Staff at the Horton Community Hospital in recent months have been operating without enough supplies and with no money to purchase needed medications, food for patients and even office supplies, a top hospital official said.

On Dec. 31, chief nursing officer Krissy Torkelson spent hours on the phone negotiating with city officials to keep the hospital's lights on, she said. Trash is piling up outside the hospital because the bill wasn't paid on time, she said.

And on Friday, the nurses and employees who have been working to keep their small-town hospital open in increasingly dire conditions didn't receive their paychecks, Torkelson said. They were first assured by CEO Ty Compton that paychecks would be in by noon, then told that if they weren't in the bank by Friday evening, it would probably be Monday morning.

In an email obtained by The Topeka Capital-Journal, Compton attributed the paycheck issue to an accounting glitch in transferring money between bank accounts.

HCH owner EmpowerHMS, a subsidiary of The Empower Group, a Florida-based corporation led by Jorge Perez, has been under fire nationwide for failing to pay bills. Empower is being investigated for billing practices involving lab tests it has run through some of its hospitals even though few if any of the tests were for the hospitals’ own patients, and those investigations have created some of the cash flow challenges being reported at many Empower facilities.

Compton, as HCH's top official, about two weeks ago said his hospital was stable, even as others in the Empower system were failing. He couldn't be reached Saturday for comment.

Few to no supplies

Torkelson told a different story.

"We currently are working with very little supplies," she said. "We didn’t have any money in an account for food, so they’ve been having to clean out our freezers for our patients. Our utilities were shut off to our business office. We have an accounts payable list that’s close to $1 million of just different vendors that we owe. And we’ve been cut off from like Medline for supplies. We can’t order for our pharmacy.

"We don’t have any type of credit with anyone, and so we ran out of paper. People have been donating copy paper to us. We’re a paper system, so it’s ..."

Her voice trailed off, and she didn't seem to know how to continue to emphasize the uncertainty and instability of the operation.

The hospital's late payments on utility bills were discussed at previous city council meetings. Horton Police Chief John Calhoon, who has been acting as city administrator, expressed concerns about late payments earlier this month.

Utilities in jeopardy

Torkelson said the business office utilities were shut off earlier this week, and the hospital got an extension to pay its bill until Friday.

"They made like a portion of the payment to the city officials in order to keep it on for Friday," she said. "Last month, New Year’s Eve, I spent half the day negotiating with our city administrator, John Calhoon, trying to keep the electricity on for the hospital. He was again just going to shut off the business office. He will not shut off the hospital because of employees and because of patients. I was negotiating with him and the corporation for four hours trying to get that paid on New Year's Eve. It’s just been a constant every month — we have not paid utilities on time."

Her words, and those of Calhoon when The Capital-Journal contacted him earlier this month, were in direct contradiction to Compton, who said in an interview, "To my knowledge, our utility bills are current."

Although the daily stress of operating with few supplies and uncertainty about the hospital's future is significant, Torkelson and another employee, who asked to remain unnamed in concern for her job, highlighted significant issues with their employee benefits.

Unpaid or unavailable benefits

Payments deducted from employee checks that were supposed to be deposited in their retirement accounts apparently haven't been made, Torkelson and the employee said. In addition, they were told they have a life insurance benefit equal to 1.5 times their salaries, and some people elected to pay additional dollars monthly to increase that benefit, Torkelson said.

"At the end of the year, it’s usually taxed," she said."Then they were told that they would not be taking taxes out on it because we did not have that benefit all year. But no one was notified of that until December."

It appears that people who were having extra dollars taken out of their paycheck lost money that should have been applied to the policy, Torkelson said.

On top of those concerns, employees don't have insurance cards and don't believe they have health insurance, even though dollars for their part of the insurance payments have been deducted from their paychecks, she said. That includes issues with a health savings account, to which Empower was supposed to contribute about $200 for the year, Torkelson said. Some employees also elected to put extra dollars into the HSA.

Instead, when employees attempt to use the cards to purchase health services or supplies, the cards show they have no balance, Torkelson said.

She has reached out to the Kansas Insurance Department and to the U.S. Department of Labor about what has been happening.

Management's response

In an email from Michael Christensen, president of EmpowerHMS, that was distributed to staff in the past week and obtained by The Capital-Journal, Christensen discussed monies taken out of paychecks for benefits that weren't available.

"Empower HMS will pay back all those premiums which were withheld," Christensen wrote.

He also alluded to problems the unnamed HCH employee discussed about insurance switching between two companies and leaving unpaid hospital or other health bills.

"Many of our team members also have claims still unpaid from the period of time when Core Management was the TPA (January 2018 thru December 2018)," Christensen said. "I personally use the self funded insurance and just got off the phone with a collector trying to collect from me for services my wife received in July 2018. We are still in the final phases of negotiation to determine how such claims will be processed and paid."

He added that he was excited that staff now have insurance cards and claims have been prepaid for 2019, "which will allow all of you to again receive medical care."

Fear and frustration

HCH's 40 to 50 full-time employees have become increasingly frustrated, Torkelson said.

"Frustration has definitely set in. As a CNO, I don’t know how many nurses I will have left," she said.

The hospital employs six nurses for day and night shifts.

"It's getting rough," Torkelson said. "I've heard a lot today from my staff, 'Can we use you as a reference?' I have nothing to offer you guys to stay here. They haven’t gotten raises for years. I can’t even give them an insurance company and a policy number to say this is what we have."

It is becoming more clear that Horton Community Hospital might close.

"I hope not," Torkelson said. "But if we stay with this corporation, I just cannot imagine that there's a different outcome. I pray that we can provide services some way. We have an EMS through our hospital. We have a rural health clinic. We have ER. We have inpatient, we have outpatient services. We have so much to offer that we hopefully can find a way to get out of this."

It doesn't help that the only other hospital in Brown County, Hiawatha Community Hospital, also is struggling, she said. The Hiawatha World reported Jan. 29 that hospital officials there were asking for help from city and county officials to meet financial obligations.

"To think that our county may or may not end up with a hospital, that’s a very scary thought for all of us," Torkelson said.

Calhoon and Compton couldn't be reached Saturday for comment.

Update: This article was corrected at 7:30 p.m. Feb. 4, 2019. Quotes originally attributed to Ty Compton were correctly attributed to Michael Christensen, president of EmpowerHMS.