Prompted by persistent reports of problems at the Edgemoor Geriatric Hospital in Santee, San Diego County supervisors are moving toward a comprehensive review of the hospital and its place as a part of county government.
That review, expected to unfold in the next month, could lead the Board of Supervisors to decide to phase out or eliminate the 342-bed convalescent hospital, three of the five supervisors have said in interviews with The Times.
If the county were to remove itself from the nursing home business, many of the poor and mostly elderly patients at the hospital would be sent to privately run care homes instead, county and state officials said.
"I find the situation with Edgemoor absolutely untenable," Supervisor Susan Golding said. "It's just unacceptable."
Golding's comments came in response to the state Department of Health Services' announcement last week that it had found Edgemoor out of compliance with 7 of the 18 criteria set by the federal government for hospitals treating Medicare and Medi-Cal patients.
In January, the state fined the county $20,000 for inadequate nursing care in connection with the December drowning of a paralyzed woman left unattended in a bathtub, and the January death of a legless patient who fell out of bed and later suffered a heart attack.
Since the the second death was made public Jan. 29, board members in closed sessions and in separate conversations with Chief Administrative Officer Clifford Graves have reportedly asked what is at the root of Edgemoor's problems.
Now, in a letter to board chairman Leon Williams, Golding has suggested that a board conference on Edgemoor scheduled for May 28 be held within 30 days instead.
Golding asked that the report address at least eight specific items and that the county staff provide a list of violations found at Edgemoor by state inspectors for the last three years. The staff should also explain what measures the county has taken to remedy those problems, Golding said.
In an interview, Golding said she believes Edgemoor has serious, ongoing problems that need to be studied in a more comprehensive way than has been the county's practice.
"I don't know exactly what the problems are," she said. "But I know where specific instances have occurred, and I know that when this many problems occur on a repeated basis there has got to be more serious, underlying trouble.
"Whether it's resources, staff trouble, training or management, I don't know yet," she said. "That's what we need to find out, and we need to make some very hard decisions when we get those answers."
Supervisor Brian Bilbray said he would expect Edgemoor to have more problems
than similar, privately run institutions because the county hospital "gets the patients no one else wants." But Bilbray said he also believes that the county needs to rethink its role as a provider of convalescent services.
"I think we should look at the entire Edgemoor operation and the common sense of us being in that business," Bilbray said Wednesday. "The county is not mandated to provide that service."
Bilbray called Edgemoor a "political hot potato." Talk of its elimination would no doubt bring protests, he said.
"If we say, 'No, we're not going to take care of these people at the county level,' there's going to be a great public outcry that we're heartless and not caring about people," Bilbray said.
But even Williams, the board's lone Democrat and a strong supporter of the county's health and social services, conceded that the future of Edgemoor as a county program needs to be reviewed.
"In the past, the county board and the administration have not been aware of what it takes to maintain facilities at first-class operating levels," Williams said. "I think that's what we're suffering from now."
If the county staff's report supports Health Department Director James Forde's statement that the physical improvements needed at the 60-year-old hospital building will cost the county almost $4 million, the elimination of Edgemoor will have to be among the options seriously considered by the board, Williams said.
"I'm not willing to go forward with temporary-type things," Williams said. "We need to take a long-range look and see what our revenue situation is going to be. You can only do what you have the dollars to do."
Graves said the Health Services Department has asked for a "substantial increase" from the $1.2 million the county spent to operate Edgemoor last year. The institution also gets $5 million from Medicare and Medi-Cal, he said.
Graves said he expects the county to decide soon whether to improve Edgemoor or abandon it.
"We've either got to bite the bullet and put more money into it and provide the best possible management, or find some less costly alternative for those patients," he said.