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Grievance by town nurse centers on daily log, privacy

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Part one of a two-part story

PEPPERELL — With two new members and a chairman who is nearing the end of a first term fraught with personnel upheavals, the Board of Health (BOH) has been developing a more “take charge” attitude, to the displeasure of some.

Chairman Virginia Malouin and board member Myra Cacace, who both have nursing backgrounds, and returning member Peter Cronin, have made it clear they intend to follow through with the full range of their board’s list of responsibilities to the community, despite losing a key supervisor in former health agent Edward Wirtanen.

While no qualified full-time replacement for Wirtanen has been found, the agent’s inspection and community response duties are being contracted out on a part-time basis.

Former BOH secretary Lisa Herget resigned, shortly after Wirtanen left, to become the assistant town treasurer. Former Townsend Fire Department assistant Sandra Grogan was hired on a part-time basis. Grogan and town nurse Ellen Castellano have no direct supervisor who reports to the BOH.

The well-known and respected Castellano filed a grievance with the Personnel Board (PB) last month, after an emotional pre-evaluation meeting with health board members at which three town employees objected to the “tone” Cacace had set with her questioning.

Cacace said there was a need for more specific daily work records, including patient information that could be reviewed as required by an employer — the BOH — by state law as well as for protection against liability for both the board and the nurse. She added that a board member would accompany Castellano occasionally so the board could check on home-care quality.

Because Castellano works in a relatively unsupervised fashion, Cacace, with the concurrence of other board members, said more detailed documentation of her activities is important. Castellano was asked to fill out daily logs instead of the current monthly report. Castellano objected, maintaining the status quo has worked for her 16-year tenure.

The board also wanted access to the key to the freezer in the Communications Center where flu vaccine is stored, in case Castellano was unavailable. Castellano refused, arguing that she must sign for the vaccine and has been told by the state nursing association that it is solely her responsibility.

Castellano also argued that patient information must be kept private and under her control, as required by the Health Insurance Portability and Accountability Act (HIPAA). While current health board members are professional nurses and familiar with privacy issues, she said, there is no guarantee that would be the case in the future.

Cacace said the state health board association contends health boards have a right and responsibility to review patient information.

During and prior to her grievance hearing, Castellano said she felt the board wanted to fire her. She objected to the “unprofessional and demeaning way I was treated in (the Board of Health’s) unethical and unlawful demand (to see patient information).” She said she was “questioned and grilled” about an “unreasonable” request for better log-keeping.

Town Clerk Lois Libby, Council on Aging Director Sharon Mercurio, outreach worker Joan Goddard, and former health secretary Lynda Pozerski had attended Castellano’s pre-evaluation screening with the BOH without the nurse’s knowledge but to support her.

Mercurio, Goddard and Libby spoke on her behalf and objected to the “tone” used by the BOH. They did so to the point that Cacace reminded them she doesn’t answer to them regarding the handling of an employee. Cacace repeatedly said, and was supported by Malouin and Cronin, that the board has no intent to fire Castellano.

Castellano’s three supporters also attended the grievance hearing, as did former council director Marcia Zaniboni and police administrative assistant Cathy Forrest. Her supporters contend the BOH is being unreasonable.

At the hearing — which is continued while board members review audio tapes — personnel director and town administrator Robert Hanson said the question of ownership of the key has been resolved.

Castellano agreed the BOH has a right to see patient charts once identifiers are redacted, but she maintains that being “continually asked for information that is illegal” constitutes “harassment.”

She disagreed with Cacace and Cronin that her annual review was a “good” one — saying it was “the worst I’ve ever received.” (She received a rating of 6, or above average on a scale of 2-4-6-8).

Castellano argued the paperwork states her evaluation is for a “non-supervised employee,” yet the board “told me I need to be supervised.”

Town administrator and personnel director Robert Hanson said the Personnel Board responds only to violations of the personnel bylaw, and while it is true any violation of HIPAA is illegal, any personal discomfort arising from public meetings is nearly impossible to address.

He said the personnel board has no authority over an independently elected board acting within the scope of its duties, nor can it demand an apology. Control over the BOH lies in the hands of voters, he said, and had Castellano come to him as personnel director prior to the grievance, the matter might have been resolved.

Mercurio described Castellano’s Nov. 6 pre-evaluation screening as “quite hostile” and that the nurse “was grilled (and) demeaned” when asked how she spent her time.

PB member Judy Dalton maintained that addressing harassment is within the board’s purview, arguing strongly that an employee has a right to air personal issues with the board — as can be done with any human resources department.

Castellano said Hanson’s statement indicates the BOH has the “OK to do it again and again,” adding, “I only refused phone numbers (on records), otherwise (her monthly log method) includes (everything necessary).”

Selectman and PB member Darrell Gilmore said he would think the BOH has the right to know what is kept in its department.

“They can, but they went behind my back,” Castellano replied.

Hanson explained that Castellano’s job evaluation carries little actual impact because she is grandfathered. At worst, she could lose longevity for one year.

“In the 25 years of my experience, the addition of one or two members to a board changes the way the board does business,” Hanson said. “I’d say she (Castellano) is lucky after 16 years (to have experienced) no shake-up in the way business is done.”

A week later, Hanson said labor counsel has ruled that including telephone numbers on Castellano’s records does not violate confidentiality.

He also said the privacy information provided Castellano by the Massachusetts Nursing Association relates only to her nursing operations, not the records. One solution could be to have one BOH member review Castellano’s log, and another member handle records. Each could be stored separately to prevent cross-referencing.

The hearing was continued to allow personnel board members to listen to audio tapes of Castellano’s pre-evaluation meeting.

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