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A group designed to draft a better way to oversee nursing home leadership has recommended the existing board stay put, as long as more members are added and the Arizona Department of Health Services checks their work.
Gov. Doug Ducey disbanded the board that licenses nursing home administrators this spring after regulators overlooked glaring problems that put seniors at risk.
The Arizona Legislature extended the board's life until March 2022 and established a study committee to advise next steps.
That committee's recommendation to retain the board, which squeaked by on a 10 to 8 vote, was delivered mostly by executives of long-term care communities, including one man whose brother also serves on the nursing home board.
Dean Kidder, who voted to preserve the board, said he never had to announce his relationship to nursing home board member Ken Kidder, but he said the organization that asked him to serve, Arizona LeadingAge, knew about it.
"It certainly didn't affect what I had to say to the committee," said Kidder, who is the executive director of a retirement community in Sun City.
He was one of six industry professionals who served on the committee.
The board they protected, comprised mostly of managers or administrators, has shown that they sympathize with their stressed-out peers.
When the committee discussed that the board seek tougher background checks for manager or administrator applicants, some of the industry committee members fretted that would draw out the process for companies desperately needing to hire.
"It's such a difficult staffing environment out there in the long-term care settings," said Kristopher Woolley, founder and CEO of Avista Senior Living in Mesa. "There is turnover. I'm just wondering how risky it would be to issue temporary licenses, abbreviating the 20 to 30 day period. My opinion would be to make the process as smooth as possible."
Christina Corieri, Gov. Doug Ducey's senior policy adviser, said there was a more important issue at hand.
"Who bares that risk?" Corieri said. "It's the person who would be in the facility and their family. I understand that it might be not ideal for a facility to wait an additional 10 days to get their manger slot filled, but its 10 days to make sure the risk for that individual who's being entrusted to the care of that facility is being protected to the best of our ability."
In the end, family members of long-term care residents, a couple of Democratic politicians and AARP's Arizona director voted against keeping the board independent. Corieri also voted against it.
The point of having a board to license and discipline long-term care managers is not simply to accelerate the hiring process for the industry, but rather to "ensure the people in their care are safe," said committee member Becky Hill during a Nov. 19 meeting.
"Frankly, I don't hear a justification for keeping the board independent," Hill said.
'Time for accountability and new leadership'
The committee's recommendations hold little weight unless the state Legislature approves a bill to enact them and Ducey signs them.
"We appreciate the work and effort that was put into looking into this important issue and while we appreciate their effort, we are not bound by these recommendations," said C.J. Karamargin, Ducey's spokesperson.
Ducey vetoed a routine bill in May that would have continued the Arizona Board of Nursing Care Institution Administrators and Assisted Living Facility Managers through July 2029.
He announced that the Arizona Department of Health Services would assume the board's responsibilities.
Ducey cited "a disturbing and heartbreaking investigation by The Arizona Republic" that revealed the board licensed a man after just minutes of friendly banter and softball questions, largely overlooking his felony record for fraud. He also had scant health care experience.
That man, Larry Michael Rasmussen, went on to force sick employees to work at his Prescott nursing home. He had the opportunity to hire relief staff but balked at the $5 to $10 extra hourly hazard-pay charge. State inspectors also found evidence that someone crossed out COVID-19 symptoms employees had reported on their daily logs.
At least 50 residents caught the disease and 15 died. Wives, husbands, mothers, fathers.
Though the board is supposed to investigate serious violations like that, members-only looked into the case after The Republic repeatedly asked why they hadn't. The director at the time said he didn't know about the deaths.
"It’s time for accountability and new leadership to supervise these facilities," Ducey wrote in his veto letter. "Our seniors—these are our grandmothers and grandfathers—deserve nothing less.”
Seven months later the same people who licensed Rasmussen and almost avoided investigating him are still deciding who gets to run long-term care facilities. And the former director who nearly overlooked Rasmussen's case is now consulting for them.
Furthermore, Rasmussen retained an active license until November — more than a year after the state cited his facilities for the egregious errors. Rasmussen voluntarily surrendered his license in lieu of answering a subpoena to appear before the board.
Much of the board's meager discussion about what may have happened at the facility —Granite Creek Health and Rehabilitation — centered around wondering who else might have been responsible that might absolve Rasmussen of some guilt.
Little attention was paid to the victims. The board's president cut off a fellow member when she mentioned deaths.
None of the board members have publicly expressed remorse for any of this.
All but one member has refused to answer The Republic's questions and Vice President Charles Seal-Villafranca even claimed it was illegal for a reporter to call him.
Karamargin said the governor's position has not changed since May and his office will hold the board accountable.
He did not respond when asked if the governor has the authority to replace existing board members before their term expires. Nor did he say why Ducey still hasn't filled all board vacancies, which would add new perspective to counter the apparent sympathy existing board members have for the people they regulate.
The board has been operating with just five long-term care managers and a Goodyear city councilwoman for months, when it's historically been required to have at least nine members.
One new member associated with AARP has recently been added.
'A rubber stamp licensing board'
Board members assumed their last meeting was in June but the Arizona Legislature surprised them a month later with a pass to continue existing through March of next year.
They had new limitations, though.
The new statute, baked into the budget bill, required the state health department to sign off on every license and certification the board approves. It also called on Ducey to appoint two additional board seats: one for an advocate for seniors and one for a relative of a long-term care resident.
The measure created the study committee to explore how best to regulate nursing home administrators and assisted living facility managers.
The Arizona Supreme Court has since struck down the budget bill, but that didn't seem to affect the nursing home administration committee, which delivered recommendations on Dec. 1.
"This will no longer be a rubber stamp licensing board," said Dana Kennedy, AARP's Arizona director, who served on the committee. "There will be some voices advocating on behalf of the residents."
The board recommended DHS continue to oversee the board's licensing decisions. In addition to echoing reforms from the budget bill, the committee advised that the board should take on three members who've had family living in a facility, seek legislation that enables FBI background checks for applicants and start explaining why they dismiss complaints forwarded to them by the state.
Corieri found over the last year the board dismissed for "insufficient evidence" cases against 30 people, who collectively racked up 400 deficiencies cited by state health inspectors.
The list included one case where inspectors found 86 deficiencies and the facility signed a settlement agreement, she said.
"Which usually doesn't happen unless there are some things that are really wrong and the facility is admitting there were things that were really wrong," Corieri said.
The committee heard a few defenses, including that the board sometimes finds managers not to blame when the problems cited at their facilities predate their employment.
Or, the board sometimes sees issues such as inadequate staffing as the fault of the corporation's tight budget and not that of the manager or administrator working the facility.
But Sen. Tyler Pace, who co-chaired the committee, said it's the manager's responsibility to ensure laws are being followed, and that includes having enough staff to manage all residents.
"If a licensee, whether the manager or a community itself, is maintaining a license by filling its beds, but not filling its positions then we have a significant issue that needs to be stopped," he said.
The committee also reviewed recent audit findings showing the board hasn't properly background checked everyone they've approved and they've taken too long to investigate and resolve complaints, which may have put residents at risk.
The audit acknowledged that staff turnover likely contributed to these problems, as the licensing specialist resigned in June and the executive director position has been vacated twice since March.
The last executive director resigned in the fallout of The Republic investigation.
The new director, Jack Confer, is taking steps to improve the board, the audit said.
'We do our very, very best'
An audit released in February 2020 found the board wasn't properly backgrounding applicants then either.
Vetting candidates was a major point of discussion during the Nov. 2 committee meeting. And board members finally had to answer a question they've been avoiding from The Republic since April.
When Board President Wally Campbell took the stand, Corieri said the board's approval of Rasmussen's license worried her.
Rasmussen received his fingerprint clearance card on a good cause exception, and member Susan Archer has argued that if the state has a problem with the board approving felons, then make it law that the board should not.
Ducey cited the board's approval of a felon in his veto letter.
"We know that individuals who are elderly are at higher risk of succumbing to financial fraud or financial schemes," Corieri said to Campbell. "Do you think it's appropriate for the board to give someone a license who has a history of committing financial fraud the ability to manage a facility full of vulnerable individuals?"
"Not if they have a history of it, but if it's something that occurred 24 years ago, do we still say no? We're supposed to be a second chance state and we're supposed to take a really hard look at this," she said. "We have people that apply to us and when we find out they have a criminal conviction, they usually come to us in person and we talk to them and find out what the case was and what the disposition was."
Rasmussen was convicted of defrauding two men about 15 years ago, not 24.
He was sentenced to 60 days in jail in Utah and three years of probation, landed a job at Grand Canyon University, moved to Arizona and started going by "Mike."
He later became the vice president of enrollment operations at a company called Dream Center Education Holdings that collapsed after stiffing students out of millions of federal loan dollars. Students missed mortgage payments, skipped book purchases required for classes and even cut grocery runs.
After that, Rasmussen got hired at Granite Creek Health and Rehabilitation and applied to be the administrator. In his application to the board, he simply described his departure from the Dream Center as an unexpected termination because the company closed his office.
The board never asked him whether he had anything to do with the student loan debacle.
And members took him at his word when he said he blamed his crimes on an unindicted co-conspirator, saying this overseas person who police never found was the one who took investor money and disappeared.
He boasted that he paid his victims back and one member praised him. He didn't mention it was under court order.
When asked about Rasmussen back in April, Campbell told The Republic she wasn't serving on the board when he got his license.
During the Nov. 2 committee meeting, Campbell stressed that it's "so important" the board remains independent because all of the other members are actually working in the field and they "grill" managers or administrators facing complaints.
Believe her or not, she said.
"We do our very, very best," she said. "We're very thorough. It's not like we don't pay attention, because we really do. We really care. All of us. Every single one of us on that board."
Reach Caitlin McGlade at email@example.com. Follow her on Twitter @caitmcglade.
This article originally appeared on Arizona Republic: Ducey fired AZ nursing home board; committee suggests reversing order