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Staffing

Feds recommend trio of changes in staffing, hiring and overtime management to facility’s new leadership

Northport VA Medical Center. File photo

A federal investigation into Northport Veterans Affairs Medical Center’s four community living centers has shown a troubling trend of chronic nursing staff shortages and excessive overtime, issues that could have placed patients “at a higher risk for adverse events.”

In one case, federal investigators found a nurse’s assistant worked double shifts for six straight days — more than 96 hours in a single week – while expected to diligently oversee a patient requiring one-on-one care.

As the Northport facility is the only VA Medical Center on Long Island it serves more than 31,000 patients per year and oversees several outpatient clinical sites. Its four nursing homes are located in two buildings, with an approximate capacity of 170 beds.

The Office of Inspector General, a division of U.S. Department of Health & Human Services, charged with independent oversight of Department of Veterans Affairs programs, received several anonymous complaints about the quality of care received at Northport VAMC in 2017 following the deaths of two patients.

In September 2017, the OIG launched a year-long investigation into staffing shortages after receiving two further emails: the first from an employee at Northport VAMC, the second from a liaison to the House Committee on Veterans’ Affairs. The investigation produced a Sept. 18 report (click here to read the full report) that found Northport VAMC’s leadership knew about the staff shortages, forced administrative level nurses to care for patients, and yet still continued to accept new patients despite knowing they wouldn’t have the staff needed to provide the expected level of care.

Federal investigators recognized in August 2017 there was significant turnover in the leadership at the Northport VAMC, affecting key positions such as its director, acting chief of staff and acting nurse executive, who were cited “as catalysts for this change.” Staff members’ remarks indicated it’s given them hope for a better future.

The agency recommended a series of changes for the Northport VAMC pertaining to the nursing staff currently being enacted, and the facility says is bringing immediate tangible results.

Two patient deaths

Anonymous complaints about two patient deaths at the Northport VAMC in 2017 started the series of federal investigations into the facility.

The first death was a male patient in his late 60s who died as a result of choking on his food. Federal inspectors found insufficient evidence the man’s death was due to a lack of nurse oversight, as alleged in the complaints, but did conclude Northport VAMC had ongoing challenges in maintaining basic necessary staffing levels.

“Conditions such as staffing shortages could create an environment where the increased workload assigned to each staff member was such that it became more difficult to remain vigilant,” the report reads.

A forum was held for the Northport VA nursing homes staff to voice their concerns with the facility and its operation while an investigation of the first patient’s death was ongoing.

“Many [staff members] shared a concern about staffing levels being too low,” the report reads.

A second death raised claims of poor quality of care in the Northport vets nursing homes, after a patient in his mid-60s slipped, fell and fractured his hip. He underwent surgery and six days later stopped breathing. Allegations included the VA staff failed to protect the patient from falling and failed to properly provide
one-on-one observation post surgery, neither of which was substantiated by federal investigators.

The investigation into the second death showed the nurse’s assistant caring for him was on her sixth consecutive day of double shifts — 16 hours at a stretch. Investigators again cited “concern that working extra hours with double shifts could lead to staff becoming tired and less vigilant.”

A staff member working double shifts was not common practice, according to Northport VAMC spokesman Levi Spellman, who said union workers are contractually required to have 10 to 12 hours off between nursing shifts.

Closer look at staffing numbers

Records pulled by the federal investigators showed Northport VAMC has been chronically short of nursing staff dating back to at least 2016. Allegations were made that understaffing could lead to a higher rate of “nurse-sensitive outcomes,” such as surgical wounds getting infected, urinary tract infections, ulcers and pneumonia.

Northport’s four nursing homes were found to be short approximately 6.3 full-time employees in 2016 needed to meet VA’s recommended number of nursing hours spent with patients per day. By 2017, the facility’s staffing shortage had more than doubled, with 15.3 additional full-time employees needed. Northport VAMC’s nursing homes were only staffed at 60 to 80 percent of recommended levels over the two years, according to federal investigators.

Northport VAMC’s leadership attempted to tackle the short staffing issue by using “floating” shifts and overtime — sometimes mandatory, according to the federal report. Floating shifts meant staff from other areas of the VAMC were brought in to assist with patients in the nursing homes.

In 2016, Northport VAMC’s nursing home employees put in a  total of 19,991 hours of overtime. It nearly doubled by the end of 2017 as only 107.9 of the facility’s authorized 128 full-time positions were filled, according to Spellman, causing the facility’s overtime costs to skyrocket to nearly $1.5 million.

“Nurse managers had no mechanism to alert them if one of their unit nursing personnel worked excessive OT,” the report reads.

Federal investigators found part of the nursing homes’ staffing issues were due to an inability to hire and retain the members of its nursing staff. Northport VAMC got approval to hire 10 additional registered nurses and 10 nurse assistants as intermittent staff in November 2016, though the team wasn’t assembled until August 2017.

Often the process of hiring new nursing staff was delayed. In one instance, Northport’s leadership said two applicants interviewed and hired in January 2017 were told they would not start working until July.

“This delay in hiring often resulted in the loss of selected applicants who took other jobs,” the report reads.

The leadership of Northport VAMC said the high cost of living on Long Island has also made finding and maintaining a full-time staff difficult.

“Not only does this affect our ability to retain talent, but to recruit it as well,” spokesman Spellman said.

Steps to improvement

The federal investigators made three recommendations to Northport VAMC in order to  ensure it has adequate nursing care for its patients and improve quality of care for residents.

First, that the VAMC’s acting director, Dr. Cathy Cruise, completes a review of the nursing homes to ensure staffing levels align with the needs of its current residents. More staff should be recruited and hired to fill the current vacancies “until optimal staffing is attained,” reads the report.

Spellman said leadership of Northport VAMC, including Cruise, have already started taking action, implementing changes to improve the quality of care and working conditions.

A registered nurse clinical coordination position has been added in order to streamline nursing staff’s efficiency, according to Spellman. At the beginning of 2018, the facility was given approval to hire 2.6 more full-time employees and another 10 staff members were recently approved to bring the total nursing staff to the equivalent 140.6 positions.

“A staffing methodology is in the process of being completed, with additional staff expected,” Spellman said.

The Northport VA has received approval to directly hire its nursing staff and is giving new employees immediate start dates, according to him. It also had plans to expand its nursing floating pool, and to cross train other VAMC nurses in long-term care to continue to grow the available number of staff who can provide residents with care.

Third, Northport’s leadership was also told to improve its management of staff’s overtime hours and make sure of future responsible use of financial resources, citing the $1.5 million in 2017 overtime.

“Federal employees are expected to be good stewards of government funds,” the report reads. “The OIG found a lack of accountability for managing OT expenditures.

Spellman said the nursing homes staff had a total weekly average of 437.3 hours of overtime for the 2018 fiscal year, which ended Sept. 30. This indicates a significant drop from last year, where the total weekly average of overtime exceeded 750 hours.

“All of this is to say that, while the OIG has helped Northport identify areas in which we can improve, we have implemented measures to make those improvements — and we are already seeing results,” Spellman said.

Huntington Town Hall. File photo by Rohma Abbas

The Town of Huntington’s new administration made a second wave of staffing changes at its Aug. 7 meeting, reinstating some positions, while abolishing others.

Huntington Supervisor Chad Lupinacci (R) sponsored a resolution last week that reinstated nine job titles with a total annual salary of $284,921 while also creating 14 new positions for a total of $272,413. The bill also cut nine staffing positions, which is estimated to save more than $268,000 annually.

We look at the different departments, I’ve been in office seven months now to see what has been working and what isn’t working.”

– Chad Lupinacci

“We look at the different departments, I’ve been in office seven months now to see what has been working and what isn’t working,” Lupinacci said.

A second bill put forth by the supervisor appointed nine individuals to the newly created positions, many of which are exempt from taking civil service tests. Both pieces of legislation passed by a narrow 3-2 vote, split on party lines with Councilman Mark Cuthbertson (D) and Councilwoman Joan Cergol (D) voting against. They accused the board’s hiring process for these position of lacking in transparency and reeking of political nepotism.

We are seeing chapter two of the Republican patronage playbook at work,” Cuthbertson said, denouncing the legislation. “A slew of positions are being created that require no civil service test. These are patronage jobs — plain and simple.”

The councilman reported he and Cergol weren’t included in the hiring process, stating he had seen only one candidate’s résumé prior to the town board meeting and questioned if those appointments had proper qualifications.

We are seeing chapter two of the Republican patronage playbook at work.”

— Mark Cuthbertson

Councilman Gene Cook (R) voiced support for Lupinacci’s appointments, stating the changes were needed in order for town government to run efficiently.

“In the past month or two, I’ve had nothing but complaints against the people in the building department,” he said. “I’ve had the same thing with the planning department. There’s been a number of issues and people deserve better.”

As part of the staffing changes, Joseph Cline, who has served as Huntington’s director of engineering services, was demoted to deputy while maintaining his $138,375 salary. Cline will be replaced by Daniel Martin, who will make more than $146,500 a year. He was appointed to serve as a Suffolk County Supreme Court judge since 2010 before becoming a deputy town attorney.

Lupinacci said he stood by the newly hired and appointed employees based on their skills and merit. Of the nine appointments made Aug. 7, five are new hires and four individuals were already employed by the town but are taking on new roles for which they will receive an additional stipend.

There’s been a number of issues and people deserve better.

— Gene Cook

Cuthbertson previously criticized Lupinacci’s February appointments for going to “11 white Republican males” many of whom had previously campaigned on the party line for various government positions. The councilman argued this second wave of appointments will also have a negative fiscal impact on the town.

“This is gravely wrong from a fiscal and budget standpoint,” Cuthbertson said.

He estimated many of the newly created positions would cost the town approximately $40,000 a year in benefits including health care insurance and retirement benefits.

The town will pull roughly $265,000 from its contingency funds in order to fill the new positions.

“Where is the transparency you promised?”

— Joan Cergol

Cergol voted against the move, calling it a “dizzying array of personnel maneuvers that mystify even those of us used to looking at these resolutions, let alone the public.” She also questioned the hiring process used.

“Where is the transparency you promised?” Cergol said.

She said the resolution Lupinacci presented to board members on the Friday before their meeting had dramatically changed by Tuesday afternoon without explanation.

Among those who will be leaving Town Hall include: John Coraor, director of cultural affairs; Rob Reichert, deputy director of planning; and Jake Turner, the deputy director of engineering services.

The town will be looking to fill three openings that have resulted due to these promotions or being newly created, according to town spokeswoman Lauren Lembo, including an entry-level auto mechanic, an audio-visual production specialist and a plumbing inspector position by civil service candidates.

Cops say arrests are up and recent violence gang-related

Christina Fudenski, a Greenlawn resident, speaks with police officer Angela Ferrara at South Huntington Public Library on Wednesday, Aug. 12. Photo by Victoria Espinoza

Residents of Huntington are calling for an increase in staffing at the Suffolk County Police Department’s 2nd Precinct in the wake of three separate shootings that occurred in less than a month.

Deputy Inspector William Read assured community members gathered at South Huntington Public Library on Wednesday, Aug. 13, that the police force is completely competent in its current size, but residents were not convinced.

“We want to ask for outside help,” Jim McGoldrick, a Huntington Station resident said. “We can’t go on this way, our kids are being shot at.”

Luis Hernandez, 21, Aaron Jolly, 18, and Nelson Hernandez, 22, all survived shootings in the Huntington Station and Greenlawn area in late July and August. Luis Hernandez and Jolly both suffered from gunshot wounds to their legs, and Nelson Hernandez was shot in the back.

“What we’re doing is working, our program is effective, and crime stats are down dramatically,” Read said. “We are having success, but it can’t be 100 percent.”

The police associate many of the recent problems in the area with gangs, and Read said that gang cops have been out undercover investigating these cases constantly. He said there are a number of social programs combatting gang issues as well.

But the crowd argued that not enough is being done, and that more problems are arising.

Lisa MacKenzie, a Huntington resident, asked what the police are doing about the ongoing problem of intoxicated individuals passing out in the streets in Huntington Station.

“Why are these individuals taken to the hospital and not arrested?”

Officer Angela Ferrara explained that it is always the duty of the police and the standard procedure to treat someone medically first. She also noted that this has become a concern in many different areas in Huntington.

“What if I am on Depot Road in the future and hit [someone] who is intoxicated and attempting to cross the street, who will actually get in trouble then?” MacKenzie said. “We need drunk crossing signs, instead of deer crossing signs.”

Residents also complained about the how 911 dispatchers handle calls. Several said in the past, dispatchers have told them to either leave their car or house to get closer to a scene.

“They had the nerve to tell me to flag down one of the patrol cars when I called, and to get out of my car…this is putting the public at risk,” Nicholas Wieland, of The Huntingtonian news website, said. “You guys have some homework to do with the 911 service.”

Robert Finnerty, a Huntington Station resident, brought his son to the meeting, and said he is now afraid to go outside.

“We have people in the street across from us saying ‘I will shoot you in the street, I will kill you,’ and it’s scaring my son,” Finnerty said. He said the residents yelling this are people living in single dwelling homes occupied by five different families.

“We have to go after the overcrowded houses,” McGoldrick said. “It’s not fair to the police officers and fire firefighters. One of the biggest problems is how housing is handled in this town.”

As members of the audience agreed housing is a town issue, not a police one, the tone changed toward a desire to see a change in leadership in Huntington Town. Councilwoman Susan Berland (D) and Councilman Gene Cook (R) were both present at the meeting, as well as Huntington Town Board candidate Jennifer Thompson, a member of the Northport-East Northport school board.

Despite the criticism throughout the night, the 2nd Precinct deputy inspector defended the department’s work.

“We’re covering all our sectors, we’ve been doing it for years,” he said.

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