Cathy Perfect-Kern Valley Sun

Forty to fifty guests turned out for an open house barbeque/reception at the home of Bob and Kay Knight in Squirrel Valley Monday evening. The Knights, who sit on the Kern Valley Healthcare District Board of Directors, planned the casual backyard get-together to welcome Robert Duncan, the district's new CEO. Conspicuously absent were board members Barbara Casas, Bob Jamison, and Brad Armstrong. The evening gave district personnel and volunteers a respite from some of the “hot potatoes” Duncan said he inherited when he took the helm on June 18.

One of the many hot potato issues - the Skilled Nursing Facility's (SNF) repeated attempts to remain in “substantial compliance” with state and federal standard of care guidelines - made a public encore when the California Department of Health and Human Services posted a legal notice in the Bakersfield Californian on July 13. The notice was an official heads-up from the U.S. Department of Health and Human Services stating that Centers for Medicare and Medicaid Services (CMS) would terminate its contract with the district on July 31 if it did not demonstrate that it could operate within the statutory requirements of substantial compliance.

Kern Valley Hospital CEO Bob Duncan, standing in rear of photo to the right of tree, enjoys talking with community supporters at Bob and Kay Knight’s open house at their home Monday evening.

The specifics of the SNF's noncompliance and “immediate jeopardy” status were not directly addressed at the board's regular monthly meeting on July 12. However, in his introductory remarks, Duncan said, “Probably one the biggest projects I'm trying to get my arms around is the nursing center. As you know, it's been reviewed by the state and they've given us a long list of things to work on.” He appeared to be referencing a visit from DHS surveyors on June 28. According to Bob Knight, who participated in the exit survey meeting with DHS, the facility failed in all areas, again. He attributed the shortfall to two factors: DHS came for a re-visit sooner than anticipated and, more importantly, the new SNF policies and procedures required board approval before they could be implemented. And the board did not meet until July 12, two weeks after the DHS visit. “We have every reason to believe that we will pass when DHS revisits us again,” Knight said.

“It's my understanding they corrected it right away,” said Jack Cheevers, a DHS spokesman in the San Francisco regional office. However, formal notification, (Form 2567), containing the SNF's “list of deficiencies” was not sent to the district until Monday, July 16.

The SNF's current status of “not in substantial compliance” stems from a DHS survey on Jan. 31. At that time, the SNF was cited and fined for noncompliance in areas of patient care such as “chemical restraints,” physical abuse, not accommodating patients' needs, administering unnecessary drugs, and lax and/or dangerous pharmacy services. CMS gave the SNF six months to implement the district's proposed “Plan of Correction.” That time period ends on July 31, hence the public notice of the impending termination of the contract with CMS.

“I have submitted a letter to Linda Wilkenson, representing the Bakersfield office of DHS, that KVHD will be in ‘substantial compliance' of all areas of concern by July 31st,” Duncan said in a press release. “The entire KVHD Team, including our consultants from Sycamore, has been working hard these past several weeks to bring the systems back into compliance. I am confident that we will be ready when the surveyors return on the 31st.”

Duncan said he continues to look forward and focus on the work ahead. At the July board meeting, he said he has met with individuals in the community and a variety of local service organizations as well as members of the board. “Everybody's had the opportunity to share with me their feelings about the operation of the hospital, things we need to work on, and the challenges that lie ahead of us, some of the ‘hot potatoes' I inherited. I know we're not perfect. We don't have a perfect organization - most hospitals don't. But we're doing the best we can to be the best organization we can be. And I'm doing everything I can to support everyone in that effort.

“As an administrator I need to be engaged in the community and I look forward to being engaged,” he said.

In meeting various groups, Duncan said he welcomed “the opportunity to talk about some of reasons we were unsuccessful the first time. So that can help us as we get further along and we can evaluate where we can take that next leap of faith and go back to the community for a vote. That's something we'll be discussing in the months ahead.”