, who subsequently closed this facility.

• Instituted a personnel policy review with regard to the following:

Hiring practices involving family relations (nepotism).

• Instructed the legal department to establish a protocol for honoring and responding to the Federal Grand Jury subpoena.

• Requested a report from all Deputy Commissioners and Division Chiefs to identify specifics relating to staff on the agency payroll to include professional and consulting contracts.

• On May 5, 2000, requested the Oklahoma State Auditors Office conduct an expanded audit (copies of document(s) sent to Board of Health members).

• Requested Oklahoma Department of Central Services to provide technical assistance to the Procurement Unit in order to determine what, if any, deficiencies exist in procurement processes.

• Reassigned staff to LTC unit (replacing suspended employees).

• Established a close working relationship with HCFA (2 staff on-site for a period of time).

• Ordered an end to the practice of issuing free birth and death certificates to legislators.

• Sent a memorandum to all OSDH staff to build morale and maintain productivity.

• Established a process to log in and then investigate all information being received (calls and letters) from private citizens and OSDH staff that pertained to the overall problems within the agency.

• Established a partnership with the Department of Labor to implement the "Safety Pays OSHA Consultation" program in nursing homes. (Copy of document(s) sent to Board of Health members).

• Modified OSDH web site to include the results of nursing home inspections so that this information could be accessed by the public.

• Requested legislature to provide for increased staffing of investigators to handle complaints that have skyrocketed since May 2, 2000.

• Secretary Regier personally inspected a nursing home in the first weeks of the crisis.

• Pursuant to HB 2019, seven of ten additional staff authorized for Special Health Services has been announced and interviews have begun.

• In concert with Food Service Advisory Committee proposed a new facility inspection process that includes a reward system.

• In the process of implementing a consumer survey packet so the general public is informed and has a mechanism for input concerning their experiences with long term care facilities. The results of the survey will identify the long term care facilities in the top 20%.

• Instructed the Quality Council to release the 1997 employee opinion survey. The purpose of the survey was to give employees a chance to have input concerning the agency’s functioning in 20 vital areas, disburse the data to employees and use it as a basis to improve the agency’s service to its customers and employees. When the data was received it was used to make a few internal improvements, but was not fully released in detail to either the council or the employees. Recommendations from the Council concerning the study were not acted upon.

• Directed the Consolidation Task Force to identify specific positions to be reassigned from the program area to one of the three core function areas of Finance, Data Management and Human Resources.

• Held a Central Office staff meeting in mid-June to provide insight into the new direction of this Administration and to allay any concerns over employee disciplinary actions.

• Instructed the Data Management Committee to identify problem areas relating to security, network operating systems, education and training, and hardware/software tools. Twenty-one specific areas of concern were identified within the four major categories which are being addressed.

• Directed Human Resources to update and/or create new personnel policies with regard to performance and evaluations of employees.

• Proposed Advocate General position for the Department of Health

• Traveled to Canadian, Logan and Cleveland County Health Departments to survey the facilities, meet staff and discuss issues faced by those on the front line of service delivery.

• Met with representatives of the Building Trades Industry to discuss issues of concern and the means to bring resolution.

• Implemented a plan to identify "ghost employees" within the Health Department pursuant to the Executive Order of Governor Keating.

• Held a County Administrators meeting to further identify areas of customer satisfaction that the Central Office should be providing the County Health Departments.

• Initiated a review of the Health Department contracting process with an interest in the frequency and the depth of the auditing process. Area of improvement includes providing staff and resources for performance auditing.

Commencing with the arrest of Health Department Special Health Services Deputy Commissioner Brent VanMeter, who was also serving as Acting Commissioner, on

May 2, 2000, Federal criminal investigative initiatives began to have a significant impact on the management operations of the Health Department.

On May 2, 2000, in conjunction with the arrest of Mr. VanMeter (see attached indictment), investigators served a federal search warrant at the offices of the Health Department in Oklahoma City, Oklahoma. The search warrant authorized an extensive search and seizure of information from the official records of the Health Department. A copy of the search warrant is attached. The fact that the federal government felt it was necessary to use an extraordinary writ, such as a search warrant, to obtain records in furtherance of their investigative and prosecutive goals underscored the serious and pervasive nature of the allegations against certain agency personnel who were employed in and/or managed departments at the time of its execution.

Subsequent to the service of the search warrant, the Health Department was served with a Federal Grand Jury Subpoena on May 4, 2000, for additional records. A copy of the records requested is also attached. The arrest of Mr. VanMeter, the witnessing of the execution of the search warrant and the compliance with the Grand Jury record demand, served to highlight the perception many employees had relating to misfeasance and corruption of many in management. The investigative revelations which validated employee perceptions resulted in a significant adverse impact on the morale of the Health Department management and staff employees.

In order to comply with the demand of the Federal Grand Jury, knowledgeable employees were diverted from their normal responsibilities by management in order to perform this task. Their assigned responsibilities included the securing of these documents, organizing them in a cogent fashion, and insuring that the information collected was also available to management and employees whose responsibilities, in part, include the ongoing licensure, regulation and inspection of special health services providers. On June 6, 2000, the Custodian of Records for the Health Department turned over nine (9) boxes of records to agents of the Federal Grand Jury in Oklahoma City, Oklahoma.

During the week of June 19-23, 2000, Secretary Regier disseminated pertinent information to State and Federal prosecutors and investigators relating to the discovery of a practice at the Health Department, which concerned certain employees being on the payroll without any apparent duties. The information disseminated includes the material set forth in this report titled, "Abuses in Productivity, Time and Attendance Accountability". As an adjunct to this referral, the Oklahoma Public Employees retirement System (OPERS) was requested to hold in abeyance certain claims for benefits until the Health Department could review and re-certify the employee’s "Time and Effort" payroll records. These referrals also required additional employees to be diverted from their normal workload in order to assist in the record review and re-calculation process.

The federal criminal trial of Brent VanMeter is currently scheduled to commence in September 2000. As the trial proceeds it can be anticipated that evidentiary revelations concerning VanMeter and his actions on behalf of the Health Department will be further publicized. It is also anticipated additional criminal charges will be filed by the United States Attorney’s Office in Oklahoma City stemming from the investigation and indictment of Brent VanMeter. These criminal investigation(s) and prosecutions will have a continuing adverse impact on the Health Department management, employees, and mandated responsibilities.

An effective review and analysis of management's success or failure must start with the Chief Executive of an organization. The Chief Executive must provide leadership. He must give the organization character and instill in its employees, both management and staff, a mission-oriented spirit. The Chief Executive must gain and command the respect of management and staff employees through quality actions and decisions made on behalf of the organization. Foresight, judgment, discipline and fairness are all qualities that an effective and efficient Chief Executive must consistently apply in order to gain the respect and admiration of not only the entire management team but also the staff employees, as well. It is a well-known principle of management that an organization will mirror the actions of its Chief Executive and the entire management team as a whole.

Dr. Jerry R. Nida was appointed Commissioner of the Oklahoma State Department of Health (Health Department) on December 6, 1994, succeeding Tom Peace, who served as Commissioner before him. Both before and after Dr. Nida's appointment as Commissioner, the Health Department was divided into five separate and distinct divisions, each headed by a Deputy Commissioner. The five divisions are Special Health Services, Administrative Services, Health Promotion and Policy Analysis, Personal Health Services, and Local Health Services. According to the latest organizational charts, the Commissioner also has management responsibility over four additional sections of the Health Department. These include Legal, Financial Management, Data Management, and Affirmative Action. The Commissioner reports to the Governor appointed State Board of Health, which consists of nine members and has oversight responsibilities.

Brent VanMeter served as Deputy Commissioner for Special Health Services, a division within the Health Department responsible for licensure, certification and inspection of long term care nursing facilities in the State of Oklahoma. Mr. VanMeter served in this capacity until his arrest on May 2, 2000 on Federal bribery charges. He was subsequently indicted by a Federal Grand Jury in Oklahoma City on these charges. Mr. VanMeter also served as Acting Commissioner while Dr. Nida was on sick leave beginning in April of 2000 and continuing until his arrest.

Roger Pirrong served as State Registrar and Deputy Commissioner for Administrative Services, a division responsible for Vital Records, Insurance and several other services within the Health Department. Mr. Pirrong retired from the Health Department, effective April 30, 2000.

Doyle Carper served as Deputy Commissioner for Local Health Services, a division within the Health Department responsible for County Health Departments, the Office of Rural Health, the Eldercare Program, and Records Management. Mr. Carper served in this capacity until June 8, 2000 when he was terminated by Secretary Regier.

Dr. Robert Vincent serves as Deputy Commissioner for Health Promotion and Policy Analysis, which oversee numerous promotions and services within the Health Department, including Human Resources.

Dr. Sara Reed DePersio serves as the Deputy Commissioner for Personal Health Services and has oversight responsibilities over State Epidemiology, Acute and Chronic Disease, Maternal Health and several other service areas, as well. Dr. DePersio also serves the Department as State Health Officer.

Through interviews and communication with management and staff employees within the Health Department, a picture emerged of a Commissioner who had relinquished a substantial amount of his leadership responsibility to Deputy Commissioner VanMeter. Management and staff personnel also advised that former Deputy Commissioner Roger Pirrong, through the real or perceived influence of Senator Gene Stipe, wielded a substantial amount of power over the Health Department until his retirement in April, 2000. Management and staff employees advised Dr. Nida was intimidated by Mr. Pirrong and his close association and friendship with Senator Stipe. The interviews revealed Mr. Pirrong's intimidation of Dr. Nida negatively impacted on the Chief Executive's ability to effectively manage and direct his Deputy Commissioners, as well as other management and staff personnel under him. In an article by Nolan Clay, published in the Daily Oklahoma, on July 5, 2000, Dr. Nida denied allegations of wrongdoing on his part while Commissioner of the Health Department.

Nevertheless, the interviews revealed even though it was common knowledge within the Health Department that Deputy Commissioner Roger Pirrong was absent from work more than 50 percent of the time during his last three years of employment at the Health Department, Dr. Nida allowed him to continue receiving his full salary of approximately $87,936.00 as Deputy Commissioner. Mr. Pirrong’s Staff Assistant advised she was instructed to prepare and sign false time sheets in Mr. Pirrong's name indicating he had worked regular hours even though Mr. Pirrong was not reporting for work as was being indicated on the time sheets. The Staff Assistant advised Dr. Nida signed those time sheets as Mr. Pirrong’s Supervisor.

Another instance further demonstrating Dr. Nida’s inability to effectively control and supervise his management team at the Health Department occurred when Mr. VanMeter was able to get legislation passed lowering the educational requirements for the Commissioner’s job. The legislation made it no longer necessary to have a doctorate degree. Management and staff personnel advised that it was commonly understood that Mr. VanMeter wanted this legislation passed because he wanted to be named as the next Commissioner but did not possess a doctorate degree. State Representative Fred Stanley and State Senator Frank Shurden co-authored legislation to lower the educational requirements, and the legislation was passed. Management and staff employees advised that Dr. Nida was opposed to the legislation and was trying to prevent it. Dr. Nida had his legislative assistant working in this regard but their efforts were not successful and the legislation passed.

When Health Board Members learned Mr. VanMeter had pushed for the legislation and wanted to replace Dr. Nida as Commissioner, the Board Members gave instructions to strip Mr. VanMeter of some of his power. They instructed Dr. Nida to remove the Financial Services and Data Management divisions from under Mr. VanMeter’s direct supervision and control and put them under Dr. Nida. However, Dr. Nida never followed through with the Board’s directive, and both divisions remained under the defacto control and supervision of Mr. VanMeter. New organizational charts were made indicating the changes directed by the Board had been implemented when, in fact, they had not. Despite the Board’s directive, Financial Services and Data Management remained under the direct control and supervision of Mr. VanMeter until his arrest on May 2, 2000.

Deputy Commissioner Brent VanMeter gained considerable power during the past several years and was the inside operations person running the Health Department. This occurred despite Dr. Nida’s position as Commissioner. In this regard, management and staff employees advised in the several years immediately prior to the arrest of Mr. VanMeter, no decisions were made at the Health Department without Mr. VanMeter’s approval and consent. For example, Roger Pirrong’s Administrative Assistant advised the decision to continue Mr. Pirrong’s salary payments for several years after he began showing up for work less than 50 percent of the time, was approved by Mr. VanMeter in addition to Dr. Nida. She advised Mr. VanMeter signed many of Mr. Pirrong’s time sheets during this period, as did Dr. Nida.

According to management and staff personnel at the Health Department, Mr. VanMeter developed his own inner circle of management, exclusive of Dr. Nida, and he communicated and shared information only with those management and staff employees chosen specifically by him. The management and staff chosen by Mr. VanMeter had administrative and oversight responsibilities directly relating to the care and custody of Oklahoma’s senior citizens and mentally retarded patients, who lived in long-term care nursing facilities. The management and staff personnel advised these employees, did exactly what Mr. VanMeter told them to do and they were very loyal to him. The employees advised Mr. VanMeter managed by instilling fear in the employees subordinate to him, but he also controlled the purse strings in the Health Department and used the department’s money, in the form of pay raises and promotions, to ensure that selected management and staff employees remained loyal to him.

Management and staff employees advised Mr. VanMeter had developed potentially corrupt relationships with owners of long term care nursing facilities charged with the responsibility of ensuring the health and safety of the senior citizens of Oklahoma. (See attached indictment of James Robert Smart and Brent VanMeter). Management and staff employees advised Mr. VanMeter showed preferential treatment to selected nursing home owners by pressuring surveyors to remove and/or lower the severity of deficiencies written at facilities they owned. These employees advised Mr. VanMeter also showed favoritism to selected nursing home owners by personally addressing their certification and re-certification requests. The Federal Grand Jury indictment of Mr. VanMeter and Mr. Smart alleged Mr. VanMeter solicited and received a bribe payment from Mr. Smart in regard to re-certification matters.

Management and staff employees further advised Mr. VanMeter scheduled retreats for selected employee groups at Roman Nose, Fountainhead, Lake Murray, and Shawnee, Oklahoma. They advised Mr. Smart, who owns several nursing homes in Oklahoma, was invited to more than one of these retreats by Mr. VanMeter. In fact, employee interviews disclosed Mr. Smart furnished liquor and food at more than one of the retreats. Management and staff employees advised Mr. VanMeter hosted parties that involved excessive drinking at these retreats and Mr. VanMeter’s inner circle of management and staff personnel were invited to these parties. For example, employees advised Mr. VanMeter hosted a party in his room at the retreat held at Roman Nose in 1999. Management and staff employees advised there was a hot tub in Mr. VanMeter’s room, and several employees discarded most of their clothing in getting in the hot tub. Several Health Department employees advised management at the Roman Nose Resort informed Mr. VanMeter that due to unruly and disruptive activity on the part of Health Department employees, they were not welcome back at this resort.

In order to evaluate information provided regarding the Roman Nose Retreat, contact was made with the management of the resort in Watonga, Oklahoma. The manager of the resort advised she would check records concerning the Health Department retreat for any information on file concerning the event. She then advised the retreat was held on October 5 and 6, 1999, at the Roman Nose Resort Park and was attended by many members of the Health Department. She furnished a copy of the State of Oklahoma, Department of Health purchase order, number T029058, showing the cost of the retreat was $3,535.00. She also furnished information indicating Brett VanMeter was in attendance at this retreat and stayed in Room 301. The information she provided reflected there were two suites reserved; one costing $125.00 per night and the other one at a rate of $150.00 per night.

She advised there was a note in the file (see attached exhibit), which was handwritten on Roman Nose letterhead and which read as follows: "October 5-6, 1999. Department of Health lots of problems! Several people drunk, fights on second floor, female Health Department employee drunk and stripping in meeting room. Took all cabin furniture out onto lawn".

Management and staff employees advised the retreat Mr. VanMeter held in 1998 at Fountainhead also resulted in excessive drinking and unruly activity. Again, employees advised Mr. Smart was at this retreat and he provided liquor for everyone’s consumption. Management and staff employees advised at least two members of the Health Department’s legal staff were present at more than one of the retreats attended by

Mr. Smart, wherein Mr. Smart provided liquor and food consumed by management and staff employees of the Health Department.

Management and staff personnel advised morale at the Health Department was at an all-time low, caused in large part by the fact Mr. VanMeter made promotions and hired personnel based on personal friendships and political loyalties, rather than competition and merit. For example, two surveyors were promoted to coordinator positions over field representatives and Title 19 surveyors, respectively, even though they lacked the requisite experience to fill those positions.

A review of management and staff employee productivity and accountability at the Health Department determined substantial discrepancies in the manner in which management personnel ensured that employees under their supervision were held accountable for their hours as well as their productivity. The review revealed management at the Health Department had failed to hold employees accountable for their work hours and productivity, through the use of time and attendance sheets and yearly performance evaluations. This in turn, led to employee complacency and in many instances job responsibilities were totally ignored.

Even though yearly performance evaluations were required at the Health Department, management had failed in most instances to complete them. In fact, a review of management and staff employees’ personnel files revealed performance evaluations had seldom been completed. There was a total failure on the part of upper management to ensure performance evaluations had been completed and discussed with employees. It is recommended that procedures be put in place that will ensure performance evaluations are given on a yearly basis and that managers be held accountable if they fail to act in this regard.

State agencies, such as the Health Department, hire employees through the merit hiring system, as well as through referrals and/or recommendations. Employees hired through the competitive merit system process are referred to as classified or non-exempt employees. Employees hired outside the merit system are referred to as unclassified or exempt employees. Employees hired outside the merit system, based on recommendations or referrals are also referred to as "Direct hires" by Health Department personnel. The review process determined many times "Direct hires" are applicants, who have been referred or recommended by members of the State Legislature. While there is nothing inherently wrong with a member of the State Legislature referring or recommending an applicant for employment at the Health Department, it is essential for an effective management team to maintain fairness, impartiality and equality not only in the hiring process, but also in performance evaluations and promotions for all employees regardless of whether they were "Direct hires" or were hired through the state competitive process. Employee perception at the Health Department was that in many instances direct hire employees received favored treatment not only in regard to the manner in which they were hired, but also in regard to job performance and promotions. It is recommended when promotional opportunities become available, management utilize a selection system that provides both notice and a competitive process.

The management review also determined there were numerous employees, who are assigned to work out of their homes. That is, they were not required to report in person to either the Central Office in Oklahoma City or to one of the many County Health Departments spread throughout the state. It would not be economically feasible and would be impractical to require an employee, who lives a hundred miles from Oklahoma City, to report to the Central Office on a daily basis. The State of Oklahoma would be better served by having the employee report to the nearest County Health Department. Regardless of where an individual employee is required to report, all employees must be held accountable for working the required number of hours per week and for carrying out the responsibilities of their job descriptions. Basic management principles require managers be held accountable for ensuring employees under their supervision report for work on a timely basis and maintain a specified level of productivity.

The management review determined the Health Department had adequate systems available to measure employee productivity, as well as their time and attendance. Managers however, had not required employees under their supervision to complete time and attendance sheets on a timely basis, nor had they required them to submit written documentation of their work. In many instances, annual performance evaluation requirements were ignored completely or were not properly documented. When performance evaluations were given, they often lacked supporting documentation to justify the performance rating that was given.

Regarding employees working out of their homes, managers were not held accountable for ensuring these employees, like all employees, had worked the required number of hours per week and had submitted written documentation of their work. While it is probable that most employees assigned to work out of their homes put in a full days work, these employees oftentimes did not have regular contact with a manager or supervisor. The perception amongst other employees was that employees working out of their homes did not have to put in a full days work and had not been held accountable for carrying out the responsibilities of their job positions. Again, basic management principles require employees be held to the same standard of accountability. In short, managers should be held accountable for ensuring all employees, under their supervision, are working on a regular basis and the employees’ work product provides a legitimate service to the Health Department.

In view of the abuses of time and attendance that have been discovered, it would be more practical and prudent for the Health Department to require employees working out of their homes to report on a daily basis to the nearest County Health Department in the area where they live.

In summary, the review process identified many instances when employees had not worked the hours claimed on their time sheets, and their supervisors had not held them responsible for the variations. Likewise, the review identified many instances when employees had submitted no documentation of their work product and were not held accountable by their supervisor.

In order for a workforce to remain effective in the performance of its duties as they relate to the accomplishment of the company’s mission, a standard of accountability concerning payroll and time and attendance must be in place. This standard of accountability necessitates all employees conform to the accepted level without any hint of impropriety. Nothing will destroy morale within an organization quicker than allowing a selected few to be exempt from this standard, while everyone else in the workforce is held accountable.

The Health Department was lax in several areas concerning the accountability of payroll and time and attendance. There have been occurrences within the Health Department that have come to the forefront that range from minor problems of not having payroll records on a timely basis to major problems relating to allowing inflated time sheets to be submitted.

The Health Department Payroll currently operates without any lag time between the pay period and the paycheck relating to that pay period. For example, for the pay period ending on the last Friday of the month, the employees’ paycheck would represent work performed until close of business on the last Friday of that month. Many businesses, both in the private and public sector, allow for a time lag between the pay period and actual paycheck relating to that period. This allows time for the payroll section to make necessary adjustments and corrections to the employee’s paycheck that occurred during that pay period. A lag time imposed on a monthly payroll schedule would create an undue burden on current or future employees, however a mechanism must be in place to allow the Financial Management Section of the Health Department to effectively manage the monthly payroll. Additionally, the Health Department has had a problem with individuals not submitting time sheets on a timely basis. This has created paychecks being issued when no verification was available as to the work being performed.

The Chief of Financial Management for the Department of Health has recognized problems exist as to the timeliness and accuracy of employee’s time sheets, which causes inaccuracy in paychecks relating to those employees. He has begun to implement a supplemental payroll system to track, identify and eventually correct some of the minor abuses as they relate to payroll and time and attendance.

There have been several major abuses with regard to payroll and time and attendance at the Health Department. Specific abuses concerning Roger Pirrong, Doyle Carper, Jim E. Lane, Gary York, Rebecca Lane, and Herbert "Buck" Dendy are additional examples of the ongoing problems that were allowed to occur for years. These examples have been set forth in another section of this report.

The Health Department does not currently have in place any daily tracking mechanism that allows supervisors to know with any certainty if their employees are on duty in a timely fashion on a daily basis. The time sheets used only allow for hours worked or hours on leave for each particular date and are totaled on a monthly basis. There is no documentation as to times employees arrive or leave for work on a daily basis. This system, as inexact as it is, creates additional burdens on diligent supervisors and allows loopholes for abuses with supervisors who are lax in their duties.

Another problem noted during the review was the practice of allowing employees to take advantage of excessive amounts of shared leave for improper reasons. For example, Roger Pirrong, the former Deputy Commissioner of Vital Records, was allowed to receive and take advantage of approximately six months of shared leave even though upper management at the Health Department knew Mr. Pirrong had not been reporting to work for at least the previous two and one half years. Employees advised Mr. Pirrong was allowed to use this shared leave in spite of the fact he was already eligible for retirement and for no apparent reason other than to increase his retirement benefits, as it was known by management he would not be returning to work. It can also lead to potential abuse when a supervisor asks for shared leave from subordinate employees, as they may feel obligated to contribute. Shared leave is intended to be used by individuals who have serious illness and have exhausted all of their annual and sick leave and not for the purpose of increasing an employee’s retirement benefits.

It is recommended the Health Department evaluate the current system and make the necessary changes to correct the existing problems with payroll and time and attendance. Specific needs to be addressed in this evaluation are current payroll methods with necessary changes to those methods and a daily time and attendance roster for everyone on the Health Department payroll. Additionally, adequate controls need to be put into place to monitor the use of shared leave at the Health Department and to ensure its use for legitimate purposes.

Set forth below are specific instances wherein employees assigned to Vital Records and Local Health Services were not fully occupied, were not held accountable for their hours, did not submit time and attendance sheets in a timely manner, were not required to submit written documentation of their work and/or did not have performance evaluations completed and reviewed as required.

FORMER DEPUTY COMMISSIONER

Roger Pirrong, former State Registrar and Deputy Commissioner of Vital Records, worked for the Health Department for more than 30 years. Management and staff employees alike advised that Mr. Pirrong garnered and maintained substantial influence over the Health Department for many years as a result of a real or imagined association and friendship with State Senator Gene Stipe. Management and staff employees advised Mr. Pirrong used his perceived friendship with Senator Stipe to intimidate and influence those around him at the Health Department, up to and including upper management.

Management and staff employees advised Mr. Pirrong reported for work less than fifty percent of the time during the last five years of his employment. They advised that when Mr. Pirrong did report for work it was usually just in time to each lunch, and that he would stay for an hour or so after lunch and then leave. The employees advised Mr. Pirrong did not report for work during the last three years of his employment.

Mr. Pirrong's longtime staff assistant advised that during approximately mid 1997, she was instructed to complete false and fraudulent time sheets indicating that Mr. Pirrong was working full time at the Health Department even though Mr. Pirrong was not reporting to work at all. This staff assistant advised she was instructed to complete the false and fraudulent time sheets indicating Mr. Pirrong had reported for work daily and had worked full eight-hour days. The staff assistant advised she was instructed to sign Mr. Pirrong's name to these time sheets. She continued to prepare and complete Mr. Pirrong's time sheets in this manner for about a year even though Mr. Pirrong was not reporting for work.

A review of Mr. Pirrong's time and attendance sheets for the past several years verified that from September, 1997 through August, 1998 Mr. Pirrong's administrative assistant completed Mr. Pirrong’s time sheets and signed his name to them. These time sheets were completed as though Mr. Pirrong had worked regular hours. Commissioner Nida signed the time sheets as Mr. Pirrong's supervisor. (See attached time sheets for Roger Pirrong.) It is noted this is the same time period for which Mr. Pirrong’s administrative assistant and other management and staff employees advised Mr. Pirrong was not reporting for work.

Documents made available by the Financial Management Division of the Health Department, revealed beginning in 1994 and continuing into 1998, substantial changes were made to the retirement benefits for employees of the State of Oklahoma. Prior to July 1, 1994 retirement benefits were computed based on an average of the employee's high three-year salary, however, the salary was capped at $40,000 for retirement computation purposes. Therefore, an employee earning more than $40,000 per year was allowed to use only $40,000 of that salary for the purpose of calculating retirement benefits. Beginning on July 1, 1994 the salary cap for purposes of computing retirement benefits was raised $10,000 per year until the cap was finally removed, effective July 1, 1998.

Documents made available by the Financial Management Division revealed Mr. Pirrong's annual salary at the time of his retirement in April 2000, was approximately $87,936.00. Therefore, Mr. Pirrong stood to benefit substantially as a result of the false and fraudulent time sheets that were submitted on his behalf for the period September, 1997 through August, 1998. By remaining on the Health Department payroll during this time even though he was not reporting for work, Mr. Pirrong’s retirement benefits would be computed using a higher salary cap rather than the figure that should actually have been used.

While it is apparent that Mr. Pirrong was suffering from various illnesses in the years prior to his retirement in April, 2000, there was no legitimate reason for him or others acting on his behalf to submit false and fraudulent time sheets certifying that he was reporting to work on a regular basis, eight hours a day, during September, 1997 through August, 1998, when in fact he was not reporting for work at all during this time period.

Former Deputy Commissioner Doyle Carper, who was a friend and close work associate of Mr. Pirrong's, advised that during the approximate two and one-half years he served as Deputy Commissioner of Local Health Services he hardly ever saw Mr. Pirrong at work. The Directors of several other service areas, including Financial Management, Personnel, Internal Security and Special Investigations, as well as numerous staff employees and the Assistant Deputy Commissioner of Vital Records, all confirmed Mr. Pirrong rarely reported for work during at least the last three years he was on the Health Department payroll. They advised Mr. Pirrong was in poor health and was suffering from various illnesses, including progressively worsening conditions of diabetes and congestive heart failure.

Management and staff employees advised Mr. Pirrong was allowed to remain on shared leave during approximately his last six months on the Health Department payroll. They advised management allowed Mr. Pirrong to remain on shared leave even though he was eligible for retirement and it was common knowledge he was not coming back to work.

A review of shared leave records for Mr. Pirrong revealed that former Commissioner Jerry Nida, former Deputy Commissioner VanMeter, former Deputy Commissioner Carper, former State Senator Jim E. Lane and others donated substantial amounts of shared leave to Mr. Pirrong, which allowed him to remain on the Health Department payroll for an additional seven months prior to his retirement in April, 2000.

(See attached shared leave records)

A review of Mr. Pirrong’s time sheets revealed that from September, 1999 through April, 2000, Mr. Pirrong was on shared leave. Mr. Pirrong’s daughter-in-law signed Mr. Pirrong’s name to his time sheets during this time period, and Mr. VanMeter signed the time sheets as Mr. Pirrong’s supervisor. (See attached time sheets for Roger Pirrong.)

The purpose of the state leave sharing program, according to state statute, is to permit state employees to donate annual or sick leave to a fellow state employee who is suffering from an extraordinary or severe illness, injury, impairment, or physical or mental condition which has caused or is likely to cause the employee to take leave without pay or terminate employment. The fact that false and fraudulent time sheets were submitted for Mr. Pirrong for a full year from September, 1997 through August, 1998, and that he was allowed to go on shared leave for an additional seven months immediately before retiring calls into question whether or not any and/or all of this time should be included in computing Mr. Pirrong’s retirement benefits.

FORMER STATE SENATOR

Herbert "Buck" Dendy was a former State Senator from 1954-1958 in what was then Senate District number 29. Management and staff employees at the Health Department advised Mr. Dendy was hired as a Vital Records Field Representative when he was approximately 75 years old. The employees advised Mr. Dendy remained on the Health Department payroll until his death in early 1996.

A review of Health Department personnel records revealed Mr. Dendy was hired in September 1979, and employed as a Field Representative in Vital Records. He was assigned to the Central Office in Oklahoma City, even though he lived in Stigler, Haskell County, Oklahoma. According to the personnel records, Mr. Dendy's supervisor in Vital Records was former Deputy Commissioner Roger Pirrong. The records revealed Mr. Dendy had, in fact, remained on the Health Department payroll until his death in February, 1996 at the age of 92. Financial records maintained by the Health Department revealed Mr. Dendy's annual salary at the time of his death was approximately $22,384.00

The Assistant Deputy Commissioner of Vital Records advised Field Representatives assigned to Vital Records are required to report to the Central Office in Oklahoma City. They are dispatched out from the Central Office to all parts of the state to obtain vital records from hospitals and other facilities on an as needed basis. The Assistant Deputy Commissioner advised there are currently two Field Representatives employed in Vital Records. He said both report in person to the Central Office of the Health Department, located at 1000 NE 10^th Street in Oklahoma City, an average of two or three days per

week. The rest of the time they are in the field. The Assistant Deputy Commissioner advised he was aware Mr. Dendy had been kept on the Health Department payroll for many years until he died, but he had never seen Mr. Dendy in the office and was not aware of the specific job performance or duties of Mr. Dendy.

Mr. Pirrong's former Administrative Assistant advised Mr. Pirrong was responsible for the hiring of Mr. Dendy and for keeping him on the payroll for approximately 15 years. She advised Mr. Pirrong was Mr. Dendy's supervisor, but Mr. Dendy did not report to the Oklahoma City Central Office, as the other field representatives were required to do. No records could be found that Mr. Dendy ever reported in person to the central office. She advised Mr. Dendy was elderly, and she believed he had been ill, and possibly bedridden, the last several years of his life. She was not aware of any services Mr. Dendy performed for the Health Department, and was even more certain Mr. Dendy had performed no services for the Health Department in the last several years.

The two Field Representatives, who are currently assigned to Vital Records, both advised they are assigned and report to the Central Office in Oklahoma City. They travel around the state as necessary, but are in daily contact with the Oklahoma City office even when they are in the field. They find it necessary to communicate with other staff employees in Vital Records in order to carry out their job. Both advised they had not been contacted by Mr. Dendy while he was on the payroll as a Field Representative, and they knew of no other employees in Vital Records with who Mr. Dendy had been in contact. Both said they found it very difficult to believe Mr. Dendy could carry out his job without maintaining contact with other employees in Vital Records and without coming in to obtain supplies.

Linda Jones, the Administrative Assistant to George Dowell, the County Administrator for Health Departments in LeFlore and Haskell Counties, advised she had been employed by the Health Department in LeFlore and Haskell Counties for 25 years. Ms. Jones advised she had never heard of Mr. Dendy.

Mr. Dendy's niece, who was appointed as Mr. Dendy’s personal representative for the purposes of his will, advised Mr. Dendy was self employed, owned gas stations and had built a motel. She was aware that Mr. Dendy had previously been employed by the State, but reported he had been sick for several years before his death, and she believed Mr. Dendy had not gone to work during that time.

A review of Mr. Dendy's death certificate revealed he died on February 7, 1996. The death certificate listed Mr. Dendy's occupation as entrepreneur. Even though Mr. Dendy was assigned to the Health Department's Central Office in Oklahoma City, the death certificate and personnel records revealed he lived in Stigler, Haskell County, Oklahoma.

FORMER DEPUTY COMMISSIONER

Former Deputy Commissioner Doyle Carper was terminated on June 8, 2000 by Secretary Regier. Mr. Carper had served as Deputy Commissioner of Local Health Services for approximately two and one-half years prior to his termination and had served at the Health Department some 29 years. As Deputy Commissioner of Local Health Services, Mr. Carper had supervision over all County Health Departments in the State of Oklahoma, which encompasses over 1,500 employees. Mr. Carper had an administrative staff and was assigned to the Health Department's Central Office in Oklahoma City. His annual salary as of June 8 was approximately $87,936.00

Shortly before his termination on June 8, Mr. Carper reported to Secretary Regier there were several employees under his supervision, who had no jobs and were performing no services for the Health Department. After Mr. Carper's termination, he was asked to be interviewed to which he consented. During this interview Mr. Carper reiterated that when he took over as Deputy Commissioner of Local Health Services there were several employees on the payroll, who had no job descriptions and were performing no services for the Health Department. He identified these employees as former State Senator Jim E. Lane, Mr. Lane’s wife Rebecca Lane, former State Representative Gary York, and several others. Mr. Carper advised he knew keeping Mr. Lane and the others on the payroll was going to be his downfall some day. Mr. Carper provided additional information regarding these matters, some of which is set forth below.

FORMER STATE SENATOR

Mr. Lane is a former State Senator from Idabel, Oklahoma. He was hired by the Health Department in April 1990, and submitted his retirement on May 18, 2000. Mr. Lane's annual salary at the time of his retirement was approximately $50,348.00. Payroll and personnel records revealed Mr. Lane was employed as an Environmental Health Consultant. As mentioned above, Mr. Lane was supervised by former Deputy Commissioner Doyle Carper.

During the interview with Mr. Carper, he advised that during the two and one half years under his supervision Mr. Lane had provided Mr. Carper with no written reports of work he had performed for the Health Department. Mr. Carper advised even though he served as Mr. Lane's immediate supervisor, he didn't know of any services Mr. Lane had performed for the Health Department during this time nor could he verify what hours, if any, Mr. Lane had worked.

Mr. Carper advised that prior to May 15, 2000 Mr. Lane had submitted no time sheets for the year 2000, and he had failed to submit time sheets for three months in 1999, as well. Mr. Carper advised when Mr. Lane finally submitted the time sheets, they were inaccurate. Mr. Carper instructed his daughter and another staff employee to correct the time sheets, including completing some of them from blank. It was pointed out to Mr. Carper that the signature of Mr. Lane on some of the time sheets did not appear to be authentic. Initially, Mr. Carper denied he had signed Mr. Lane’s name to any of the time sheets; however, he finally admitted he signed Mr. Lane’s name to one of the time sheets. He continued to deny that he signed Mr. Lane’s name to the other time sheets.

Mr. Carper’s staff assistant confirmed he had instructed her and Mr. Carper’s daughter to correct and complete Mr. Lane’s time sheets. This staff assistant advised she believed Mr. Carper had signed Mr. Lane’s name to the time sheets. She said when she completed the time sheets and gave them back to Mr. Carper, the sheets she had to complete from blank were unsigned. Mr. Carper gave them back to her later that same day, and they were all signed in Mr. Lane’s name. She said Mr. Carper instructed her to shred the original time sheets, which she then did. She advised another staff assistant had completed Mr. Lane’s time sheets in the past. This second staff assistant was interviewed and advised Mr. Carper also instructed her to correct and complete time sheets for Mr. Lane. (See attached time sheets for Jim E. Lane.)

Michael A. Echelle, Administrator of the County Health Department in McAlester, Pittsburgh County, Oklahoma, advised he has known former State Senator Jim Lane for approximately ten years. He advised Mr. Lane and his wife Rebecca Lane reside in McAlester. Even though Mr. Echelle was aware from conversations with Doyle Carper that Mr. Lane and his wife were on the Health Department payroll, Mr. Echelle was never their supervisor and they never reported to him. He advised he has had nothing to do with the Lanes insofar as their employment is concerned and does not know what, if anything, they have done for the Health Department.

Ms. Lane is the current wife of former State Senator Jim E. Lane. Payroll and personnel records maintained by the Health Department revealed Ms. Lane, who began working at the Health Department in August 1990, was employed as an Environmental Health Consultant in Pittsburgh County, Oklahoma. As of May 2000, her annual salary was approximately $40,712.00.

Former Deputy Commissioner Doyle Carper advised he had been the direct supervisor of Ms. Lane for the past two and one-half years. Mr. Carper advised that after Secretary Regier was appointed Acting Director of the Health Department, he (Mr. Carper) asked Ms. Lane to submit a report to him so Mr. Carper would know what, if any, services she had provided to the Health Department. Mr. Carper advised even though he served as Ms. Lane's immediate supervisor for two and one-half years, he didn't know of any services she had provided to the Health Department before he received her first and only written report, dated May 21, 2000. Similarly, Mr. Carper advised he had no way of verifying Ms. Lane had actually worked the hours she had turned in on her time sheets.

A review of Ms. Lane's personnel file revealed she was placed on leave without pay at her own request in December 1991. In December 1993, her employee status at the Health Department was changed to active for one day and then returned to leave without pay. Employees in the Personnel Office advised this was done as a "legal" way to circumvent the merit system regulations that state an employee can remain on leave without pay for only two years. Personnel records revealed Ms. Lane was on leave without pay status, while she was employed at Eastern University in Wilberton, Oklahoma under a grant obtained by the Health Department.

As mentioned above, Michael A. Echelle, the County Administrator for Pittsburgh County, where Ms. Lane resides, advised that even though he has met Ms. Lane, she has never worked for the Pittsburgh County Health Department. Mr. Echelle said he has never heard of the Eastern 2000 project with which Ms. Lane was purportedly involved. Mr. Echelle was unaware of what, if any, services Ms. Lane had provided for the State Health Department.

FORMER STATE REPRESENTATIVE

Mr. York is a former State Representative from Blanchard, Oklahoma. He was hired by the Health Department as a Health Facilities Consultant in April 1996. Mr. York's annual salary as of May 2000, was approximately $43,595.00.

Former Deputy Commissioner Doyle Carper advised he had served as Mr. York's immediate supervisor for the past two and one-half years. Mr. Carper advised Mr. York worked out of his home, and during the time he has been under Mr. Carper's supervision, Mr. York submitted no written documentation of his work to Mr. Carper. Mr. Carper advised even though he supervised Mr. York for two and one-half years, he could not verify what hours, if any, Mr. York had worked during this time. Mr. Carper advised that more recently Mr. York's job was to conduct airflow tests in County Health Department isolation rooms to help prevent the spread of tuberculosis. However, Mr. Carper said he didn't really know if Mr. York had conducted any of these tests or if he had ever been trained to do the job.

The Assistant Deputy Commissioner of Local Health Services advised that approximately three or four months ago Local Health Services needed a person to conduct TB airflow tests in the County Health Departments. He said the decision was made at that time to assign Gary York these duties, as Mr. York had very minimal job responsibilities assigned to him, and this would give Mr. York something to do.

Michael Milton, the Administrator for County Health Department’s in Duncan (Stephens County) and Chickasha (Grady County), advised several years ago he received a telephone call from James Beale, Doyle Carper’s predecessor as the Deputy Commissioner over Local Health Services, wherein Mr. Beale informed him they had hired a new employee and needed to find a duty station for him. Mr. Beale identified this new employee to Mr. Milton as Gary York. Mr. Beale told Mr. Milton he was going to supervise Mr. York himself, and that Mr. Milton would have no oversight or supervisory responsibilities over Mr. York. He said Mr. Beale informed him that all he needed from Mr. Milton was for Mr. Milton to have a desk for Mr. York in the County Health Department building in Chickasha. Mr. Milton advised that after Doyle Carper followed Mr. Beale as Deputy Commissioner over Local Health Services, Mr. Carper had total supervisory and oversight responsibility over Mr. York and Mr. Milton had none.

Mr. Milton advised he heard Mr. York provided inspection services regarding new building construction for County Health Administrators around the State, but Mr. York had never performed any such services for him in the four counties that Mr. Milton supervises. Mr. Milton said he had heard Mr. York provided such services to the County Health Administrators in Jackson and Kiowa Counties.

Mr. Milton advised more recently he was told Mr. York had received training in conducting airflow tests of isolation rooms in the various County Health Department buildings.

Mr. Milton’s Administrative Assistant at the Grady County Health Department in Chickasha advised that prior to the time Mr. York started performing TB airflow tests, which was approximately three to four months ago, Mr. York reported in person to the Grady County Health Department an average of only about one hour per week. She explained that Mr. York sometimes would come in once or twice a week, and other times he would not come in for two weeks at a time. When Mr. York did come in, he would usually joke around with one or more of the employees for a while and then leave. The Administrative Assistant advised Mr. York hardly ever stayed in the office more than an hour at a time, and she knew of no work he performed while he was there. Other employees in the Grady County Health Department used to make comments that they sure would like to have a job like Mr. York’s. She said this was in reference to the fact Mr. York had no apparent job responsibilities.

The complaint unit is tasked with the responsibility of receiving and investigating complaints on nursing facilities. These complaints are categorized according to severity, some of which require immediate action. Interviews conducted with complaint surveyors determined the unit had several hundred complaints, which prior to Mr. Regier’s arrival had not been addressed. Complaints received by this unit are separate and distinct from issues and responsibilities relating to the routine long term care nursing facility surveys.

The previous Director of the Complaint Surveyors Unit retired in the Fall of 1999, and was not replaced. However, Secretary Regier has since made a temporary replacement. This unit is now staffed with a coordinator, eight surveyors and one secretary.

Due to the previous Director’s retirement and the failure of prior management to find a replacement for her position, the complaint surveyors unit had virtually no leadership or organizational structure until May of 2000.

Interviews were conducted with seven of the eight surveyors assigned to the complaint surveyors unit. As a group, these employees advised that the complaint unit lacked organization and leadership. Management was allowing the complaint surveyors to pick and choose the complaints they wanted to investigate. Many of these complaints had not even been segregated into categories according to their immediacy. The complaints were placed in a stack, and the surveyors were allowed to choose the ones they wanted to investigate. Similarly, there was no system in place to accurately track the specific action, if any, that had been taken by a complaint surveyor on each complaint. Nor was there a system in place to identify the number or complexity of complaints handled by each complaint surveyor.

In many instances, multiple complaints at the same nursing facility were allowed to accumulate without being investigated by a complaint surveyor. They were simply held

until the routine annual survey was conducted at the facility and then were given to the survey team to be investigated during the routine annual survey. By holding these complaints and assigning them as the routine annual survey was scheduled created multiple problems. First, the routine annual survey team now had to spend hours on complaint investigations. Given the limited time spent at the nursing facility, the increased workload placed on the survey team often created a time problem in finishing the survey. Secondly, the survey team resented the fact they had additional work placed on them because of mismanagement in the complaint unit.

The majority of the complaint surveyors advised management had not supported them in regard to deficiencies written against nursing facility operators. Most indicated that management had a negative attitude against them writing deficiencies, and was not supportive in most instances. Several surveyors advised that management personnel had asked them to either remove deficiencies or to lower their severity levels. Many felt that preferential treatment was afforded to favored long term care nursing facility owners.

One complaint surveyor advised while he was assigned to a survey team at long term care nursing facilities, he had been called in and told that if he continued writing deficiencies at certain facilities, his team would be broken up and team members would be subject to reassignment to the southeastern Oklahoma region. This surveyor was subsequently reassigned to the complaint unit.

Many of the complaint surveyors advised management had used the complaint unit as a dumping ground for inefficient and inadequate surveyors. The complaint surveyors need to have a balance of experience, coupled with initiative, to be effective in this position. The placing of ineffective surveyors into this unit caused the complaint unit to perform at a substandard level exacerbating the current problem. This, in turn, had an adverse impact on the competent surveyors in the unit, affecting both their morale and initiative. All complaint surveyors, who were interviewed, advised that additional surveyors needed to be added to the unit, and management needed to stop using the unit as a dumping ground.

The complaint surveyors advised that, as a rule, for each eight hours spent investigating, they spend another 24 hours preparing their report. They were also required to spend additional non-investigative time in deficiency reviews or in waiting to attend these reviews.

The Title 19 Surveyors Unit consists of eight separate teams, which are assigned to conduct routine annual surveys at long-term care nursing facilities throughout the State of Oklahoma. Each team consists of four team members and is assigned a representative number of nursing facilities usually determined by geographic location and density of population. The teams are made up of registered nurses, pharmacists, and dieticians. A registered nurse is required to be on each team and often two or more nurses are assigned to the same team. There are two Title 19 Surveyor coordinator positions with one coordinator responsible for the northern half of the state and the other responsible for the southern half.

There is also a group of field representatives who are responsible for environmental requirements at long term care nursing facilities. These field representatives usually conduct an on-site environmental survey at the facilities while they are undergoing the Title 19 routine annual survey.

Interviews conducted with Title 19 team leaders, survey team members, and field representatives identified irregularities, favoritism by management, and possible corruption between management personnel and long term care nursing providers. Several survey team leaders and team members reported they had been asked and/or told by management personnel in Special Health Services to remove and/or lower the severity level of deficiencies they found while conducting the annual surveys, especially at nursing facilities owned by certain favored individuals. Also, deficiencies had been removed or their severity level lowered by management personnel without consultation with the team leaders or team members. The surveyors eventually became so upset with management decisions in regard to their deficiencies they insisted on being included in the review process. The surveyors advised several long term care facility owners had received preferential treatment in regard to deficiencies, licensure and certificates of need from management personnel in Special Health Services.

Many Title 19 surveyors advised some long term care facility owners/operators seemed to know in advance when the survey team was coming. They reported that prior to Secretary Regier’s arrival, surprise, unannounced surveys were rarely performed. The surveyors believed surprise, unannounced surveys would better serve to identify problem facility owners.

Many of the Title 19 surveyors and team leaders reported management had not backed them in regard to deficiencies they had written. Again, they reported favorable treatment by management toward some long-term care nursing facility owners. For example, one team leader reported being told by a nurse consultant at one of the facilities under survey, she was not concerned about a deficiency that had been written because the owner would call the Health Department and have it removed. Another surveyor reported one of the deficiency reviewers instructed her to remove two deficiencies she had written the nursing facility. She agreed to remove these deficiencies because she was instructed to do so by management, even though she did not agree with the decision.

The surveyors reported management allowed preferred nursing home operators to ignore fines that had been levied against them for deficiencies or to use this money to make capital improvements at their facilities.

The surveyors advised many of the field representative positions and, at least, several of the Title 19 surveyors were filled on the basis of political favoritism rather than competition. While they seemed to understand that political appointments or direct hires as they are called by the surveyors are not inherently wrong, they did complain that some of these hires had received preferential treatment by upper management.

The prior intervention by upper management personnel concerning the hiring and placing of individuals as Title 19 surveyors and field representatives has created distrust and cynicism within the Title 19 Surveyors Unit. Many of the appointments appear to have been based solely on friendship or political connections, which taints the hiring process within the department.

Reducing or removing deficiencies unilaterally or through management coercion on behalf of favored nursing facility owners does little but fuel and ratify suspicion within the Title 19 Surveyors Unit. Additionally, this action nullifies any chance to place integrity upon the Title 19 surveys.