Olive View treated ill babies despite staff shortages, report says

Olive View- UCLA Medical Center put critically ill babies at risk when the county facility continued to care for the infants despite lacking the staff to do so, according to a report released this month by state investigators.

Investigators from the California Department of Public Health found that Olive View did not have enough neonatologists or staff to treat babies in the neonatal intensive care unit, according to the report released by the Centers for Medicare & Medicaid Services after a public records request by The Times.

The state inquiry confirms what The Times first reported May 7: that in November 2008, the unit had been downgraded from “community” to “intermediate” status by state officials but continued to operate as though it had the higher designation. Hospital and county health officials later said that they were unaware of the downgrade until The Times inquired about the change in status.

The downgrade, largely due to a lack of neonatologists, doctors who specialize in the care of premature infants, meant Olive View was required under state rules to transfer all babies on ventilators for more than four hours and those in need of surgery to better-equipped and staffed hospitals, according to Norman Williams, a spokesman for the California Department of Health Services.

But Olive View officials continued to advertise the unit as being “community” level on the hospital website and to treat babies in need of transfer, according to the report. When investigators reviewed a sample of five out of 30 babies cared for at the unit as of June 2, they found all of them required higher-level care than Olive View could provide, despite a May 12 memo from the hospital’s chief executive instructing the unit to provide “intermediate” level care.

Investigators found the unit had only one board-certified neonatologist, identified by county officials as Dr. Richard Findlay, insufficient to provide the required 24-hour coverage. Nursing staff did not know how to reach the on-call doctor in case of emergency and for more than two months before Findlay was hired late last year, the unit’s interim director did not meet certification standards, investigators said.

“The cumulative effect of these systemic problems resulted in the hospital’s inability to ensure the provision of quality healthcare in a safe environment,” investigators wrote.

In response to the problems, Olive View officials brought in Dr. Uday Devaskar to head the unit in June. Devaskar, who held the same job at Mattel Children’s Hospital UCLA, hired five additional part-time neonatologists and arranged for backup coverage, hospital officials told the state. Findlay stayed on as associate director, said Michael Wilson, a spokesman for the county’s Department of Health Services.

In July, state officials temporarily reinstated Olive View’s “community” status. For now, the hospital will transfer newborns in need of surgery, but will continue to care for those on ventilators, Wilson said.

“All necessary corrective actions have been taken,” said Carol Meyer, the department’s chief network officer. She said with recent hires and staff education “we are confident the neonatal care meets and exceeds community standards.”

Prior to those changes, at least two newborns died this year who had been kept on ventilators at Olive View for well over the four hours allowed under state requirements. One of the infants also underwent surgery at the hospital.

Meyer would not discuss either baby’s case, due to patient confidentiality. She said a baby died after surgery and ventilation at the unit, but said the death was due to “prematurity” and was unrelated to issues with care at the hospital.

“We are licensed as a neonatal intensive-care unit and therefore we did these surgeries and we were qualified to do these surgeries,” Meyer said.

Antonio de Jesus Rincon was on a ventilator from his birth March 21 until he was transferred to Ronald Reagan-UCLA Medical Center in Westwood May 3, according to his mother, Martina Rincon.

Rincon, 46, of Newhall, was covered by Medi-Cal and said she had been transferred to Olive View from Henry Mayo Newhall Memorial Hospital because she was told she would receive a higher level of care for her high-risk pregnancy.

The Kmart maintenance worker said her son’s condition improved soon after he was transferred, but he remained hospitalized for months. Antonio died July 9 of heart failure and extreme prematurity complicated by chronic lung disease, renal failure, sepsis, pneumonia, and cholestasis, according to his death certificate.

Rincon said she believed the hospital should have transferred her son to UCLA sooner. She has since retained an attorney.

Jaemy Vasquez was born at Olive View April 19, three months premature. She was placed on a ventilator and underwent intestinal and heart surgery before her death April 30, according to her parents Theresa and Darwin Vasquez of Sylmar.

Theresa Vasquez, 34, a home health aide whose insurance required her to be cared for at county facilities, said Olive View officials at first told her that Jaemy might be transferred to UCLA for the surgery, “because they don’t do it at Olive View.” But the next morning, hospital staff called to say plans had changed: a surgeon would operate on Jaemy at Olive View instead.

“I said ‘Whatever you guys think is best for her,’ ” Vasquez said.

According to her death certificate, Jaemy died of asystole and nonresponsive bradycardia —meaning her heart slowed then stopped — and extreme prematurity.

Babies in that condition were required to be transferred to a better-equipped and staffed hospital by California Children’s Services, a state program that funds healthcare for needy children, including many receiving Medi-Cal, according to Williams, the state health department spokesman.

Hospital officials did not stop allowing surgeries until May 17, Wilson said, a move that came after The Times documented problems at the neonatal intensive care unit.

Dr. Gail V. Anderson Jr., interim chief medical officer for the county’s Department of Health Services, said pediatric surgeons operating at Olive View had the training and staff needed to perform such surgeries.

“All these surgeons are eminently qualified,” Anderson said, “With adequate subspecialists and nursing support.”

But neonatologists familiar with state regulations said it was risky to perform such surgeries at intermediate facilities because they do not have enough skilled staff and do not treat enough high-risk babies to be truly familiar with the required procedures.

It takes a daily census of at least 15 babies to establish the skills needed for such surgeries, experts said. Olive View’s 24-bed unit had an average daily census of six babies as of August, the most recent month available, and an average daily census of about eight babies a month since January.

Dr. David Durand, director of the neonatology division at Children’s Hospital & Research Center Oakland and a technical advisor to California Children’s Services, said the agency’s regulations were intended to ensure that hospitals have enough trained staff to care for critically ill babies.

“Most neonatologists would say you should not be doing surgery routinely at an intermediate hospital,” Durand said.

Vasquez said she and her husband, who tried for 11 years to conceive, have lingering questions about whether their daughter might have fared differently had she been transferred from Olive View.

“In the other hospital they might have more equipment or more doctors and it would have been better,” Vasquez said. “But they didn’t give us a choice.”

molly.hennessy-fiske@latimes.com

Times staff writer Rong-Gong Lin II contributed to this report