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Sunday, October 16, 2016

Critics claim ‘collusion’ in hospital’s $36.5M contract


Newly released emails show New Hampshire Hospital Chief Medical Officer David Folks - employed at the time by Dartmouth College - worked directly with state employees to write the state's RFP to provide psychiatric staff at the hospital.

Former professional staff members have confirmed Folks also told them that he was involved in writing Dartmouth-Hitchcock's contract proposal, which they claim is a conflict of interest. ...

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Newly released emails show New Hampshire Hospital Chief Medical Officer David Folks - employed at the time by Dartmouth College - worked directly with state employees to write the state's RFP to provide psychiatric staff at the hospital.

Former professional staff members have confirmed Folks also told them that he was involved in writing Dartmouth-Hitchcock's contract proposal, which they claim is a conflict of interest.

Folks still works at New Hampshire Hospital under the state's controversial $36.5 million
contract with Dartmouth-Hitchcock Medical Center, but the state recently announced he will leave in January.

The Concerned Psychiatric Professionals of New Hampshire Hospital, whose dozen members were forced out of their hospital jobs in a labor dispute, told Executive Councilors in a June 10 letter that Folks and Assistant Medical Officer Alex de Nesnera both worked on the state's Request for Proposals and on Dartmouth-Hitchcock Medical Center's bid as well.

"This represents a conflict of interest and a complete lack of ethics of all involved," the Concerned Psychiatric Professionals said in the letter.

Health and Human Services Commissioner Jeffrey Meyers told the Executive Council in June that such a thing would not happen.

"It was not written by anybody outside the department. I want to state emphatically at no time do we let anybody outside the department (of Health and Human Services) write an RFP that we then issue. That's not accepted practice, and business is not done that way," Meyers said at the June 15 Governor and Council meeting.

Emails between Folks, de Nesnera (also employed at the time by Dartmouth College), New Hampshire Hospital CEO Robert MacLeod and COO Geoffrey Souther, both state Health and Human Services employees, show the four had discussed psychiatric and medical staffing at the hospital, including personnel qualifications for the RFP.

An email dated Jan. 28 shows that Folks told Souther and MacLeod that he added information to the state's RFP.

Under the subject line "Re: Dartmouth RFP," Folks wrote, "Geoff, I have provided two sentences for each of the personnel below. Let me know if you wish to have more detail as to the qualifications. David."

The next day, Souther responded, "Excellent, thank you David."

Folks also provided a document titled "Proposed RFP Metrics" for the three others to review, according to emails, which were part of 450 pages of state documents about the
Dartmouth-Hitchcock contract. They were released to under a Right-to-Know request.

Victoria Cronin, a psychiatric nurse practitioner who was a member of the ousted group, said the state-released emails, which she reviewed, proved she was right about conflicts in the bidding process.

"Now we have documentation - clear and convincing evidence that in fact there was collusion between Dartmouth College and the commissioner's office," Cronin said.

Cronin, an outspoken critic of Hassan's handling of the process, now works at the Veterans Administration Medical Center in Manchester.

She was suspicious that only a few of the emails directly referenced Dartmouth College and state employees working on the RFP. Others may have been redacted so the public wouldn't find out, she said.

About 80 pages were partially or completely blacked out. Lawyers from Health and Human Services and the Attorney General's Office offered only general explanations as to what they redacted.'s right-to-know request involved documents in the state's possession related to the Dartmouth-Hitchcock contract process. An unknown number of documents in the governor's office were redacted or withheld.

"Please be advised that it is the long-standing position of the New Hampshire Department of Justice that RSA 91-A does not apply to the Governor's Office," wrote Associate Attorney General Anne Edwards who responded for her office and the governor's office. Chief Legal Counsel Frank Nachman responded for DHHS.

In an op-ed piece last month published in the Concord Monitor, Cronin wrote: "Gov. Maggie Hassan made it clear her priority was ensuring her Dartmouth benefactors were awarded the $36.5 million contract.

"... Interestingly, according to published reports, Dartmouth employees have contributed more than $30,000 to her Senate campaign," Cronin wrote.

Folks often mentioned in meetings with medical staff that he was writing Dartmouth-Hitchcock's bid, she said.

"The commissioner lied to the executive council and the governor when the council asked directly if anybody helped write the state's RFP. He was adamant that they did not," Cronin said.

According to the audio recording of the Governor and Executive Council meeting on June 15, Meyers insisted no one outside of Health and Human Services worked on the state's RFP.

In fact, Executive Councilor Chris Sununu , a Republican who is running for governor against Democratic Councilor Colin Van Ostern, referenced the letter from the Concerned Psychiatric Professionals of New Hampshire Hospital at the meeting. He asked Meyers directly if two Dartmouth College employees had written both the state's RFP and Dartmouth's bid.

Meyers responded: "I can state categorically that the RFP was produced internally at the department by the contracts unit and other staff."

One email also indicates that Meyers was aware that losing 12 of the 19 top psychiatric professionals at the hospital could interfere with patient care. He told councilors at the June 15 meeting they should vote for the four-month extension of the Dartmouth College contract.

Dartmouth College no longer wanted to bid on the contract and the extension language allowed assigning it to Dartmouth-Hitchcock Medical Center.

On the eve of that meeting, Meyers sent an email to John Kacavas, legal counsel for Dartmouth-Hitchcock Medical Center.

"John - Just FYI, NAMI has or will be reaching out to the Governor and Executive Council about the continuity of care concerns with the change in doctors. Bob MacLeod tells me that about 12 of the current staff will be gone by July 1, assuming approval of the extension tomorrow - which I believe will happen.

"This is all to say that the info I requested about how many patients will be seeing new docs is important to have by early morning. I will be meeting with the Council at Breakfast at 8 a.m.," Meyers wrote. Kacavas did not return phone calls.

The dozen psychiatrists and psychiatric nurse practitioners ended up leaving June 30 raising concerns about adequate staffing at the state's psychiatric hospital.

Those concerns were heightened after the July 27 suicide of a 63-year-old woman who jumped from a third-floor window in Nashua just hours after being released from the hospital.

In late August, the Executive Council delayed the contract vote, but approved it on Sept. 7. Days later, Dartmouth-Hitchcock Medical Center announced it was planning to lay off hundreds of employees.

Concord attorney Sean List, who previously represented the Concerned Psychiatric Professionals of New Hampshire Hospital, said by law the RFP process should ensure a neutral, impartial selection and procurement procedure based upon objective criteria.

"If in fact there were any individuals who worked on both the RFP on behalf of the state and formal bid on behalf of Dartmouth-Hitchcock, that would not be objective, impartial or fair," List said. sought interviews with Meyers and Gov. Hassan on Tuesday, Wednesday and Thursday. They were unavailable.

Meyers' spokesman Jake Leon acknowledged NAMI's concerns for patients during the transition to Dartmouth-Hitchcock that occurred on July 1. He said that was conveyed to the Governor and Executive Council.

Leon said Meyers planned to provide more information to on Friday. He also acknowledged that Folks had provided information to the state relative to its RFP "based on his clinical experience at NH Hospital."

Gov. Hassan's spokesman William Hinkle said the Department of Health and Human Services prepared the RFP for psychiatric services ... "and this contract went through a competitive bidding process."