Attorneys hired by the Bingham Memorial Hospital board reported their internal review of allegations raised in the press during the months of May and June 2012.
Attorneys Walter Bithell and Erik Stidham from Holland & Hart in Boise conducted this review.
"We had full access," Bithell said. [The board's direction was, "whatever you think you need to review."
The attorneys investigated seven basic allegations:
° Outdated Medications and Supplies
° Billing for Saipan Hospital
° Purchase and Sale of Equipment by Cyberdine
° Telephone Monitoring
° Medicare Secondary Payer Forms
° Length of Stay
° Conflicts of Interest
Holland & Hart interviewed current and former BMH employees including board members, administrators, doctors, nurses, IT employees and other BMH staff. They also interviewed individuals who made complaints to the media.
"Holland & Hart attorneys conducted over 90 interviews and searched more than 500,000 documents and e-mails during the investigation," the report states.
"It was more of an historical exercise," Bithell said. "Almost everything we looked at was something from the past year or two."
What did they find?
Outdated Medications and Supplies
According to this report, in 2010, one BMH nurse went through the Medical Office Building and removed expired medication samples and supplies during a Joint Commission Audit. She filled four garbage bags and placed these in the trunk of her automobile.
The next day, these materials were disposed of in the trash and bio-hazard receptacles.
In conclusion, following the Joint Commission inspection, BMH required weekly inspections for outdated medication samples and supplies.
The recommendation was to ensure hospital personal are properly trained regarding the inspection, handling and disposing of outdated medications and supplies.
Billings for Saipan Hospital
Without informing the BMH Board of Directors, CEO Louis Kraml and COO Dan Cochran formed a company called International Consulting Services and, through it entered into billing and consulting agreements with a hospital on Saipan.
The recommendation was for board members to amend Kraml's contract going forward. "Administrators would be required to report and disclose involvement in actual or contemplated outside business or employment opportunities to the BMH Board of Directors," the report states.
"The former IT Director used BMH employees to install IT equipment for a Cyberdine customer while they were on the clock for BMH," the report states. "During the time period between September 2011 and April 2012, BMH Administration closely monitored the installation of the new computer system and IT Department activities.
IT Director Jack York was suspended on April 6, 2012. He resigned from BMH on April 19, 2012.
The former IT Director of BMH instructed an IT employee to record telephone conversations of one BMH doctor, his nurse and receptionist. These phone conversations were recorded for 10 days to two weeks and ended on July 6, 2010. It has not happened since that time.
"When the phones were discovered, BMH Administrators immediately ordered removal of the phones," the report states.
The former IT Director said he was instructed to install the listening devices by an administrator but he doesn't remember who the administrator was.
The administration said no one was authorized to do this.
No one was able to produce the recordings and no one interviewed knew the content of the recordings, Bithell said.
Bithell would not call this wiretapping but said it was "listening."
"It shouldn't have happened," he said.
The recommendation was to appoint an independent ethics officer or ombudsman who reports directly to the Board of Directors.
Medicare Secondary Payer Forms
In June 2010, the emergency room (ER) clerks were instructed to complete Medicare Secondary Payer (MSP) forms for patients admitted to the ER between July 2009 and May 2010.
Clerks are now trained to insure MSP forms are being completed.
Length of Stay
In the spring of 2011, the head of the Case Management Group (CMG) became aggressive in telling physicians that increased emphasis needed to be placed on reducing patients' length of stay.
In the early summer of 2011, BMH instructed the CMG to stop putting recommendations about length of stay in patient files.
Alleged Conflicts of Interest
It was alleged certain board members profited by leasing physician office space to Bingham Memorial through their joint company.
In conclusion, the report states the SMH Board properly handled the leases of property from BMH board members.
The Attorney General's office conducted a review of the transaction to determine if there was a conflict of interest and warranted further review. In April of 2012, the Attorney General concluded that "no further action … is necessary."
Bithell said the Idaho Attorney General's office is conducting its own investigation. The criminal side of the AG office is looking into two of the allegations. The civil side of the AG office is looking into the remaining five allegations.
"Responsibility for these events rests solely with me," said Kraml. "The hospital serves the public and needs to be transparent to employees, the public and the press going forward."
When ask if the press allegations helped foster this investigation, Stidham said, "Our investigation differs in two points [from the allegations brought by the press.]
Point one. "Our investigation was more thorough," he said. "We had more authorization and authority in and out of the hospital.
Point two. "Bias was clearly evident," he said. "We were able to provide facts and conclusions to the board [without bias]."
Stidham said the amount of time put into this investigation was approximately 1,500 hours.
The cost of the investigation was between $400,000-$500,000, said Bithell.