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SHAUGHNESSY REHAB HOSPITAL - BOARD OF TRUSTEES MEETING MINUTES OF SPECIAL MEETING JULY, 1979 DR. R -ERT SHAUGHNESSY CHRONIC DISEASE/REHABILITATION HOSPITAL MEETING OF THE BOARD OF TRUSTEES July 24 , 1979 A special meting of the Board of Trustees was held in the Board Room on Tuesday, July 24, 1979. The meeting was called to order at 7:10 p. m. , Mr. Brophy presiding. Tnistees present were: Messrs. Brophy, Blenkhorn, Carnevale, Noonan, Pelletier, and St. Pierre; 1,1-sdames MacDonald, Moulton, Norton; Doctors Shaughnessy and Kaplan. Also present were Doctor Krukonis, Messrs. Affanato, Centor_ino and Morency and Ms. E. J. Brown. Mr. Brophy explained that the intent of the meeting was to evaluate the per- formance of the Director. He then turned over to Mr. Affanato a supply of evaluation forms and for the September meeting of the Board he requested the Director to prepare the forms for key personnel in the hospital. In addition, as part of the agenda, he requested an outline of a program as to haw the administration will proceed with the evaluation process of all salaried personnel. The order of evaluations should be: (1) Executive Director; (2) Director of Nursing; (3) Doctor Vbll; (4) Director of Personnel; (5) Director of Fiscal Services. The purpose is to provide the Board with an ongoing program of evaluation on all salaried personnel in the hospital. In starting this evaluation process in motion, he has requested the Board to convene to evaluate the Executive Director, including in the call to the meeting the evaluation form which he requested them to review, and asking them to come up with a summary evaluation of the .first position of responsibility in the hospital. The President offered the trustees an opportunity to corm nt, or make a state- ment prior to proceeding with a recorded appraisal frcm each member of the Board. Mr. Affanato asked to be heard. He stated that twice before he had asked for a performance evaluation which should have been conducted by the Personnel Committee on his anniversary date. This evaluation should be in confidence and done on a standard form used by other hospitals with stated goals and objectives, with his performance being compared to those objectives. He also stated that he felt the Mayor should be involved in part of the evaluation. Mr. St. Pierre informed the Board that he preferred to refrain from submitting an evaluation because he felt that being at a meeting on a monthly basis does not qualify him to evaluate Mr. Affanato's performance properly, and that he does not feel that he can judge him on the number of times he has had occasion to deal with him. The President then proceeded to go around the table for individual summary evaluations from each of those present, which were as follows: Minutes - Board of Trustees July 24, 1979 - Page 2 Doctor Shaughnessy 1 Ruth Norton 2 Effie MacDonald 1 Mildred Moulton 1 Jean Pelletier 1 Timothy Noonan 1+ Doctor Kaplan 1 Robert Blenkhorn Abstained (see letter to Mr. Brophy attached) Tony Carnevale 1 Doctor Krukonis stated that he realized that he was a non-voting member and that his evaluation would have to be related only to his Medical Staff relationships and inter-actions between the Medical Staff and that he would reserve judgment on items which are administrative, directing his coma Lents only to working with the Director over the past year and a half. He remarked that his relationship has improved over this period. He felt that there had been a lot of foot dragging on things that the Medical Staff thought were important to be instituted and that through pressure being brought to bear these things have been turned around, and there is more responsiveness to Medical Staff needs. He felt there was some misunderstanding between the way they operate and the way other Medical Staffs operate, but some progress has been made along these lines. From a Medical Staff standpoint he said he could work with the director but he could not go into other aspects of the administrative function. He remarked that he likes to think at this stage the Medical Staff has made these things so well know that they are becoming clearer and clearer. In summary he felt that as President of the Medical Staff his evaluation would be that they were approaching a satisfactory level at this time. The President reaffirmed that Doctor Krukonis' evaluation could not be counted as he is a non-voting member. He then asked Mr. Centorino, the other non-voting member present if he cared to mike any comment. Mr. Centorino stated that he was present as an observer and that he preferred to reserve comment. Robert Brophy 1 Joseph Richard 1 (in absentia) The President asked for a tally of the voting which was as follows: 9 ones; 1 two and 2 abstentions. The meeting was opened for discussion or further comment from any members. Mr. St. Pierre commented that he had some experience with evaluations and that the procedure that was usually used was for the person doing the evaluation to sit down with the interviewee and do it together. Mr. Brophy stated that it should only be discussed with the interviewee and that he has never experienced a self-evaluation. Mr. St. Pierre reiterated that his experience was to ask the person being evaluated to sit dawn and discuss the evaluation back and forth. Mr. Noonan remarked that he had done some evaluating in industry and was familiar with these procedures. He made the following statement: This uncompensated Board of Trustees accepted the responsibility for the operation of this important health care facility and its employees. In doing so it recognized the heavy burden that this needed facility had placed upon the Salem taxpayer and therefore we must proceed to administer its business in such a manner that it should meet its objectives at an absolute minimum of costs generated in manpower and facility costs. The Trustees must appraise each function of the operation stringently on a strict job related and results basis. Minutes - Board of Trustees July 24, 1979 - Page 3 Mr. Brophy cited the responsibilities of the Board with respect to the Acts as passed by the legislature, Chapter 290. Under powers and duties of the Board he cited (a) Responsibility for the general care and control of the hospital subject to all applicable general laws; and (b) Any powers and duties from time to time conferred or imposed on then by statute or ordinance; and (c) Authority to establish rules and regulations for operation of the hospital and supervision of the officers and employees in its service. He stated that clearly therefore the responsibility of supervision of all employees rests with the Trustees and he feels that the Trustees are performing their responsibility when it canes to the duties and responsibilities of the Trustees. Mr. Affanato stated that he was disappointed with the evaluations of the Trustees, and that he is somewhat disappointed with his own performance. The reasons he expressed are that he feels he has taken on more responsibility than he should have. For eighteen months the hospital has been without a Personnel Director. For sixteen months it has been without a Public Relations Director. For two and a half months it has been without a Director of Fiscal Services. He has asked the Board for help, but for these reasons his own job has not been covered 1000 of the time. He listed his goals for the past year and a half: (1) Blue Cross contract; (2) Overcoming the deficit (explaining that there was an 18% increase in revenue this year) ; (3) Settling the case with Rate Setting Ccnrdssion regarding the SNF floor. He explained that he had to attend meetings which other personnel should have attended to. He stated that he was not making excuses, but giving reasons. He does not feel comfortable, but thinks that he can do better. Ile does not think he deserves a rating of ten in the evaluation but that he expected to do a lot better than ones. Mr. Carnevale asked to make an explanation of his evaluation, stating that he has felt that there is a lack of communication between administration and the rest of the hospital, along with a lack of ability to get some things accomplished. Ile felt that the Board should not have had to step in to correct the problem with the cleaning and that other things should have been done that weren't done. Miss Norton stated that she felt one of the top priorities for the hospital that was not being done was the JCAH approval which she thinks should be pursued with vigor, in order to make the taxpayers aware that we have a quality institution and there would not be so much criticism. Mr. Noonan reported that he had called the hospital on Monday of this week and found that there was no one in charge. Dr. Woll reported that he was unaware- that he was the only one here. Mr. Noonan was aware that Miss Dumont had authority to act for the Director in his absence, but she was not back from vacation. Mr. Brophy reported that he likewise called the hospital and that the secretary in the Director's Office who did not identify herself said that she did not know who was in charge. He added that he did not feel that anybody should be expected to give 24 hours a day to the job, but he feels that the facility should be covered in case of any malfunction or disaster and that he could not condone a loose type of responsibility. Minutes - Board of Trustees July 24, 1979 - Page 4 Doctor Kaplan reported that he spends a lot of time on the floors of the hospital and that he senses a lack of confidence among the working people. Mr. Affanato stated that the Trustees were due an explanation. He went on to say that three people take turns on administrative call, that they carry beepers and leave notice with the switchboard as to their whereabouts. He reported that the administrative office is covered even on lunch hours. Doctor Woll took a vacation day on Friday and was told about Miss Dumont on Monday. Mr. Greene was on call for the present week through next Thursday. Jean Osborne was acting for Miss Dumont and was present all week. There is a medical Code 99 team available at all times from Salem Hospital for emergencies. Regarding the lack of staff communication, Mr. Affanato responded that he has had difficulty in frequently getting up to all floors, but that last week he met with all the head nurses on the 3 to 11 shift about the issues of staffing on the floors, dietary from the new Salem Hospital kitchen and patients being transferred to other rooms. He has had monthly Department Head Meetings throughout the summer to keep the staff up to date on the Blue Cross contract and other problems. Doctor Shaughnessy stated that he felt the biggest problem was the inability to get things done. He had asked for folders which were not being done and the JCAH inspection had not been scheduled. He reiterated that when things are voted by the Trustees they should be implemented. Mr. Noonan listed the following incidents: (1) On March 20, 1979 he gave Mr. Affanato a document indicating government surplus equipment available for hospitals. He stated that he never heard anything more about it. (2) At the Trustee meeting in March the Trustees gave direction that the requiring of timeclock punching was discriminatory. He is not sure that this has been corrected as voted. (3) In May there was inaction in housekeeping and it took three trustees to correct the situation which should have been taken care of by administration. (4) On June 26, 1979, there was a direction by the Board pertaining to grants available from H.E.W. and that he expected the Director to go directly to H.E.W. personally and obtain information and report back by July 6 to the Trustees. He has had no reply. Mr. Noonan asked if the minutes of the meetings are edited. Mr. Affanato replied in the negative and stated that the minutes as taken are sent to the Board each month for approval. The Trustees have this responsibility and have the opportunity to make amendments at the monthly meetings. Mr. Noonan asked why the minutes were relatively short, while in fact the meetings go on for hours. The Secretary (Mrs. McManus) explained that her understanding of proper minutes was to report what was actually done or voted by the Trustees and pertinent comments, not merely what was said, and that she attempted to be as concise as possible without losing any of the sense of the meeting. Mrs. MacDonald inquired as to what was done about a communication system for the van. Mr. Affanato replied that he was waiting for funds to be made available to him through the Auxiliary and that until he had the funds in hand, he could not purchase equipment. Mr. St. Pierre remarked that one of the things that has disturbed him is that many of the Trustees speak to Mr. Affanato personally and then do not mention these things at meetings. It is his feeling that the Board should be appraised of these things and this is not being done. Minutes - Board of Trustees July 24, 1979 - Page 5 Miss Norton expressed the opinion that such items should be brought up at the meetings and voted on and then acted upon. Mr. Blenkhorn interjected that he .felt that every item pertaining to the hospital belongs before the Board. Mr. Brophy took exception to Mr. Blenkhorn's comTent, stating that it is the Trustee's responsibility to make recommendations to the Mayor and ultimately to the City Council for the key position, namely Executive Director of the facility. He stated that the Director is responsible for the ongoing day-to-day operation of the facility and that he does not feel that every decision should came before the Board. He gave as an example the purchase of the van which was done with funds raised by the Auxiliary. Mr. Affanato addressed two issues: (1) H.E.W. money. He reported that he called the Planning Department who told him that they had the material. The next week he went in and looked at the section which he had written down at the meeting and it was not the proper section. He did, however, find the material. Mr. Noonan stated that he had asked him to go to Boston, directly to H.E.W. Mr. Carnevale reported a lack of confidence in the administration and stated that he was not -sure of the powers of the Board and that the evaluations should go directly to the Mayor and he should decide if Mr. Affanato should be replaced. mow Miss Norton asked the Director for his resignation, remarking that she felt that it was the honest thing to do. She added that she did not feel that there is an opportunity for him to redeem the confidence and that we should give him that opportunity. Mr. Affanato said that he would like the Board to set down goals and objectives and charge him on those goals and objectives and he would be willing to go through them and address than, adding that he is looking forward to JCAH. He reported that the 5th floor is reaching a solution and that he would be very concerned about not being given more time. He would like to ask the Mayor to complete the staffing here at the hospital. Doctor Shaughnessy complained that he had called about JCAH and was told that Mr. Affanato had not done anything and that Mr. Affanato had to wait to check with a Director who was coming on. Miss Norton asked Mr. Affanato to respond to her request for his resignation, asking if he thought he could rise above this and take over the organization, or should all the Trustees resign and have a new group come on. Mr. Affanato replied that he wanted to make a constructive criticism. He said that he leaves the Board Meetings in a state of confusion. He has attended a lot of Board Meetings and he does not feel that this board moves quickly and precisely. He stated that he would like the opportunity to sit down with Mr. Brophy and to work up the agendas based on Trustee and Administrative input, Mr. Brophy replied that in the past year and a half he has had to bring up many distasteful items before the Board which were the responsibility of the Administrator. Minutes - Board of Trustees July 24, 1979 - Page 5 Miss Norton expressed the opinion that such items should be brought up at the meetings and voted on and then acted upon. Mr. Blenkhorn interjected that he felt that every item pertaining to the hospital belongs before the Board. Mr. Brophy took exception to Mr. Blenkhorn's ccment, stating that it is the Trustee's responsibility to make recommendations to the Mayor and ultimately to the City Council for the key position, namely Executive Director of the facility. He stated that the Director is responsible for the ongoing day-to-day operation of the facility and that he does not feel that every decision should came before the Board. He gave as an example the purchase of the van which was done with funds raised by the Auxiliary. Mr. Affanato addressed two issues: (1) H.E.W. money. He reported that he called the Planning Department who told him that they had the material. The next week he went in and looked at the section which he had written down at the meeting and it was not the proper section. He did, however, find the material. Mr. Noonan stated that he had asked him to go to Boston, directly to H.E.W. Mr. Carpevale reported a lack of confidence in the administration and stated that he was not -sure of the powers of the Board and that the evaluations should go directly to the Mayor and he should decide if Mr. Affanato should be replaced. Miss Norton asked the Director for his resignation, remarking that she felt that it was the honest thing to do. She added that she did not feel that there is an opportunity for him to redeem the confidence and that we should give him that opportunity. Mr. Affanato said that he would like the Board to set down goals and objectives and charge him on those goals and objectives and he would be willing to go through them and address than, adding that he is looking forward to JCAH. He reported that the 5th floor is reaching a solution and that he would be very concerned about not being given more time. He would like to ask the Mayor to complete the staffing here at the hospital. Doctor Shaughnessy complained that he had called about JCAH and was told that Mr. Affanato had not done anything and that Mr. Affanato had to wait to check with a Director who was coming on. Miss Norton asked Mr. Affanato to respond to her request for his resignation, asking if he thought he could rise above this and take over the organization, or should all the Trustees resign and have a new group cone on. Mr. Affanato replied that he wanted to make a constructive criticism. He said that he leaves the Board Meetings in a state of confusion. He has attended a lot of Board Meetings and he does not feel that this board moves quickly and precisely. He stated that he would like the opportunity to sit down with Mr. Brophy and to work up the agendas based on Trustee and Administrative input. Mr. Brophy replied that in the past year and a half he has had to bring up many distasteful items before the Board which were the responsibility of the Administrator. Minutes - Board of Trustees July 24, 1979 - Page 6 Mr. Brophy continued, stating that over and over again the Board had approached him as President with the problems, rather than approaching the Director. He reported that he had made a chronological document regarding the Director's attendance at the facility. On February 7 he had a meeting at 4:00 P.M. with the Director regarding the following items: (1) attendance, requiring strict adherence to the hours of 8:30 - 5:00; (2) Discontinue attendance at outside meetings; (3) Agendas of any meetings which are necessary to be presented to Mr. Brophy for prior approval; (4) He stated that he gave approval for pre- viously scheduled meetings but expected to be asked for permission for future meetings; (5) He recommended weekly or biweekly update letter to be forwarded to all Board members, and these have never been received. On February 8, 1979, Mr. Affanato attended a meeting and no location or reason for attendance was given. In March Mr. Brophy called and was advised that Mr. Affanato had gone to Canada with his family. On inquiry, Mr. Affanato explained that he had told Mr. Car- nevale about it. On March 28 Mr. Brophy called and found that Mr. Affanato was attending a 3-day meting in Boston. Mr. Brophy then sent a Registered Letter, Return Receipt Re- quested, advising Mr. Affanato of working hours and stipulations regarding fu- ture meetings. ... On March 30, 1979, Mr. Brophy met with Mr. Affanato to discuss the meaning of the letter and thought Mr. Affanato understood and would adhere to the wishes of the Board. He stated that he felt that he had given a fair amunt of time to this problem. Mr. Affanato replied that he never intended this kind of management, that he did not give notices in writing as he thought it was only to be discussed. Mr. Brophy asked if Mr. Affanato had not agreed to put this in writing at least monthly. Mr. Affanato replied that after the June 26 meeting he sat with Mr. Brophy and reviewed the meetings for June, July and August. Doctor Kaplan interjected that he felt there had been enough discussion and proceeded to make the following two motions: (1) Move that the Director be asked to resign his position; and (2) If the Director does not wish to resign he moves that the Trustees send a recommendation to the Mayor to replace the Director. Mrs. Moulton seconded the first motion. Mr. St. Pierre stated that in view of the evaluations we have no alternative, since the cost of the hospital reflects on the taxpayers and we would be criticized for acting in any other fashion. Mr. Noonan stated that the discussion that has been brought forth had been job related and results related only and not involving personalities. Mr. Brophy informed the Trustees that this was a public meeting and that he had conferred with the City Solicitor in this regard. Thereafter on role call vote, it was unanimously VOTED THAT THE DIRECTOR BE ASKED TO RESIGN HIS POSITION. Minutes - Board of Trustees e July 24, 1979 - Page 7 Mr. Affanato stated that he would like some time to have some input and requested an evaluation before the Human Resources Committee. He stated that he felt he could do the job and would like to pursue it. He thought the Trustees were going to discuss the evaluation of other department heads, and appealed to the Trustees to replace the vacant positions of other department heads. The new Personnel Director is expected on Monday and this should help. Mr. Brophy asked for a "yes or no" response from Mr. Affanato. Dr. Kaplan was asked to repeat his second motion, as follows: Moved that if the Director does not wish to resign, the Trustees send a recommendation to the Mayor to replace the Director. Motion seconded by Mrs. MacDonald. There was no discussion on the motion. Thereafter it was unanimously VOTED THAT IF THE DIRECTOR DOES NOT WISH TO RESIGN, THE TRUSTEES SEND A RECOMMATION TO THE MAYOR TO REPLACE THE DIRECTOR. Mr. Affanato stated that his "No" response did not mean that he would not resign but that he would not resign at this time. A motibn to adjourn was made and seconded. Mr. Carnevale asked to include one suggestion in the minutes of the meeting, namely: that the Trustees give Mr. Affanato some time away frCm the hospital as a suspension or something of that nature for a week or so. Mr. Noonan replied that he felt that the Trustees do not have this authority, but that it rests in the hands of the Mayor. Meeting adjourned at 8:57. Respectfully submitted, v Joanne McManus Executive Secretary