Health & Hospitals Corp. (Metropolitan Hospital Center) v. Shea OATH Index No. 687/09 (Dec. 17, 2008), rev d, Hosp. s Dec. (Jan. 28, 2009), appended

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1 Health & Hospitals Corp. (Metropolitan Hospital Center) v. Shea OATH Index No. 687/09 (Dec. 17, 2008), rev d, Hosp. s Dec. (Jan. 28, 2009), appended ALJ recommends dismissal of charges where petitioner failed to prove that respondent was insubordinate to an assistant director, was derelict in her duties, failed to maintain patient safety, or engaged in unbecoming conduct. Hospital found respondent was insubordinate and had failed to maintain hospital safety. Hospital rejected as unsupported in fact ALJ s finding that supervisor acquiesced when respondent told supervisor she would not comply with the order. Ten day suspension without pay imposed. NEW YORK CITY OFFICE OF ADMINISTRATIVE TRIALS AND HEARINGS In the Matter of HEALTH AND HOSPITALS CORPORATION (METROPOLITAN HOSPITAL CENTER) Petitioner -against- KATHLEEN SHEA Respondent REPORT AND RECOMMENDATION INGRID M. ADDISON, Administrative Law Judge This disciplinary proceeding was referred by petitioner, the New York City Health and Hospitals Corporation, Metropolitan Hospital Center ( Metropolitan ), pursuant to section 7.5 of the Personnel Rules and Regulations of the Corporation. The Corporation charges respondent Kathleen Shea, a social worker, with various acts of misconduct, including insubordination, dereliction of duty, failure to maintain patient safety, and unbecoming conduct, when she failed to assess two children in the hospital s psychiatric emergency room, in spite of a telephone call made to her by the assistant director of social work. At a hearing before me on November 24, 2008, petitioner relied on the testimony of the assistant director, the office manager of the psychiatric unit, and documentary evidence.

2 - 2 - Respondent appeared with counsel and testified on her own behalf. For the following reasons, I find that petitioner has failed to prove the charges and recommend that they be dismissed. ANALYSIS Respondent is a licensed clinical social worker, who has been employed intermittently by the Health and Hospitals Corporation since From 1985 to 1989, she worked in the detox unit at Jacobi Medical Center. She worked at Metropolitan from 1990 to 1995, and from 2001 to the present. She was promoted to a social work supervisor in In April 2008, she worked in the inpatient psychiatric unit, referred to as 5 West, and the psychiatric emergency room ( ER ), where she had been providing coverage for some nine months after a worker had resigned (Tr ). The charges against respondent stem from her interaction with Angela Montague, Metropolitan s Assistant Director of Social Work, and the psychiatric ER technician on April 16, 2008 (ALJ Ex. 2). Ms. Montague has been the assistant director of social work since February 2008 (Tr. 17). She testified that at about 3:35 p.m. on April 16, Elizabeth Gallaway, office manager of the psychiatric unit, called to report that two minor siblings had been in the ER in need of attention since about 1:00 p.m., and that respondent had informed the technician that she could not attend to the children but someone would be sent to the ER (Tr. 18). Ms. Montague said that she asked Ms. Gallaway to reach respondent on her beeper (Tr. 19). Immediately thereafter, around 3:40 to 3:45 p.m., she called respondent and asked her to see the children because respondent had known of their presence in the ER for at least two hours (Tr. 20). Respondent refused, stating that she had been very busy, had been covering the ER for a very long time, and had left a message for her (respondent s) immediate supervisor, Ms. Morales, in accordance with Metropolitan s existing protocol, which requires that a supervisor assign a staff member to a task to which the supervisor is unable to personally respond. If no staff is available, that supervisor must contact her immediate supervisor. Ms. Montague opined that respondent s voice message for Ms. Morales did not constitute communicating with her supervisor (Montague: Tr , 28-29, 33-34; Shea: Tr ). Ms. Montague knew that Ms. Morales was not in the office, and said that she expressed her disbelief when respondent said that she did not know that (Tr. 21). According to her, when respondent refused, the following dialogue ensued:

3 - 3 - Ms. Montague: Respondent: Ms. Montague: Are you sure? Are you saying that you are refusing, you know, a direct order to address, you know, the children in the ER? Yes. I am refusing. Okay. No problem. I ll take care of it. (Tr. 21). Ms. Montague issued a written report on April 22, in which she noted that respondent had proposed that the adult ER social worker, who worked the evening shift, should handle the case (Pet. Ex. 3). She stated that she was opposed to that suggestion because it would have caused additional wait time for the children. She said that it was not yet 4:00 p.m., the time that his tour commences. Further, at the beginning of his tour, the evening social worker is required to make rounds which could take about a half-hour, during which time he would be unable to work with the children. Moreover, she could not vouch for his on-time arrival (Tr ). Her report further reflected that when respondent refused to see the children, Ms. Montague sought clarity, by asking Are you saying that you refuse to see the patients? (Pet. Ex. 3). Like respondent, Ms. Montague is a licensed, certified social worker. She works a 9:00 a.m. to 5:00 p.m. schedule, while respondent s was 8:00 a.m. to 4:00 p.m. She stated that workers are sometimes required to work beyond their regular hours based on the needs of the Department. For instance, if a worker was working with a family and needed to continue the session, it might require late work (Tr. 22). Ms. Montague said that she was concerned that the children had been at the hospital for almost the entire day, first in the pediatric outpatient unit, then the pediatric ER, and then the psychiatric ER. To compound that, the evaluation was necessary because one of the children had expressed suicidal ideas. Accordingly, soon after her discussion with respondent, she assumed the responsibility of evaluating the children (Tr ). The evidence revealed that entire process, including completion of the necessary paperwork, took approximately three and three-quarter hours (Pet. Ex. 2). Ms. Gallaway, the office manager, corroborated that, the psychiatric ER technician had called to make her aware of the children in the ER and respondent s position. She testified that she received this call at around 3:10 p.m. (Tr. 9-10). According to Ms. Gallaway, somewhere between 3:10 and 3:15 p.m., she called respondent, who told her that she was aware of the children in the ER. However, she was in the middle of something, it was almost four o clock,

4 - 4 - she was ready to leave, and therefore she could not see them. Ms. Gallaway said that she informed respondent that she intended to call Ms. Montague (Tr. 12). There were significant contradictions between the testimony of Ms. Montague and Ms. Gallaway. For instance, Ms. Gallaway said that she called Ms. Montague at around 3:20 p.m., while Ms. Montague testified that Ms. Gallaway called her around 3:35 p.m (Gallaway: Tr. 13; Montague: Tr. 18). In addition, Ms. Montague s report reflected that she received Ms. Gallaway s call at around 3:40 p.m. (Pet. Ex. 3). Further, Ms. Gallaway testified that Ms. Montague replied that she would contact respondent. Ms. Gallaway said she had no further involvement. On the other hand, Ms. Montague testified that she asked Ms. Gallaway to reach respondent on her beeper (Gallaway: Tr. 13; Montague: Tr. 19, 32-33). As the office manager of the psychiatric unit, Ms. Gallaway said that she was unaware that respondent was the only social worker assigned to the psychiatric inpatient unit. Nor was she aware that there was a case conference and family meeting, of which respondent was a participant that afternoon (Tr ). Ms. Gallaway was never asked to document the incident, and she never did. Moreover, even though there had been a Step IA disciplinary conference at the agency, Ms. Gallaway only became involved in the proceeding against respondent two weeks ago, when she received an from petitioner s counsel (Tr ). Therefore, I did not accord much weight to her testimony. Respondent did not dispute that somewhere between 1:00 and 2:00 p.m., on April 16, the psychiatric ER technician notified her that there were two children in the ER who needed to be seen by a social worker before they could be sent home. She informed the technician that she was scheduled to participate in a case conference almost immediately, to be followed by a large family meeting, but she would contact her supervisor to respond to the ER. She could not extricate herself from those pre-arranged meetings because representatives from other agencies, who collaborated in the treatment of the subject patient, were present for the conference. The family meeting, which involved another patient, had required a significant amount of coordination in having the necessary parties present. Those meetings were expected to run from 1:30 to 4:00 p.m. Accordingly, she could not personally respond to the children. Further, the only staff available to her was a new social worker whom she could not assign to the children. Ruth Morales, her supervisor, is a clinical social worker who had experience in the ER, and was the only other person who could respond. Respondent therefore called Ms. Morales. She

5 - 5 - admitted that she did not have a direct conversation with Ms. Morales, but rather, left her a voice message. Later, she forgot to follow-up on her voice message (Tr , 45-46). She also assumed that the children had been seen because normally the technician who had called her about the children would have persisted in calling respondent. In this case, the technician did not, possibly because respondent had informed her that the job was being handed off to Ms. Morales (Tr. 41). Respondent contradicted Ms. Montague s testimony that she called respondent around 3:40 or 3:45 p.m. She said that she normally returns to her office from the psychiatric unit close to 4:00 p.m., to listen to her voice messages and check her s, before completing her shift. She noted that on that afternoon, she had received no messages, nor had she been beeped by Ms. Gallaway. It was soon after she had checked her messages and s that Ms. Montague had called, in other words, closer to 4:00 p.m. than Ms. Montague had stated (Tr. 41). She testified that Ms. Montague inquired into her whereabouts all afternoon, and wanted to know why she had not attended to the children. She explained that she had been otherwise engaged and had left Ms. Morales a message. She confirmed that Ms. Montague expressed disbelief that respondent did not know of Ms. Morales absence from the office. However, she explained that even when Ms. Morales is in the office, she did not normally see her. Therefore, she would not have known of Ms. Morales absence. Moreover, the activation of Ms. Morales voice mail was not unusual because that often happens when the call recipient is on the telephone. Respondent said that she told Ms. Montague that she was at the end of her shift and would not commence work on the children, but suggested that the evening social worker handle the case (Tr ). She contradicted Ms. Montague s testimony that the evening social worker could not report immediately to the ER. According to her, he had done so in the past in order to assume casework from the previous ER worker whom she supervised, and whose shift ended at 4:30 p.m. Further, at her proposition of the evening social worker, Ms. Montague s response was that he was not yet present (Tr. 43). Respondent s recollection of the remainder of her discussion with Ms. Montague did not deviate significantly from Ms. Montague s written report. She testified that Ms. Montague s conversation was punctuated with [a]re you refusing to go down? Are you refusing to go down? At trial, she ruminated that, from the repeated nature of the question, she knew that she should not have declined to see the children. She acknowledged telling Ms. Montague, It s four

6 - 6 - o clock and I m off now, so I m not going down, and stated that that was the end of their discourse. Her purpose for declining was two-fold. First, she had not previously seen the children and therefore, no follow-up service was required to be performed by her. She explained that she has frequently worked beyond her regular hours to complete a case that she had already started. However, that was not the case here. Second, it was the end of her shift. To commence the evaluation of new clients after her shift had ended did not make sense, and seemed unreasonable. She said that the ER is staffed by multiple people and, it has been Metropolitan s practice that when one social worker is unavailable, another is called to respond (Tr , 46). Insubordination Charge Petitioner charges that respondent was insubordinate because she refused to follow a directive from Ms. Montague to assist the two siblings in the psychiatric ER, and responded in the affirmative at Ms. Montague s inquiry whether she was refusing to see the children, as directed (charge I, specifications 1 and 2). As a general rule, an employee is required to obey a supervisor s order when it is given. Dep t of Transportation v. Hines, OATH Index No. 790/07, at 3 (Feb. 9, 2007). To establish insubordination, the petitioner must prove by a preponderance of the credible evidence that (1) an order was communicated to respondent; (2) that order was clear and unambiguous in its content; and, (3) having heard the order, the respondent willfully refused to obey. Transit Auth. v. Wong, OATH Index No. 1866/08, at (Aug. 28, 2008); Dep't of Sanitation v. Dobie, OATH Index Nos. 2092/07, 2093/07, 2094/07 & 2095/07, at 8 (May 2, 2008); Dep t of Sanitation v. Nieves, OATH Index No. 1683/07, at 10 (Sep. 19, 2007), (citing Dep't of Environmental Protection v. Schnell, OATH Index No. 2262/00, at 6 (Oct. 25, 2000)); Health & Hospitals Corp. (Woodhull Medical & Mental Health Center) v. Muniz, OATH Index No. 1666/05, at 8 (Oct. 17, 2005). The directive need not be in the form of a command, as long as the request was clear and unambiguous. Wong, at 16; Dep t of Sanitation v. David, OATH Index No. 766/07, at 5 (Jan. 25, 2007), modified on penalty, NYC Civ. Serv. Comm n Item No. CD M (Oct. 25, 2007); Dep't of Environmental Protection v. Salinas, OATH Index No. 1020/04, at 5 (Nov. 15, 2004), aff'd, NYC Civ. Serv. Comm'n Item No. CD06-16-SA (Jan. 9, 2006) (citing Human Resources Admin. v. Aguirre, OATH Index No. 1734/00 (Sept. 14, 2000)); Police Dep't v. McKeon, OATH Index No. 736/90 (Mar. 29, 1990).

7 - 7 - Respondent did not deny that she was aware of the children s presence in the ER since at least around 2:00 p.m. Nor did she deny that she refused Ms. Montague s request to see the children because her shift had ended. However, petitioner did not establish that respondent s refusal was in response to a clear and unambiguous order from Ms. Montague. Even though Ms. Montague testified that she asked whether respondent was refusing a direct order, I find such terminology to be at odds with her reply of Okay. No problem. I ll take care of it, by which she appeared to be tacitly approving respondent s refusal. Her contemporaneous report does not support her testimony that she used the phrase, direct order. Thus, her use of the term at trial appeared to be contrived and calculated solely to bolster the charge of insubordination. We have held that [a] respondent who reasonably believed that he was not given an order is not guilty of insubordination, because he lacked the intent necessary to disobey an order. Transit Auth. v. Wong, OATH Index No. 1866/08, at 17 (Aug. 28, 2008). In Wong, respondent waited until the day before his assignment to request, during a face-to-face conversation with his supervisor, an adjustment to his schedule. The supervisor indicated that he would try to accommodate the request. In a contemporaneous , the supervisor, while expressing his displeasure and insisting that respondent had been scheduled for the assignment and it was too late to change, still indicated a willingness to accommodate the request. The judge found that this created an ambiguity which the respondent interpreted as an approval. Likewise, here, I find that such an ambiguity existed. It is undisputed that respondent refused Ms. Montague s request to see the children and suggested the evening social worker as an option. Ms. Montague s response to this refusal was ambiguous. She stated that it was not yet 4:00 p.m., the time that the evening social worker was scheduled to arrive, and the children had been waiting a long while. When respondent persisted in her refusal, Ms. Montague once again failed to clearly and unambiguously direct respondent to evaluate the children. Her response of [n]o problem. I ll take care of it, sent a message that she understood and accepted respondent s refusal. Indeed, respondent acknowledged that from Ms. Montague s repetitious probing, she felt that she should not have refused. Her ultimate refusal suggests that she processed Ms. Montague s response as acceptance of her position, and did not perceive the request as an order. Thus, as in Wong, I find that respondent lacked the intent necessary to disobey a direct order.

8 - 8 - Dereliction of Duty and Failure to Maintain Patient Safety Petitioner charges that respondent was derelict in her duties when she failed to assess the children, and when she failed to provide social work assistance in the ER from approximately 1:00 p.m. to 4:00 p.m., as a result of which patient safety was implicated (charge II, specifications 1 and 2; charge III, specification 1). It is undisputed that respondent was in charge of the inpatient psychiatric clinic as well as the psychiatric ER on the day in question. Thus, her responsibility included ensuring that patients in the ER received attention. It was also clear that respondent had only one social worker, who was new and could not be assigned the task of evaluating the children. Petitioner did not dispute that on the afternoon of April 16, respondent had a scheduled case conference followed by a family meeting, and was therefore unable to respond to the children. Nor was it contested that under such circumstances Metropolitan s protocol required respondent to call her immediate supervisor, which she did. I believed respondent when she stated that she did not know that Ms. Morales was out. It made no sense that she would otherwise have left a voice message for Ms. Morales. There was nothing to suggest that respondent was deliberately trying to shirk her responsibilities. Rather, there was every indication that she was so occupied, and possibly overworked, that she genuinely forgot to follow up on the message, as she claimed. Therefore, at most, respondent is guilty of failing to ensure that her immediate supervisor had received her voice message that the children needed to be seen. By itself, that is not tantamount to dereliction of duty. Accordingly, petitioner has failed to sustain specifications 1 and 2 of charge II. Further, there was nothing in the record to suggest that patient safety was jeopardized. Petitioner alleges that respondent failed to maintain patient safety by failing to provide social work assistance in the psychiatric emergency room. This allegation was overly broad and unsupported. Even if this charge was more specifically related to respondent s failure to attend to the children, there was no evidence that their safety was jeopardized. In fact, respondent, knowing that the evening social worker was scheduled to report for duty shortly, proposed him as a feasible alternative. Further, respondent testified that it was not unusual for a social worker to be called from another unit when help was needed. Thus, charge III, that respondent failed to maintain patient safety, is not sustained. Moreover, Ms. Montague, who eventually performed

9 - 9 - the evaluation of the children, was present. Thus, I find petitioner s charge that respondent failed to maintain patient safety is without merit. Unbecoming conduct Petitioner charges respondent with unbecoming conduct because she informed the psychiatric technician that she was busy and would be unable to attend to the children in the ER (charge IV, specification 1). The specification infers that respondent summarily dismissed the technician when told about the children in the ER. Ms. Montague s report indicates that respondent informed the technician, not only that she was busy, but that she would have someone sent to the ER. Respondent convincingly testified that she had scheduled meetings that afternoon, and that when she received the technician s call, one of the meetings was about to convene. It is entirely possible that this caused her to respond to the technician in a brusque manner. Nonetheless, there was no challenge to respondent s testimony that she participated in scheduled meetings that afternoon. Therefore, I find that petitioner has failed to sustain this charge. FINDINGS AND CONCLUSIONS 1. Petitioner failed to sustain specifications 1 and 2 of Charge I, that on April 16, 2008, respondent was given a directive by the Assistant Director, which she refused. 2. Petitioner failed to sustain specifications 1 and 2 of charge II, that on April 16, 2008, respondent was derelict in her duties when she failed to assess two patients in the psychiatric emergency room, and that respondent failed to provide psychiatric emergency room assistance from 1:00 p.m. to 4:00 p.m. 3. Petitioner failed to sustain charge III, that respondent failed to maintain patient safety in the psychiatric emergency room on April 16, Petitioner failed to sustain charge IV, that respondent s notification to the psychiatric technician that she was busy and could not attend to the children, constituted unbecoming conduct.

10 RECOMMENDATION Having made the above findings, I recommend that the charges be dismissed in their entirety. December 17, 2008 Ingrid M. Addison Administrative Law Judge SUBMITTED TO: MERYL WEINBERG Executive Director APPEARANCES: MOIRA FITZGERALD, ESQ. Attorney for Petitioner BROWN & GROPPER, LLP Attorneys for Respondent BY: JAMES BROWN, ESQ.

11 Metropolitan Hospital Center s Decision, January 28, 2009 In the Matter of HEALTH AND HOSPITALS CORPORATION (METROPOLITAN HOSPITAL CENTER) Petitioner -against- KATHLEEN SHEA Respondent RAQUEL AYALA, Designee of Executive Director, Meryl Weinberg DECISION As the designee of Meryl Weinberg, Executive Director of Metropolitan Hospital Center, I am in receipt of Judge Ingrid M. Addison's Report and Recommendation regarding respondent s Administrative Hearing. I have also reviewed the entire record and counsel's letter pursuant to Fogel v. Board of Education. After careful consideration, I disagree with Judge Addison's recommended dismissal of all of the disciplinary charges against respondent. While I do not disagree with Judge Addison's findings of credibility, I disagree with both her assessment of the credible facts and her reasoning. Specifically, I find that the testimony and evidence adduced at trial clearly establishes that respondent is guilty of insubordination and failure to maintain patient safety. For her conduct, I am imposing a penalty of a ten (10) day suspension without pay. The disciplinary charges against respondent concern an incident that occurred on April 16, On that date, it is undisputed that respondent held the supervisory position of Social Worker Level III, and that it was her responsibility to provide social work services on 5 West, an inpatient psychiatric unit, and in the Psychiatric Emergency Room. It is also undisputed that she received a telephone call on that date, between 1 PM and 2 PM, advising her that there were two (2) children in the Psychiatric Emergency Room that needed to be assessed by a Social Worker. Respondent did not go to the Psychiatric Emergency Room to assess the children. Nor did she direct a subordinate to see the children. Rather, respondent testified that she left a voic for her supervisor, Ruth Morales, who is also a Social Worker, asking her to see them. It is undisputed that respondent failed to followup with Ms. Morales to confirm that the children had been assessed. Thereafter, close to 4 PM, respondent received a telephone call from her superior, Angela Montague, the Assistant Director of Social Work. During this telephone call, Assistant Director Montague asked respondent why she had not attended to the two (2) children in the Psychiatric Emergency Room. Respondent testified that she told Assistant Director Montague that she had handed the job off to Ms. Morales. Assistant Director Montague then informed respondent that Ms. Morales was absent that day and asked respondent to take care of the children. Respondent refused. To wit, Assistant Director Montague asked respondent more than once, "[a]re you refusing to go down," and respondent answered in the affirmative each time. Indeed, at the hearing, respondent acknowledged responding to Assistant Director Montague with, "I'm not

12 going down." Based on the aforementioned, it is clear that respondent is guilty of insubordination: she was given an order and she refused. However, despite these facts, Judge Addison recommends the dismissal of the insubordination charge that has been preferred against respondent. In support of her position, Judge Addison cites Assistant Director Montague's response to respondent s refusal to attend to the children. Specifically, after respondent stated, "I'm not going down," Assistant Director Montague replied, "[o]kay, no problem, I'll take care of it." Judge Addison opined that the aforementioned response, "sent a message that she understood and accepted your refusal" to go to the Psychiatric Emergency Room to assess the children. According to Judge Addison, it therefore follows that "[a] respondent who reasonably believed that he was not given an order is not guilty of insubordination, because he lacked the intent necessary to disobey an order." I disagree with Judge Addison for two (2) reasons. First, at the hearing, respondent conceded that she knew that she should not have refused Assistant Director Montague's request. Hence, by her own testimony, respondent knew that she had been given an order. As such, Judge Addison's finding that respondent did not believe that she had been given an order is not grounded in the facts. Second, Assistant Director Montague's statement, "[o]kay, no problem, I'll take care of it," ended the conversation between the two. Thus, respondent s refusal to assess the children preceded Assistant Director Montague's response. Therefore, Judge Addison's finding that respondent s refusal to assess the children suggests that respondent "processed Ms. Montague's response as acceptance of her position, and did not perceive the request as an order," is similarly not based in fact. Consequently, I find that the charge of insubordination was substantiated. For respondent s actions on April 16, 2008, she was also charged with failure to maintain patient safety. It undisputed that respondent did not personally assess the two (2) children in the Psychiatric Emergency Room. Nor did she direct a subordinate to do so. It is also undisputed that respondent failed to confirm that the children had been assessed, after handing the job off to Ms. Morales via voic . Lastly, it is undisputed that the children remained in the Psychiatric Emergency Room, without being assessed, for two (2) to three (3) hours after respondent was made aware of their presence. Yet, despite the aforementioned facts, Judge Addison recommends the dismissal of this charge on the ground that there was no evidence that the safety of the children was jeopardized. I disagree. Further, in support of her recommendation, Judge Addison references the fact that when contacted by Assistant Director Montague, respondent, "knowing that the evening social worker was scheduled to report for duty shortly, proposed him as a feasible alternative," and further, the fact that "Ms. Montague, who eventually performed the evaluation of the children, was present." However, I find these facts to be irrelevant. Assistant Director Montague testified at length as to the conditions in the Psychiatric Emergency Room, and clearly, it is not a place for children. While it is fortunate that there were no adverse consequences to respondent s inaction, a crisis or emergency could have arisen at any time during the two (2) to three (3) hours that the children remained unattended in the Psychiatric Emergency Room, after respondent was made aware of their presence. The Psychiatric Emergency Room was respondent s area of responsibility. As such, it was her responsibility to ensure that the two (2) children were assessed. By failing to see them personally or directing a subordinate to do so, and neglecting to confirm that they had been assessed, she failed to

13 maintain patient safety. Whether another social worker was available to assess those children, well after their presence was made known to respondent, is irrelevant. Therefore, respondent s conduct on the date in question constituted inexcusable neglect and unnecessarily placed the welfare of two (2) children at risk. Thus, I find that the charge that respondent failed to maintain patient safety has been sustained. For respondent to assert that she did nothing wrong on the date in question belies the reality of the situation and the level of responsibility required of her as a patient care provider. Thus, based on the foregoing, the testimony and evidence produced at trial, I find that respondent is guilty of insubordination and failure to maintain patient safety. Consequently, I am imposing a penalty of a ten (10) day suspension without pay. RAQUEL AYALA, Designee of Executive Director, Meryl Weinberg, Health & Hospital Corp.