'Vast conspiracy': Missouri hospital board, executives speak out on controversial reshuffling

Memphis, Mo.-based Scotland County Hospital District suddenly ousted its CEO and CFO on Aug. 16, sparking questions and fueling controversy. Three months later, former executives and board members — and one state senator — shared their perspectives on what happened, according to a Nov. 14 report from the Missouri Independent

The Independent put together an overview of the situation using interviews, Sunshine Law requests and reports from the local paper, the Memphis Democrat

Scotland County Hospital District was under financial pressure before the firings. The 25-bed critical access hospital and its three outpatient clinics serve as the primary care points for roughly 12,300 patients across five counties, but recent audits have raised "substantial doubt" about its ability to stay open, KTTN reported Nov. 16. The hospital lost $2.3 million in 2020 and $5.6 million in 2021, per an accounting firm involved in the audit. 

An emergency board meeting

On the evening of Aug. 15, Joni Lloyd, vice chair of the hospital's board of directors, was called into an emergency meeting by board chair Lori Fulk. The meeting, which took place at Ms. Fulk's home, intentionally excluded two board members: Bob Neese and Joe Doubet. 

Also in attendance at the meeting were Meagan Weber and Brent Pierick, who were recently selected as co-chief operating officers. They were appointed after then-CEO, Randy Tobler, MD, submitted his resignation in March; their new roles were set to begin when he officially left office Sept. 3. 

The final attendee was Achim Hoyal, listed in the meeting minutes as a "consultant." Mr. Neese and Mr. Doubet later told the newspaper they do not know who authorized Mr. Hoyal's services, as the board never voted to let him view the hospital's financial records. 

Mr. Hoyal accused Dr. Tobler of overtaking Memphis County Pharmacy, whose proceeds above costs were supposed to go to the Scotland County Hospital Foundation, which was established at the same time. According to Mr. Hoyal, $16 million could not be accounted for. 

The pharmacy never turned that sort of profit, Michael Brandon, who served the hospital as CFO while Dr. Tobler was CEO, told the newspaper. 

The board members present at the emergency meeting voted to fire Dr. Tobler and Mr. Brandon. Their closed meeting minutes allege they received a financial report "with concerns of malicious impropriety and content."

"That evening, a vast conspiracy was laid out," Ms. Lloyd said at a Sept. 27 board meeting, where she resigned. "I was manipulated, threatened and made to fear by words that were spoken," she wrote in a Sunshine Law complaint to the state attorney general.

Police escort execs out as accusations fly

On Aug. 16, Dr. Tobler and Mr. Brandon were escorted out of the hospital by a state trooper — less than one month before Dr. Tobler was set to resign. Mr. Brandon said he did not know why he was being fired and that he was not allowed to collect his things. 

That evening, another board meeting was called. This time, Mr. Neese and Mr. Doubet were included and notified of the firings. 

Mr. Hoyal and Ms. Fulk accused Mr. Neese of personally benefiting from one of the hospital's land deals, and Ms. Fulk alleged the hospital's auditor, state senator Cindy O'Laughlin, was involved in the conspiracy. According to Ms. Fulk, the hospital's foundation donated $50,000 to Ms. O'Laughlin's campaign. 

The foundation never appears on Ms. O'Laughlin's reports to the state ethics commission and the maximum donation is $2,400, according to the newspaper. 

"This is the craziest thing you've ever seen," Ms. O'Laughlin told the newspaper. 

Days after firing Mr. Tober, Ms. Weber, acting as the new CEO, filed a complaint about healthcare fraud with the Office of Inspector General in the state's Department of Health and Senior Services. Ms. Weber said an FBI agent came to interview her and a forensic audit was recommended. 

Mr. Hoyal takes the reins

Yet another board meeting was called on Aug. 18, at which Mr. Hoyal made the case for full-time employment. Mr. Doubet and Ms. Lloyd told the newspaper Mr. Hoyal called them in advance to ask for support. 

"He said, 'Time is of the essence. The government is coming in here and freezing all your assets. And you're going down for this unless you let me help you out,'" Mr. Doubet told the newspaper. 

Mr. Hoyal — who previously interviewed for a revenue cycle management position but was not hired, according to Mr. Brandon — received his bachelor's degree in accounting over eight years from an online university, according to the newspaper. His proposed contract included several demands: a seven-year contract paying an inflation-adjusted $175,000 per year, a $100,000 tax-paid bonus, ownership of a 12-acre lot adjacent to the hospital with amenities like hot tubs and a seven-car garage, and a raise and bonus for his father, Neil Hoyal, DO, a physician at the hospital. 

Mr. Hoyal was named interim financial officer on Aug. 24. His final contract, signed Sept. 30, promised a $200,000 annual salary – $60,000 per year more than Ms. Weber and double the salary Mr. Brandon received. It also protects him from firing during his seven-year term unless he is convicted of a misdemeanor or felony. 

"The organization is very thinly protected against the CFO's misconduct in this case," Michael Harris, a St. Louis employment lawyer who reviewed the contract, told the newspaper.

Investigations pending 

Mr. Doubet and Mr. Neese joined Ms. Lloyd in resigning from the board. Four spots will be up for re-election in April. 

Ms. Fulk said she cannot speak out on advice of the board's attorneys; however, those who resigned or have been fired are urging the state government to take action. 

The state's attorney general is reviewing the Aug. 15 board meeting, according to a letter sent to the hospital's attorney Sept. 18. The letter demanded future meetings include all board members and required the board to attend a Sunshine Law training session within 60 days, according to the newspaper. 

"Our entire hospital is being jeopardized by the actions of a few rogue board members, an outsider, Achim Hoyal, who has made outlandish allegations and demands, and the supposed new CEO, Meagan Weber, who has fully bought into what appears to be a con and is now a coup," Mr. Neese wrote in a Sunshine Law complaint. 

"May God have mercy, because I don't believe the lawyers will," he told the newspaper. 

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