Alleged CPR Training Scam Probed

Los Angeles County health officials are scrutinizing the CPR training of dozens of nurses at Martin Luther King Jr./Drew Medical Center amid allegations that a nurse manager was selling or, in at least one case, giving away the required certification, officials said Thursday.

Virginia A. Williams, a 23-year King/Drew veteran, was escorted off the hospital grounds Wednesday after health officials conducted a sting. Williams, who estimates that she has provided cardiopulmonary-resuscitation training to half of King/Drew’s staff, has been put on unpaid administrative leave while the inquiry continues, officials said. She has denied the allegations.

“The thing I worry most about is who would buy such a credential,” said Dr. Thomas Garthwaite, county health director. “The question is not only her ethics in selling a credential, it would be anyone’s ethics in buying such a credential.”

Garthwaite said his department has no idea how many King/Drew doctors and nurses might have acquired the certifications improperly. Following up on a tip about Williams’ alleged illicit sales, auditors so far have identified 37 cases in which she signed nurses’ CPR cards. It is unknown whether those cards were obtained legitimately, but all of the nurses involved will be retested, he said.

The inquiry could expand significantly. A preliminary review found hundreds of instances in which a card was issued but no instructor’s signature could be found, county officials said. And they said officials have not yet begun reviewing the files of doctors and other hospital staff certified in CPR.

Garthwaite said that the county auditors received the tip about the nurse manager in mid-August but that it took a while to set up the undercover operation. In an interview, he conceded that officials may have waited too long.

He refused to confirm the identity of the nurse manager, but two other sources familiar with the investigation confirmed that it was Williams.

Garthwaite said the nurse manager’s alleged activities were a disheartening indication that the ethical problems that have dogged the 33-year-old hospital remain stubbornly entrenched. King/Drew, south of Watts, serves a largely impoverished minority community.

Several cases have surfaced in the last two years in which King/Drew nurses are alleged to have falsified documents or medical records, but this is the first indication of a potentially broader scheme among staffers to skirt critical life-saving requirements.

In a memo Thursday to the county Board of Supervisors, Garthwaite said, “We are deeply concerned if even one individual who should be certified in CPR is not able to perform those activities should they be needed.”

Basic cardiac life support certification indicates that a person has demonstrated an ability to revive someone whose heart has stopped. Such certification requires the completion of a four-hour class and the passing of a test, county health officials said. The credential is required for all employees who provide direct care to patients. A retest is needed every two years.

King/Drew staffers who require CPR credentials can receive them from any certified instructor inside or outside the hospital, health officials said. Hospitals provide CPR certification as a courtesy.

Williams, reached at her home, said she had never sold CPR cards or allowed King/Drew staffers to obtain them without passing the required test.

“I take my time out to do this,” she said, noting that she provides the training in addition to her other official duties as a manager. “I don’t put a price on it. If someone’s making these allegations, I’m sorry.”

Williams said she has been instructing physicians, nurses and other hospital staff in CPR for more than 10 years. “Basically I taught half of King/Drew Medical Center,” she said.

The allegations again raise questions about the qualifications of the hospital’s nursing staff. Last year, a consulting group tested King/Drew’s nurses and determined that one in five could not pass competency tests.

Last month, county auditors faulted a second consulting firm for failing to complete competency evaluations of all the hospital’s nurses, even though the task was considered among its highest priorities.

Supervisor Mike Antonovich said the newest allegation marks another failure of leadership by the Department of Health Services.

“The allegations, if true, once again puts the county patients at King/Drew at risk,” he said. “My response to the department is why it took the department so long to respond to the allegations.... Why didn’t immediate action take place?”

Antionette Smith Epps, who started last month as King/Drew’s chief executive officer, said she is “very concerned” that there may be members of her staff who have not had the required training despite what it says in their files.

“Everyone who is entrusted with the care of patients should have objective demonstrations of their skills,” she said.

Any staffer who received CPR certification from Williams, she said, “will have to demonstrate competency. We will make sure every person has an appropriate credential.”

There has been a string of scandals at King/Drew, which has lost its accreditation and faces potential revocation of federal funds. The hospital is now struggling to reform.

Since January 2004, at least 730 King/Drew employees have been referred to human resources for investigation of performance problems or misconduct, and about 480 of those have been disciplined. Several nurses have been fired for lying on medical records to cover up alleged lapses in care -- some of which contributed to patient deaths.

“We have taken multiple actions against various staff for sick leave abuse, time card abuse, turning off alarms,” Garthwaite said. “A lot of the personnel actions we’ve been taking probably align somewhat with the kind of person who might do this.”

During the sting, an employee approached Williams saying he was under pressure by his supervisor to get a CPR card, Garthwaite said.

Williams gave the employee an exam booklet and provided the first five answers to the test, Garthwaite said. Even though the employee didn’t complete the rest, Williams agreed to certify him, he said. “In this instance, the nurse manager did not solicit money” for the certification letter, Garthwaite said in his memo to the board.

Williams disputed Garthwaite’s account of the sting, saying she reviewed techniques with the employee on a CPR dummy, then “went over a couple of answers” on the test. She said he promised to complete the test later and return it.

At the employee’s request, she said, she did give him a letter saying he had completed the CPR class and wrote on the letter that CPR “cards will be distributed in 10 to 15 days.” But she only did so because “he gave me his word he was going to come back and finish this up,” she said.

In his memo to the supervisors Thursday, Garthwaite offered some news that might lessen the blow of the latest allegations. Because the hospital has lost so many nurses to dismissals and resignations, 65% of the nurses are temporary staffers.

These nurses must be CPR-certified before they are hired.