Document about director to health board

Here is the document left anonymously at the Standard. It outlines serious claims of fault by Todd County Health Department Director Leslie Daniels.

For more on the document and reaction to it see this week's Todd County Standard.

Date: October 19, 2009

To: Todd County Board of Health Members

From: Vicki Myers, Asst. Superintendent of Schools and Todd County Health Coalition Member

RE: Health Department Grant Issues

I am submitting the following information so that all Board members are aware, and so corrections can be made as needed:

Since mid-April, 2009, the Health Department Director has:
• Missed critical deadlines, 7 times
• Said verbally or by email she had taken care of something, when she had not, 21 times
• Stated something as fact which was not, 6 times
• Been very late or missed meetings which she should have been very involved in, 5 times
• Caused students to be in danger (medication errors), 2 times
• Not trained or supervised staff adequately (treatment protocols, confidentiality, billing, pay-rate/personnel issues, daily supervision)
• Not taken adequate responsibility/ownership of this grant: in most other counties, these grants are completely through the HD

Additional Information:
• Mr. Green has been very involved in this grant and has worked diligently to make any corrections as needed.
• There are many opportunities for the Health Department to generate revenue with this grant and they simply are not being put in place.
• Why was a new billing clerk hired for the grant? We were told all along that a current employee would do the billing, that they had plenty of time to do it and had already been trained.
• Why were there only 600 doses of seasonal flu vaccine ordered again this year (same # as last year), when flu is such a huge issue this year?
• What are the exact numbers of services provided at the Health Department each year (how many physicals, immunizations, etc.)?
• Do these numbers support the hiring of the two additional new RNs at the HD, or could these services be covered by giving additional hours to the nurses working at the schools?
• The public explanation of the Health Department budget is simply unacceptable.
• In Todd County our Health Department is critical to the healthcare of our citizens, yet available services have declined over the past several years

Tuesday, April 21, 2009
• Sandra asked Leslie about interviewing and hiring nurses for upcoming school year.
• She informed Sandra per email that she would begin taking applications and once they were on the state registry she could pull their names and start interviewing.

Log that accompanied the summary:

Monday, April 27, 2009
• Per Leslie’s request, sent her the school nurse interview questions that the school uses when interviewing potential nurses.

Friday, May 08, 2009
• Received email from Leslie stating she will start interviewing for RN positions next week and that her ARNP had resigned.

Monday, May 25, 2009
• Sandra emailed Leslie inquiring about health insurance for the nurses that would be transitioning over to the HD.

Wednesday, May 27, 2009
• Leslie replied via email to Sandra stating the nurse’s insurance would go into effect the first day of the month following the month they were hired.

Thursday, May 28, 2009
• Sandra emailed Leslie to inquire about interviews for existing LPNs.
• Sandra advised Leslie that the transitioning nurse’s health insurance would lapse August 1st if not hired in July according to what she had previously told her.
• Sandra advised Leslie about the (DPH) required school nurse orientation training on July 14-15, but that registration was due by June 10th.

Friday, May 29, 2009
• Leslie’s response pertaining to email from May 28th: “I will contact personnel about the register to make sure each person is on there. If they aren’t then I cannot interview them. As soon as I know they are on there I can pull the register.”

Monday, June 01, 2009
• Sandra inquired to Leslie about re-hiring existing LPNs.
• Sandra advised Leslie that Christian County HD transitioned their existing school LPNs without going through the official hiring process.
• Sandra suggested that Leslie contact Mark Pyle (CCHD director).
• Leslie responded by email stating, “I will contact Mark.”

Leslie emailed the CCHD director on June 01, 2009 below:

From: Daniels, Leslie M (LHD-Todd Co)
Sent: Monday, June 01, 2009 9:23 AM
To: Pyle, Mark (LHD - Christian Co)
Subject: School based Program

It is my understanding you were able to switch LPN’s hired by the school system to your employees and that you didn’t have to go through the hiring process. Please let me know if this is correct and if so, how were you able to get approval from the state?
Thank you,

Leslie Daniels, MS
Public Health Director
Todd County Health Department
205 McReynolds Drive
Elkton, KY 42220
270-265-2362

His response was:

From: Pyle, Mark (LHD - Christian Co)
Sent: Monday, June 01, 2009 10:06 AM
To: Daniels, Leslie M (LHD-Todd Co)
Subject: RE: School based Program

Leslie,
We did have to post the position internally. Every school nurse from the school system has to complete an application, provide copies of license and college transcript, and is subject to a background check. This is important so that we can verify experience. We are paying based on experience. I worked with Ron on this for about a year.

• Sandra asked Leslie what information the LPNs needed to provide and reminded her that their rate of pay as per the Foundation proposal was $15/hr.

Leslie’s email response to Sandra:
I have to advertise. Once hired I do a background check on each employee. I will call personnel today about the pay rate since the rate has to be included in the advertisement or the state won’t agree or I’ll have to advertise again. I’ll let you know what I find out.
Leslie Daniels, MS

Friday, June 05, 2009
• Sandra emailed Leslie requesting a meeting with Dr. Manthey to discuss his role in the school clinics, along with Donna Talley and Sheila Griggs for them to discuss payroll and funding issues.
• Leslie replied stating she would get back with us when she got the dates set. She emailed back later that day with email below:
I have to check with Dr. Manthey Monday to see when he has a gap in his schedule. Mondays seem to be busy and people call in the morning wanting appointments and he will know by 9am Monday when he will have time that afternoon. That’s the most information I can get today.
Leslie Daniels, MS

Wednesday, June 10, 2009
• BOE mailed in registration fees for 3 nurses to attend required school nurse orientation training.
• This training had been discussed with Leslie on Thursday, May 28th , but had not heard back from her regarding hiring of nurses, but registration for this training was due today.

Friday, June 12, 2009
• Annmarie emailed Leslie requesting a meeting on Monday, June 15th, 2009 at 10am.
• Also asked for Sheila Griggs and Dr. Manthey to attend.
Monday, June 15, 2009
• Meeting with Mr. Green, Vicki Myers, Donna Talley, Annmarie Spurlin and Sandra Brown to discuss contract between BOE and HD. No one from HD showed up for the meeting.
• Annmarie emailed Leslie and Sheila a copy of the contract. Leslie advised she was out of town and Sheila stated she was not aware of the meeting.
• Annmarie emailed Mark Pyle (CCHD director) inquiring if new nursing staff, once hired, could attend his coding and billing training.
• Mr. Pyle replied that the training would be on July 28th and that our nurses could attend.

Friday, June 19, 2009
• Annmarie emailed Leslie regarding getting school health packets together to be able to distribute them during school open houses.

Wednesday July, 08, 2009
• Foundation requested a letter from Dr. Manthey stating his role in school health program.

Thursday, July 09, 2009
• Received email from Leslie stating she will pull registry today and does not know if the nurses will be hired in time to attend the required school nurse training.
• Leslie states she was interviewing ARNPs on July 9 & 10.

Friday, July 10, 2009
• Received and email from Leslie stating she had hired an ARNP who could start on July 31st.
• Leslie also stated she had set interviews for the RNs next week and would have them hired by Friday, July 17th.
• Leslie also states the state will help with training and coding for new staff and is working on space for the RNs to do their online training for well child exams.
• Leslie advised that she dropped off letter for the Foundation from Dr. Manthey at the BOE with Vicki Myers.

Monday, July 13, 2009
• Leslie started interviewing existing LPNs. (Sandra and Annmarie had been asking since April about the transitioning of the existing LPNs and Leslie had just now started interviewing them).

Tuesday, July 14, 2009
• Leslie informed Sandra per email that she was dropping off school protocols for Dr. Manthey to sign and that she was making copies of the practice reference manual for each school and requested to meet with Sandra on July 27th to go to each school site to make a list of supplies needed.
• Sandra replied per email to Leslie to let her know what time on the 27th she would like to meet.

Wednesday, July 15, 2009
• Annmarie met with Leslie she stated she had hired 2 LPNs and that the RNs would be hired in a couple of weeks.
• Leslie stated she was still awaiting a reply back from the state regarding Humana.
• Annmarie reminded Leslie that protocols needed to be typed up and signed by Dr. Manthey.
• Annmarie inquired about health packets for school open houses, which Leslie said she would get together. Deadline for packets and protocols of August 10th was given.

Friday, July 17, 2009
• RNs not hired as promised on July 10th.

Thursday, July 23, 2009
• Sandra emailed Leslie requesting to change site visit date to Tuesday, July 28th.
• Leslie confirmed change.

Monday, July 27, 2009
• Annmarie inquired about RN applications.
• Annmarie asked Leslie if Callie Wells, ARNP could attend the Leadership meeting on Monday, August 3rd to introduce her to the Principals and for her to tour the schools.

Tuesday, July 28, 2009
• At 2:20 p.m. Sandra received an email stating Leslie could not do the site visits today as previously rescheduled.
• Sandra sent Leslie an email explaining what was in each school clinic in detail and reminded her of what we had requested in the grant proposal.

Wednesday, July 29, 2009
• Annmarie emailed Leslie reminding her about the meeting on Monday, August 3rd and requesting that Callie tour the schools after the meeting.

Monday, August 03, 2009
• Leadership meeting 8:00am at South Todd Elementary school which Leslie had previously been informed that she needed to attend and bring the ARNP.
• Leslie called Annmarie at 7:45am to inform that the ARNP would not be able to attend the meeting and inquired if she needed to be there and was informed that she still needed to attend. Leslie arrived 15 minutes late to the meeting.
• Administrators asked several questions, including billing for Humana, who would cover the schools if a nurse was absent, and operations of the new school clinics. Leslie could not answer any of these questions, but she assured them she would find out.
• After the meeting several administrators questioned Leslie’s awkward behavior and slurred speech. Mr. Kenner, Superintendent, addressed this issue with Mr. Green.
• Sandra emailed Leslie inquiring about Medicaid Provider numbers which are needed to bill Medicaid.

Leslie’s Response to above referenced email:
Provider numbers are assigned when the employee is keyed in the system unless it is a contract. I didn’t apply for a Medicaid number yet since we weren’t sure we were going to have school clinics. I don’t know where your friend received her information, but that is not correct. Medicaid can be rebilled or billed back one full year so I am not worried about that. We will get things set up as soon as they can be completed on our end for the health department.
Leslie Daniels, MS

Tuesday, August 04, 2009
• Annmarie inquired about the status of the RNs. (still not hired and Leslie promised to have them hired by July 17th)
• Annmarie requested all new nursing staff attend opening day assembly at the high school for introduction of new nursing staff and a meeting afterwards with Vicki Myers.
• Annmarie inquired again about billing Humana.

Friday, August 07, 2009
• Leslie emailed Sandra and Annmarie a list of new employees hired to date.
• Sandra asked Leslie about coverage at the elementary schools until nurses could officially start.
• Sandra reminded Leslie about the opening day assembly.
• Sandra also asked Leslie about nursing supervision per KRS 314.011 regarding LPN supervision.
• Leslie states she is still interviewing for RN and clerical position.
• Leslie states clerical position will be posted in next week’s paper.
• Leslie is requesting Medicaid numbers today.
• Received notification from Leslie that RNs had been hired.
• Leslie advised that she was having copies of PHPRs made, employee handbooks, signed protocols and “making sure we have everything ready to go”.
• Annmarie called Ron Horseman regarding Humana. He advised that Humana can be billed by a mid level provider. Asked Mr. Green to confirm this information.

Monday, August 10, 2009
• Deadline for Leslie to have Health Packets ready for distribution in schools. Health Packets not ready.
• Opening day assembly for school. Nurses and Leslie arrived late, were briefly introduced upon arrival, then immediately left the assembly following introduction.
• Leslie and school nurses attended meeting with Sandra, Annmarie and Vicki Myers at 1:30 in annex.

Wednesday, August 12, 2009 *FIRST DAY OF SCHOOL*
• NO HEALTH PACKETS SENT OUT TO STUDENTS.
• NO HEALTH CONSENTS IN PLACE. Except for the regular school consents.
• NO NURSE AT NORTH TODD.
• NO CODING OR BILLING TRAINING FOR NEW NURSES HAD BEEN DONE.
• NO WELL CHILD OR TRAINING MODULES COMPLETED.
• NO PHPR FOR NURSES.
• NO SIGNED PROTOCOLS.
• NO HD FORMS FOR NURSES.
• NO CLARIFICATION ON SUPERVISION OF NURSES.
• NO INFORMATION SENT OUT TO PARENTS PERTAINING TO NEW SCHOOL HEALTH PROGRAM.
ALL OF WHICH LESLIE ADVISED SHE HAD TAKEN CARE OF!!

Thursday, August 13, 2009
• Annmarie inquired to Leslie about PEFs, consents, and nursing coverage at North Todd.
• Leslie gave Annmarie a consent to treat form, which Sandra and Annmarie had to revise to fit school health and they also typed a letter to go out with the consent on behalf of the HD.
• Leslie inquired to Annmarie about who the nursing staff contacts for questions and who her BOE contact is.
• Leslie emailed stating she had received Medicaid site numbers. (email below)

Subject: FW: Mediaid site numbers

We just received the site numbers for each clinic. We are complete with hiring, employees in the system, provider numbers for employees, working on basic health department training, Medicaid site numbers for each site, protocols signed, and the PHPR should be to each site by Monday.
I think we are set to start billing as soon as we have the consent forms from the parents.

Annmarie, please make sure the grant people know everything that can be done from our end is complete.

Leslie Daniels, MS

Monday, August 17, 2009
• New nurse starts at North Todd.
• ARNP to begin her rotation through schools beginning August 24th.

Tuesday, August 18, 2009
• Annmarie emailed Leslie concerning Humana AGAIN and she states they are still working on it. Also inquired about HD providing flu shots to school staff. She did not respond to this question.
• STILL NOTHING IN PLACE AS STATED ON AUGUST 12TH.

Wednesday, August 19, 2009
• Sandra updated over the counter medication protocol that was previously given to her by Leslie to include only medications pertinent to the school clinics. Sandra advised Leslie that yeast infection medication, vitamin B12 injections and cancer/rheumatoid arthritis medication should be removed from the original protocols since these would not be necessary in school clinics.
• Sandra reminded Leslie about the Advisory Council meeting on September 2nd.

Friday, August 21, 2009
• Annmarie notified Leslie of meeting on Wednesday, August 26th with Dave Bolt regarding Foundation requirements.
• Annmarie advised Leslie that she would need to bring signed protocols to the meeting.
• Early release Friday nurses meeting, arranged by Sandra and Annmarie, in the high school annex. Questions asked by the school nurses were specific to billing and coding, documentation, who their supervisor was, supplies and protocols for over the counter medication. Leslie advised everyone that she was still working on getting them trained for coding and billing but it probably would be the first of October before she could get anyone down from state level to train them, also that she would look into how they needed to chart for the HD side.
• ST nurse inquired about Principal requesting her work hours change from 7:30am-3:30pm to 7:15am-3:15pm to accommodate early arriving student issues. Leslie told Sandra to have the Principal send her something in writing requesting this change.
• Some concerns were raised about Leslie’s awkward behavior and slurred speech.
• With regards to needing supplies, BOE purchased $500 worth of first aid supplies to get the nurse started.
• STILL NOTHING IN PLACE AS STATED ON AUGUST 12TH .

Monday, August 24, 2009
• Sandra forwarded the ST Principal email requesting school nurse’s hour change as Leslie had requested on August 21st.

Tuesday, August 25, 2009
• Sandra received email from Leslie stating she would prefer all nurses to be on the same time schedule and did not want ST nurse to arrive at school early.
• S.C.O.R.E. Meeting at Board of Education. Leslie arrived late, had to be called by Mr. Green to remind her that she had to attend.
• After meeting adjourned, Sandra talked to Leslie about nursing concerns from Friday’s meeting and she states,” I don’t remember anything from that day. I’m doing good to be here because I had a wreck over the weekend.”
• Sandra reminded Leslie to bring protocols to meeting with Dave Bolt on Wednesday, August 26th. Leslie confirmed that she would bring them.
• Sandra discussed with Leslie about what to do for nurse absences. Sandra expressed the importance of having HD nurses in place to be able to bill for services. (If Sandra covers a school, she cannot bill for services). Leslie stated that she was not concerned about the nurse missing one day. She did not think that would hurt reimbursement of revenue.

Wednesday, August 26, 2009
• Meeting with Dave Bolt with the Foundation. Leslie had been aware of this meeting for some time, but arrived 1 hour late. When Annmarie called the HD to see where she was, Sheila stated that Leslie had left to go to Dr. Manthey’s office to get the protocols signed. (Please note that on August 13th email, highlighted section, Leslie said this had already been done.)
• Chain of Command issues were discussed and Annmarie stated we preferred not to go through Sheila because of her outburst at the Board of Health Meeting on June 18, 2009 and we did not feel like she was on board with this program after that.
• Leslie informed us that she would not be able to get the state people down for coding/billing training for the nurses until fall break.

Thursday, August 27, 2009
• Sandra emailed Mark Pyle (CCHD director) to inquire about obtaining DVD of coding/billing training he had taped over the summer for training his school nurses. (Sandra and Annmarie felt the nurses did not need to wait until October before they were properly trained on how to code PEFs and bill.) He said he would burn us a copy if Leslie would come and pick it up.
• Sandra informed Leslie of the need to email Mark Pyle to make arrangements to pick up coding/billing DVD.

Friday, August 28, 2009
• Leslie emailed Mark Pyle to make arrangements to pick up coding DVD.
• After no response from Leslie regarding Humana. Annmarie called Humana to inquire about billing for services for staff. It was at this time that Humana confirmed that services were billable by a mid level provider.
• Early release Friday nurses meeting in the high school annex. Nurses still having questions regarding charting for HD. Leslie said she would email someone regarding what is required for HD charting. Nurses still having questions pertaining to consents. Leslie advises that students can be seen but not billed if a consent is not on file.
• Sandra inquired about nursing coverage for the high school due to high school nurse requesting day off. Leslie said she would check into it.
• Nurses inquired about their pay being wrong.
• Talked about chain of command.
• Nurse at NT quit due to needing more hours. She is going to work in clinic and Leslie sending clinic nurse to work NT beginning Monday, August 31st. Leslie stated she wasn’t sure how this nurse was going to work because she was a new graduate and didn’t like to give shots.
• Leslie also advised us that she had told Sheila what was said about Sandra and Annmarie being reluctant to go through Sheila after her outburst at the board of health meeting. Leslie stated that because of this Sheila had washed her hands of this program.
• At this time, no billing consents have gone out. Leslie states that she was going to continue to bill anyway because the date on the form is for 09-10 school year. Leslie agreed that by Monday, August 31, she would have a Medicaid consent in place.

Monday, August 31, 2009
• Leslie picked up coding DVD from CCHD.
• Leslie delivered Medicaid consents, as agreed, but after reviewing Medicaid consents, they were not appropriate for school health. New consent designed by Annmarie and Sandra.
• North Todd nurse quit. Leslie advised that nurse quit due to a discrepancy in her pay.
• Sandra discussed with Leslie about coverage for NT and high school.
• Sandra spoke with Leslie regarding nurse coverage. TCCHS nurse requesting day off on Tuesday. Leslie advised that she would work it out and let Sandra know in the morning, but that she would go to the high school first thing in the to have Callie go to NT.

Tuesday, September 01, 2009
• Todd County High School – not covered.
• Sandra called Leslie this morning to inquire about nursing coverage because she had told Sandra she had nurses at the HD today that she would possibly be able to get to the school to cover after lunch because they were in clinic doing their on line Train modules. Sandra inquired how quick she could get a new nurse hired and she told Sandra at this time that she had been busy working all morning talking to people in Frankfort on how to remove the nurse who quit from the system. Leslie stated she hadn’t had time to pull the registry to look at it to get a new nurse hired. Leslie then said her nurses that were in clinic doing the online Train modules could not be pulled to the schools because they can’t be interrupted. At this time Sandra agreed to cover lunch time meds and diabetics.
• Sandra received a phone call from the high school stating there was no nursing coverage and that someone from the HD had come to the high school this morning stating that Sandra would be covering all day.
• Sandra received a phone call from high school Principal inquiring about nursing coverage. Sandra informed the Principal that she would be over to cover lunch time meds and diabetic only. The Principal stated that a HD person said Sandra would be covering all day, which was not correct.
• While at the high school to cover lunch time meds and diabetics. Sandra was confronted by the Principal who was extremely upset about not having nursing coverage.

Wednesday, September 02, 2009
• Callie had to be pulled from regular scheduled school (TCMS) to cover vacancy at North Todd.
• Vicki Myers, Annmarie Spurlin and Sandra Brown met with Leslie to discuss Medicaid consent form and billing. A revised Medicaid consent form was shown to Leslie for approval. Leslie approved consent form and it was copied same day and sent to schools for distribution by Annmarie and Sandra.
• Leslie informed Vicki, Annmarie and Sandra at this meeting that they were behind on keying PEFs. Leslie brought a report for 2 schools for 4 days worth of billing. Annmarie had a report showing that the nurses had seen over 400 students already to date. Leslie assured us that by the Advisory Committee Meeting on Wednesday, September 9th, most PEFs would be keyed in and she would bring an accurate billing report.
• Discussed hiring nurse at North Todd. Leslie advised that things were being held up at state level.
• Sandra talked to Leslie by phone regarding nurse vacancy at North Todd and how it would covered for next week. Leslie informed Sandra that she would have Brandy (HD nurse) cover the high school on Wednesday, September 9th and Linda (High School nurse) would cover North Todd. Christy (HD nurse) would cover the high school on Friday, September 11th and Linda would cover North Todd. Leslie requested that Sandra inform Linda of the change.
• Sandra called Linda to inform of coverage change for week of Sept. 8-11.

Thursday, September 03, 2009
• Callie pulled from regular scheduled school (TCCHS) to cover vacancy at North Todd.
• Sandra received an email from ST nurse requesting time off. Sandra emailed Leslie asking that Leslie make arrangements with the HD nurses for coverage on September 15th and September 24th.

Friday, September 04, 2009
• North Todd not covered. Still no nurse hired.
• Early release Friday nurses meeting in annex. Nurses watched Coding and Billing Training DVD provided by CCHD.
• Sandra reminded Linda about the change in her schedule for week of Sept. 8-11 to cover North Todd and Leslie secured coverage for high school.

Tuesday, September 08, 2009
• Linda mistakenly went to North Todd today, which left the high school uncovered.
• Sandra covered lunch time medication and diabetics.
• Sandra emailed Leslie to ask for an update on hiring status for NT nurse.
• Leslie replied that 2 new applicants had been send to Personnel and she was awaiting the state to approve them for interviews.
• Sandra emailed Leslie to inform her that ST nurse did not need off an entire day on September 15th or September 24th. Sandra asked Leslie if she wanted Linda to cover ST for the partial day on those dates and if she could arrange for HD nurse to cover high school. Leslie replied that she would have HD nurse cover high school on 15th and 24th.
• Sandra reminded Leslie of Advisory Council Meeting on Wednesday, September 9th and reminded her to bring Medicaid billing information.

Wednesday, September 09, 2009
• Advisory Council Meeting at 10am.
• Sandra asked Leslie about getting seasonal flu vaccine for staff and she stated she was only allotted 600 doses and that she has a flu clinic to cover before she can promise vaccine to anyone else. Most of school staff is covered by Humana insurance and this would be guaranteed money generated for the HD. Sandra asked CCHD about what happens if they run out of flu vaccine and was told that all they have to do is order more because there was no shortage of seasonal flu vaccine.
• Sandra asked Leslie where she is at hiring a clerk to key PEFs and she stated that the one she had in mind is not going to be able to do this now and that she has stacks and stacks of PEFs that need to be put in.
• Nearing the end of the meeting 11:15am, Sandra double checked with Leslie to make sure the high school had nursing coverage as per our conversation the previous week (September 2nd). The arrangement that Leslie agreed to was that Linda Spurlin would go to NT on Wednesday, Thursday and Friday and that Leslie would have HD nurses cover the high school on Wednesday and Friday and Callie would cover the high school on Thursday. At our Advisory Council Meeting when Sandra questioned coverage, Leslie said she knew nothing about needing nursing coverage for this day. A student’s medication was not given this day because there was no nursing coverage and once Sandra realized this, by the time she got to the high school it was past the legal time to give the medication. The student’s parent was notified of the omission by Sandra. Leslie and Vicki Myers were also notified of medication error.
• Sandra emailed Leslie to verify coverage for September 11th (see September 2nd conversation) and Leslie stated that the HD was double booked for Friday and Sherry Moody was out of the office on that day so there was no one to cover NT.
• Sandra also inquired about nursing coverage for the week of September 14th thru September 18th. Sandra compiled a nurse coverage chart for Thursday, September 10th thru Friday, September 18th and submitted this to Leslie for approval.
• Leslie informed Sandra that she would have HD nurse cover high school September 14th from 11-1pm and HD nurse to cover high school September 15th, she was unsure about coverage on Sept. 16th. Callie would be at high school on the 17th and couldn’t guarantee coverage for September 18th.
• Leslie stated she was working on a list of possible RNs to fill in PRN.
• Leslie informed Sandra and Annmarie that she would not be in the office for the remainder of the week, nor on Monday. She said Sandra needed to contact Sherry Moody if problems came up. She then gave Sandra Sherry cell phone so she could reach Sherry if she was out of the office.



Thursday, September 10, 2009
• Leslie approved nurse coverage chart that was submitted to her by Sandra on September 9, 2009.
• Linda called to inform Sandra that she was going to be out on Friday, due to surgery.
• Sandra emailed Leslie to inform her of this. Leslie emailed back stating that she would have Brandy cover the high school on Friday, September 11th from 11-1.
• Leslie requested that Sandra forward her email on to Mr. Green.

Friday, September 11, 2009
• No nursing coverage at North Todd and High School.
• Annmarie emailed Mr. Green requesting a meeting to discuss problems with no nursing coverage, medication errors occurring, etc. Annmarie informed Mr. Green that Sandra had received an email from CCHD requesting to get in touch with Callie.
• Mr. Green scheduled a meeting with Vicki, Sandra and Annmarie for Monday, September 14th.
• Sandra called high school at 11:30am to make sure HD nurse had shown up and was informed that no nurse was there, but that all lunch time meds had been covered by trained school staff.
• At this time Sandra called Sherry Moody at the HD, but was informed that she was in a room with a patient and that she would have to call me back. Sandra never received a return phone call.
• 12noon, still no call back. Sandra called to speak to Brandy. Brandy informed Sandra that she had never been made aware that she was supposed to cover the high school and that they were too busy doing PAP Smears to leave.
• At this time Sandra went to the high school to give the medication at the Academy and there were no students in the nurse’s office nor was anything abnormal reported at this time.
• Sandra forwarded Leslie’s email from the previous day to Arthur Green as Leslie had requested. Sandra also informed him that no nurse showed up today unlike what was stated in Leslie’s email from the previous day.
• At approx. 3:00pm Sandra received an email from Vicki Myers stating that a diabetic student did not receive their insulin at lunch and the parent called the School Board Office upset because the student stated he went to the nurse’s office but no nurse was there and he waited for quite some time but did not know who to go to. The student’s blood sugar was 270 when he got home. This is the 2nd medication error in one week due to lack of nursing coverage, when Sandra and Annmarie had been informed by Leslie that coverage would be in place!!
• Vicki Myers emailed Leslie to inform her of the upset parent of the diabetic student. Vicki also expressed concern about nursing coverage not being in place when Sandra had been told by Leslie that it would be.
• Leslie replied to Vicki stating that she addressed the nursing coverage issue with Sheila and that she should have told Sheila who she was sending to cover the high school. Leslie stated she did tell one of the HD RNs to cover the high school on Friday, September 11th from 11-1, but she didn’t have an answer for why they didn’t cover the school.
• Leslie informed Vicki that she has requested from Personnel to have the new nursing applicants reviewed and placed on the register so she can interview them next will and fill the vacant nurse position ASAP.
Monday, September 14, 2009
• Vicki, Sandra and Annmarie met with Mr. Green to discuss concerns. He assured them he would look into the issues and get back with them.
• Sandra called HD to confirm that Brandy was to cover high school from 11-1.

Tuesday, September 15, 2009
• HD nurse covering high school until 12noon, then South Todd nurse covering high school for remainder of day.
• Callie ARNP at South Todd all day.
• Linda (TCCHS nurse) covering North Todd because Leslie requests that clinic HD nurses cover high school only.
• Leslie sent email stating 2 RN applicants have been approved by personnel and she has called them to set up interviews.

Wednesday, September 16, 2009
• Sandra emailed Leslie to inform her that Callie may be out Thursday, September 17th because of jury duty which meant that if Callie was out that the high school would not be covered because high school nurse was covering North Todd on Thursday since Callie was regularly scheduled to be at high school.
• Sandra asked Leslie to be prepared to provide HD nurses to cover due to Callie’s absence on Thursday as well as needed coverage for North Todd on Friday.
• Leslie responded to Sandra saying that she would have an HD nurse cover North Todd on Friday, September 18th, but that Thursday was the flu clinic at the HD and that she only had 2 HD nurses to handle the flow of patients at the HD.
• Sandra had inquired to Leslie about the status of hiring a nurse at North Todd and Leslie informed Sandra that she had called the 2 new applicants for the North Todd nurse position and will be interviewing one on Friday, September 18th and hopes to have one hired that same day.
• Sandra had inquired about where Leslie was as far as getting RNs on a sub list to cover for absences. Leslie informed Sandra that she had received a call from an RN who was interested in being on call.

Thursday, September 17, 2009
• Leslie emailed Sandra inquiring about a Flu consent form that she had heard was sent out by the schools. I reassured Leslie that NO consent for flu shots had been sent out.
• Leslie requested a total number of flu shots needed for school staff.
• Sandra informed Leslie she would get that total to her as soon as she could.
• Sandra emailed Leslie to ask who she was sending to North Todd to cover.
• Leslie replied and stated the HD nurse would be covering North Todd all day.
• Leslie informed Sandra that she would be doing another change that should help with coverage in the event someone was absent and stated she would discuss that further at the meeting on Friday.

Friday, September 18, 2009
• Leslie informed Sandra and Annmarie that she is looking at going through a Temp Agency to get nurses to cover absences.
• Leslie informed Sandra, Annmarie and Vicki that she was appointing Sherry Moody as school nurse supervisor.
• Leslie emailed Sandra and Annmarie informing them that she had hired an RN for North Todd and that she would be starting on Friday, October 2nd.
• Sandra asked Leslie about nurse coverage September 21st thru September 25th. Sandra informed Leslie that she would work on the nurse coverage chart and email it to her for approval.
• Sandra also informed Leslie that if Sherry Moody was going to be the nursing supervisor that Sherry should sign time sheets instead of Sandra doing it. Leslie agreed.
• Sandra emailed Leslie a nurse coverage chart for September 21, 2009 thru October, 2, 2009. The chart showed nursing coverage needed for the middle school on Tuesday, September 22nd for a few hours. No nursing coverage for North Todd on Thursday, September 24, Friday, September 25th and Thursday, October 1.
• Leslie approved nurse coverage chart and stated she would have HD nurse cover middle school if needed and that she would get back to Sandra about coverage for the other days.
• Sandra spoke with Leslie and emailed her reminding her to check with her supplier for cost of POC testing. Sandra informed Leslie that she would check with the school supplier to see which would be cheaper. Sandra also informed Leslie that the BOE would pay for the testing supplies until grant funds came in if needed.
• Sandra expressed concern that we need to offering POC testing to our students instead of sending them out to have this done.

Monday, September 21, 2009
• Leslie emailed Sandra and stated she had spoken with the middle school nurse and made arrangements for HD nurse to cover from 10-12.
• Sandra reminded Leslie about needing coverage for North Todd on September 24th and 25th.
• Sandra informed Leslie that the schools needed 150 flu shots for staff. Leslie had told Sandra previously that she had set back only 100 flu shots for school staff.
• Sandra asked Leslie what days she wanted to starting giving the flu shots to staff.
• Leslie stated that flu consents would need to be sent out before coming to the schools and that staff would need to provide a copy of their Humana card for filing insurance
• Leslie informed Sandra that there were actually 120 flu shots held back for school staff. Sandra told Leslie that the BOE could buy an extra vial of flu vaccine if needed to cover the extra staff requesting flu shots. Leslie emailed Sandra back and stated that she would see what she could work out.

Thursday, September 24, 2009
• Sandra called Leslie this morning to inform her that North Todd needed more Tylenol. Sandra also informed Leslie that North Todd had reported that Sherry Moody had made arrangements to go to North Todd on Friday, September 25th to start giving flu shots. Sandra informed Leslie that she knew nothing about this until receiving a phone call from the school. Leslie stated that Sherry would not be able to go on Friday, because she (Leslie) needed to be with her and wasn’t going to be able to go on this day.
• Sandra asked Leslie to have Sherry call her to set up dates and Leslie said she would let Sherry know.
• Sarah Evans, Family Resource Center Coordinator, sent out a mass email to all North Todd staff informing them that Sherry Moody would be at North Todd, on Friday, September 25th at 1:00 to start giving flu shots. This email was sent out without Sandra’s knowledge. Sandra had just spoken with Leslie earlier this morning and to her understanding this was not going to happen.
• Sandra spoke with Sarah Evans for clarification and Sarah informed Sandra that when Leslie came to North Todd to drop of the Tylenol that she had told her that she and Sherry would be out on Friday to start giving flu shots. Once again Sandra had no knowledge of the change because just this morning Leslie had told her that it was not possible to start flu shots on Friday.
• This issue was emailed to Mr. Green and he was informed of the major miscommunication and that Sandra still had not received a return call from Sherry, but that apparently things had been set up without Sandra’s knowledge.
• Sherry finally contacted Sandra, flu shot dates were finalized.
• Sandra emailed school staff informing them of flu shot dates and times at each school.

Friday, September 25, 2009
• Sandra received a phone call from Mr. Voth, Asst. Principal at South Todd, informing her that the nurse had called out sick today.
• Sandra informed Mr. Voth to call Leslie at the HD to inform her of this and to inquire about coverage.
• Mr. Voth called Sandra back and said that Leslie stated that she could not send an HD nurse to cover the school.
• Sandra informed Mr. Voth that she would come out to cover.
• Sandra covered South Todd from 8am-12noon and saw 13 students, all of which were not billable because Sandra is not an HD employee which equals a day of lost revenue for the HD.
• Sandra and Annmarie had plans to attend a meeting in Hopkinsville that pertained to projects for the grant, but had to cancel due to covering a nurse absence.

Monday, September 28, 2009
• South Todd nurse still absent.
• Callie at South Todd as regularly scheduled, but had to leave due to her sick child.
• Sandra called Leslie to get nursing coverage for South Todd, but Leslie informed her that she was unable to send a HD nurse to cover.
• Sandra had to cover South Todd this day.
• Sandra saw 23 students this day and since she is not an HD employee she is unable to bill for her services. This was another day of lost revenue, which if Leslie could have provided an HD nurse to cover, then these services would have been billable.

Tuesday, September 29, 2009 thru Friday, October 2, 2009 – NO SCHOOL due to illness

Monday, October 5, 2009 thru Friday, October 9, 2009 – NO SCHOOL- Fall Break

Monday, October 12, 2009
• Annmarie and Sandra planned to go to North Todd to meet new nurse and train on Infinite Campus.
• Annmarie and Sandra stopped by South Todd before going to North Todd and noticed that there was no nurse present. Upon inquiring to the office staff, Annmarie and Sandra were informed that the nurse had called out for the day.
• Sandra called the HD to speak to Leslie about this but was told by Sheila Griggs that Leslie had not yet arrived, but that she (Sheila) was not aware of why the nurse was absent this day.
• Sheila informs Sandra that the ST nurse had given her 2 week notice but that she was supposed to be there this day.
• Sandra asks Sheila to have Leslie call her as soon as she arrived.
• While Annmarie and Sandra were at ST a student who had fallen in the hallway arrived for treatment and a diabetic arrived for his morning blood sugar check which were assessed and treated by Sandra and Annmarie.
• During this time Callie Wells arrives as regularly scheduled.
• Sandra receives a call back from Leslie before leaving and Leslie informs her that she was not aware that ST nurse was absent and informed Sandra that the ST nurse had given her resignation letter Friday, October 9th.
• Leslie states that she was planning on calling or emailing Sandra to let her know that the ST nurse had resigned, but because it was so late in the day on Friday when she was made aware of it that she hadn’t had time to do that yet.
• Sandra reminded Leslie that South Todd nurse needed to go with a diabetic on a field trip on Wednesday, October 14th and that a HD nurse needed to cover the school until regular nurse returned.
• Leslie stated that she needed to be made aware of field trips in advance so she could make arrangements. Sandra informed Leslie at this time that she had emailed her on Monday, September 28th to inform her of this upcoming field trip and for her to go back and check her emails.
• Leslie emailed Sandra back informing her she would have an HD nurse cover South Todd while regular ST nurse went on the field trip.
• Sandra emailed Leslie back asking her if she had talked to ST nurse to see what it would take for her to stay. Sandra expressed to Leslie what a great job the ST nurse was doing and that it would be bad to lose her.
• Leslie emailed Sandra back replying that she had not had a chance to talk to the ST nurse yet, but that the reason she was leaving was because of issues with her pay and then stated that she didn’t think she would be able to do anything about the pay.
• Leslie emailed Sandra stating that the new North Todd nurse was having problems and inquired if Sandra and/or Annmarie were planning on going out to help her.
• Sandra informed Leslie that she had already taken care of getting the new nurse set up in the school computer system, but that Sandra had to address some other important issues that came up (such as the nurse being absent at ST this morning and having to cover the school until Callie arrived) which hindered her from getting out to North Todd.
• Sandra asked Leslie if Sherry Moody (nursing supervisor) could go out to North Todd to show the new nurse how to fill out the PEFs and code for her services.
• Sandra informed Leslie that she had important meetings scheduled for the rest of the day, but would go out Tuesday, October 13th to show North Todd nurse how to access Infinite Campus.
• Annmarie and Sandra went to speak with ST nurse to see what it would take for her to stay. ST nurse stated that her pay rate and benefits were not being given as promised by Leslie during her interview.

Tuesday, October 13, 2009
• Sandra went to North Todd to train new nurse on Infinite Campus.
• Callie at North Todd this day and states she will help new nurse with charting and filling out PEFs.
• New nurse stated she was at the HD all last week with nothing to do. She stated she cleaned counter tops.
• Sandra inquired as to why she was not sent to the middle school because the middle school nurse worked last week and could have shown her how to do things. New nurse did not know the answer to that question.
• Annmarie emailed Mr. Green and Leslie to inform him of the reason why ST nurse was quitting and asked if there was anything that could be done to keep the nurse from quitting.
• Mr. Green replied to Annmarie’s email requesting all the school nurse’s email addresses. He was going to set up a meeting with the school nurses.
• Leslie replied to Annmarie’s email stating that she had spoken with the ST nurse and that the nurse was not quitting now. Leslie stated she had resolved the pay rate issue and that she and Mr. Green were checking into annualized pay for the nurses.

Wednesday, October 14, 2009
• Advisory Council Meeting
• Mr. Green questioned who was supposed to train the new nurses on Infinite Campus. Sandra informed Mr. Green that she was supposed to do that. (please see entry on Monday, October 13th for explanation of why this was not done on the new nurse’s first day. Infinite Campus is important for the nurses to know, but there are more important things such as filling out PEFs and proper coding that need to be addressed for revenue to be generated. These things can be done without the nurse having knowledge of Infinite Campus.)
• Sandra asked Leslie why the new nurse was not sent to the middle school to orient with the middle school nurse last week.
• Leslie stated she was not aware that the middle school nurse had worked last week.

Friday, October 16, 2009
• Leslie emailed Sandra and Annmarie to inform them that she has ordered POC test kits. (Sandra and Annmarie had been asking for these since the initiation of the school health program because this was a service that was to be offered in the school clinics per the grant proposal.)