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Former Community Hospice nurses say work environment was toxic

Community Hospice, at 4368 Spyres Way in Modesto, is pictured Aug. 4, 2016.
Community Hospice, at 4368 Spyres Way in Modesto, is pictured Aug. 4, 2016. jlee@modbee.com

Carolynn Peterson was making a fresh start in late 2014 as interim director of a nonprofit hospice in Grass Valley after spending almost 10 years in leadership positions with Modesto-based Community Hospice Inc.

She had held her job for three months when her new employer received a terse certified letter dated Jan. 7, 2015. It was from Peterson’s former boss – DeSha McLeod, Community Hospice’s chief executive officer.

McLeod wrote that Peterson had been demoted from her position of chief operating officer in 2011 and that her work history was incorrect in a biography listed on the Grass Valley hospice’s website. She requested that all references to Community Hospice be removed from the site and that Grass Valley hospice employees refrain from seeking to use policies and forms used by Community Hospice.

Peterson was stunned. She had served as Community Hospice’s chief operating officer for four years before her title was changed to vice president and chief clinical officer in a 2011 reorganization.

“She was a very effective manager,” said Harold Peterson, former longtime CEO of Community Hospice, who was puzzled why McLeod would write such a letter. He said Carolynn Peterson’s pay was not cut and her performance was not an issue when the reorganization occurred under his leadership in 2011. The two Petersons are not related.

At the time of McLeod’s letter, Carolynn Peterson was under consideration to be the permanent executive director of the Grass Valley hospice. The Grass Valley board was undeterred by the letter and later gave Peterson the job.

When asked about the letter, McLeod said she wanted to stop any sharing of proprietary information and insisted her letter was correct about Carolynn Peterson’s work history. “(The hospice) website showed that Carolynn Peterson was the chief operating officer when in fact her title was chief clinical officer when she left Community Hospice,” she stated.

The Grass Valley board complained about McLeod’s “false and misleading” letter in a response to Jonathan Felton, then board chairman for Community Hospice, who said he did not recall the details around the letter and had no other comment.

Since taking over as CEO in June of 2013, McLeod has won ardent supporters while alienating other people such as Carolynn Peterson. Last month, the respected nonprofit with the “Helping hands, healing hearts” slogan was thrust into the spotlight when five doctors who cut ties with the organization publicly aired complaints about McLeod’s leadership.

That now has prompted public comments from former nursing staff members, who said a significant number of nurses left the hospice two years ago because of what they say was a toxic work environment under McLeod.

It raises questions about what’s going on with the nonprofit hospice. Are the complaints legitimate, or just the grumbling of people who’ve had a beef with the CEO?

New management

McLeod managed a for-profit hospice in Mississippi before replacing Harold Peterson, a popular CEO who for 17 years developed Community Hospice into a leading charity in Stanislaus County, with a list of donors that includes the region’s business elite. The agency provides end-of-life care for patients in their homes, nursing facilities and the Alexander Cohen Hospice House in Hughson.

Based on conversations with people who have worked with her, McLeod is a hard-driving manager responsible for improving the nonprofit’s bottom line.

The agency says it has recorded improved financial numbers under McLeod, with net income more than tripling from $276,620 in 2013 to $971,802 in 2015. McLeod, whose salary is $250,000 a year, has enjoyed strong support from board members and longtime hospice supporters.

“My opinion is DeSha has taken the baton and done an excellent job managing the organization,” said John Tremayne, Community Hospice Foundation chairman. He says many volunteers donate their time after loved ones received compassionate care from the hospice. He said that hasn’t changed under McLeod’s leadership.

McLeod has said the recent criticism is invalid, and the hospice remains committed to its mission of providing quality end-of-life care.

Dr. Edward Auen, a former medical staff member and one of her biggest critics, is unconvinced. “She has taken (hospice) down the wrong path,” he said.

Shelly Stewart, a former nurse practitioner for the hospice, said her heart remains with Community Hospice but the organization’s internal problems in the last three years are a red flag.

In an August 2014 letter to the board, Stewart wrote that 27 nurses had left since McLeod took over in June 2013. Stewart said many of those nurses had five to 10 years’ experience or more and were first-rate staff members.

McLeod installed her own chief clinical officer and placed tougher demands on nursing staff, said former employees, who say the work environment became unpleasant.

Nurses said they worked long hours trying to meet the demands and had to work off the clock to finish their charting. Several nurses said Lori Davis, a nursing director from Mississippi hired by McLeod, threatened to use GPS to track them and make sure their mileage statements were accurate. Nurses were allegedly told they could quit if they didn’t like the policies.

“It became quite impossible to accomplish what we were expected to do on a daily basis,” said Katherin Daubenberger, a nine-year veteran who decided to retire. “This lady (Davis) was something else. She did not trust us. She threatened to track us on GPS. It was just ugly.”

The Modesto Bee’s efforts to reach Davis were unsuccessful. No complaints regarding working conditions or overtime pay were filed with the state, and none of the employees brought litigation.

According to nurses, cost-cutting piled more work on the staff, forcing home nurses to take time away from patients to admit new patients. One nurse complained to the board she had a caseload of 26 to 30 patients, double the recommended guideline, and was working many hours off the clock to finish paperwork.

Dr. Gary Pickell, a former medical director, came to the nurses’ defense after seeing how they were berated at a staff meeting. His letter to the board in August 2014 said: “Several nurses have told me they are no longer able to endure what they perceive as gross disrespect and denigration, unreasonable, inappropriate and possibly unlawful work demands, and verbal and occupational abuse.”

Conflict with VP

Davis, who has an associate’s nursing degree, arrived in September 2013 and soon replaced Carolynn Peterson, the chief clinical officer whose credentials included a master’s degree and certifications in hospice care.

“DeSha and I didn’t do well from the get-go,” Peterson said recently. “She felt she needed to fix us and we disagreed. ... It was hostile. You never knew when she was going to blow up at you.”

Peterson said McLeod gave her the opportunity to resign with a severance package, which she accepted in January 2014.

Doctors including Auen, a longtime physician for Community Hospice, brought issues regarding Davis to the attention of the hospice board in August 2014. The board was about to place her on paid leave while the issues were investigated, but Davis resigned.

McLeod said her staff never used GPS on work phones to track employees and has complied with employment laws concerning overtime. She said Community Hospice nurses are required to carry a load of up to 14 patients, consistent with an industry standard.

McLeod said the departure of nurses should not be characterized as an exodus. According to its records, the hospice has lost 40 nurses under McLeod’s leadership: 12 from June 1, 2013, to Aug. 1, 2014, and 28 from August 2014 to the present. The hospice said 51 nurses have been hired since 2013 and it currently has 74 nurses.

The turnover numbers are inconsistent with Stewart’s statement the hospice had lost 27 nurses by Aug. 20, 2014. Paperwork from August 2014 shows the board tried to address a spike in attrition that month and Stewart’s claim that the hospice had lost 27 nurses.

McLeod said nursing staff turnover was 20.75 percent in the past year, below a regional average of 24 percent, according to the Hospital and Healthcare Compensation Service.

After the employee complaints were considered by the board in August 2014, the hospice conducted an audit and hired a consultant, which found its clinical records were in compliance with federal and state regulations, McLeod said. A contract with the See Strategies firm of Folsom enabled employees to anonymously voice any concerns.

An employee survey was conducted and the firm worked with management staff and conducted leadership training for five months.

“We respect and greatly value our employees, many of whom have worked for the nonprofit for years,” the hospice said in a statement. “We strive to create an honest, transparent and healthy environment.”

Community Hospice board members have said the complaints came from a small percentage of nurses, who dug in their heels in resistance to necessary changes, some of which were directed by the board.

Current conditions

Working conditions at Community Hospice today are a matter of opinion.

Social worker Jan Jordison, an 18-year employee, said she has seen employee morale wax and wane over the years. “I feel like morale is high today,” Jordison said. “I see good morale, and employees have a voice. I attribute that to the leadership of DeSha.”

Katherine Yarrington, a Community Hospice nurse for two years, said staff meetings are “wonderful,” informative and well-attended. “We care deeply about our patients. With any job, there are going to be changes and you work through them,” she said.

The hospice sent statements to The Bee from five other employees who said they are provided with good education and support from Community Hospice and senior management.

Alma Poblador Lopez, a nurse practitioner who took a job with a competitor in July, fired a parting shot with an Aug. 11 letter to the hospice board that was shared with The Bee. Lopez wrote that the hospice once invested resources in education and mentorship for nurses, but under McLeod’s leadership it hired a licensed vocational nurse to take charge of education for registered nurses.

“They keep on hiring new nurses, and I don’t know if the amount of training they receive is sufficient,” Lopez wrote. “Before you would have 90 days of orientation.”

More education for nurses was an issue raised by five physicians – Auen, Pickell, former medical director Centi Younan, Dana Buchanan and Erin Kiesel – who walked out in June after contract talks with McLeod failed. Aside from payment issues, the doctors wanted guarantees that nurses would receive better education in hospice care.

Stewart, who has taught at UC Davis, said good staff training is essential for hospice care. The specialty is not adequately taught in nursing schools, but is learned through experience and mentorship, she said.

Hospice nurses need to understand the disease processes of terminally ill patients – whether they are elderly or children – and know the effects of pain medication and how to work with families who know nothing about end-of-life care, Stewart said.

Since the five physicians left, the hospice has used temporary doctors and nurse practitioners from staffing agencies to fill in, Lopez said.

McLeod acknowledged the hospice hired an experienced clinical educator last year on condition he obtain a registered nurse license within six months. An RN with almost 20 years’ experience with Community Hospice replaced him as clinical education director when he did not become a registered nurse, she said.

The hospice said it offers continuing education for nurses, hosts annual quality of life and bioethics conferences, and has in-service training throughout the year. In the past two years, the hospice sent nursing staff to a three-day Hospice Regulatory Bootcamp in Las Vegas.

Besides the loss of clinical staff, finance director Rick Dahlseid departed in March and Lynis Chaffey, director of development, resigned last month to take a position with another employer.

“I remain firmly and completely committed to the mission of Community Hospice,” Chaffey wrote in an email. “Seldom do you have the opportunity to work with such a compassionate and mission driven team of professionals. I have been blessed by the experience.”

Others recruit hospice’s staff

Stewart said she is saddened to see so many quality staff members leave Community Hospice.

“They have lost a lot of good nurses and they lost those doctors who were community-based, who knew the staff and patients and knew the community,” Stewart said. “It was the best team, the best doctors and best mentors and educators I have seen in 45 years of nursing. In less than three years, it became the worst place I had ever worked.”

Nurse Joey Louis-Codoni said the pressure to increase her workload caused her to leave Community Hospice.

“The territory was crazy big. I was driving from Modesto to Los Banos, to Merced and Livingston and seeing patients in Atwater and Keyes,” Codoni said. “I was charting all the time after work. I could not deal with pressure like that and it was affecting my family.”

Codoni said McLeod was pleasant with her and believes the board expected the CEO to improve the bottom line. McLeod implored her to stay and offered her a promotion when she resigned, Codoni said, but she turned it down.

Noting that things changed quickly after Harold Peterson retired, Karen Sly said four or five nurses in her group left. “I kept trying to stick it out as long as I could,” Sly said. “It seemed like no matter how hard we worked, we could not get ahead and were not recognized for our efforts.”

Carolynn Peterson, the former chief operating officer and chief clinical officer, said the board needs to get more involved with improving matters at Community Hospice.

McLeod has declined to discuss her management goals and decisions to place more demands on nurses. Last month, she released a statement in response to written questions from The Bee sent to the hospice at her request and simply referred to the responses during a phone interview.

She is faced with hiring a new medical director and the agency has posted the development director job on its website.

“One reason for turnover is we have wonderful staff and other agencies recruit them away,” McLeod said. “Finding a medical director is a slow process and we are in that process now.”

As this article was prepared for publication last week, four board members of Community Hospice sent emails expressing their support for McLeod.

Eric Tobias, a board member for 2 1/2 years, wrote that McLeod “has demonstrated strong leadership skills, addresses issues directly and fairly ... and always looks for ways to improve the organization. As a board member, she has my support in her role as CEO.”

Ken Carlson: 209-578-2321

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