Hospital Tries to Cure Ailing Image, Plans New Growth

At first, they were embarrassed by the frightful incidents. Then they grew irritated.

“Every time it came on TV someone would say, ‘Did you see Channel 4?’ ” said nurse Helen Benedikter. But, she said, the wave of bad publicity that has engulfed Long Beach Community Hospital over the past year has only strengthened the staff’s resolve.

“Nobody likes to see that, hear that or read that” kind of news, said Benedikter. “Some patients would ask us about it.”

“Despite the incidents,” she said, “there was quite a strong, almost fierce pride in the kind of nursing care we give.”

Board member Jean Bixby Smith agreed that morale suffered. “It’s very difficult to see articles that cast your hospital in an unfavorable light,” she said, particularly when “both of the incidents that have garnered us the recent publicity were to a large measure beyond the hospital’s control. We had to grin and bear it.”

While some might disagree that the incidents were, in fact, largely beyond Community Hospital’s control, no one argues that the 300-bed, white Mediterranean complex perched on an east city hillside suffered two of the most horrifying events ever to befall a Long Beach medical facility.

Viewed X-Ray Backward

In late 1984, a lawsuit disclosed that a team of physicians--working from an X-ray they somehow viewed backward--removed the wrong kidney from a cancer victim who was no less than a director of the hospital’s money-raising foundation board. The patient won a $5.2-million damage award against some of the doctors (although the amount was later reduced), but the hospital itself was absolved of any legal responsibility.

Then last month, a woman masquerading as a obstetrical nurse sneaked onto a hospital ward and kidnaped a 3-day-old boy from the arms of his mother. Police later found the newborn, apparently unharmed, and arrested a young Bakersfield woman who had been pregnant last spring but suffered a miscarriage.

“It’s dramatic,” said Dr. Joseph Dahlquist, a 28-year Community Hospital physician and a former chief of staff, referring to the incidents. “The lightning keeps striking the same tree. But I don’t think there’s anything wrong with the tree.”

The precise toll on the hospital has been difficult to measure. Dahlquist said the events may well have prompted some doctors to steer patients away. Or some patients may have simply refused to enter on their own. “Patients are always asking me about it in the office here,” said the internist, who also practices out of a downtown Long Beach clinic.

“I saw the (patient) census figures decline, but I’m not sure it was due to that,” Dahlquist said “I’m not sure it wasn’t just a sign of the times . . . The hospital parking lot used to be bulging with cars at 7 o’clock.”

But no more, not at Community or most any other hospital its size.

Ranked in Third Place

Growing public dissatisfaction over the high cost of medical care nationwide has thrown hospitals into a competitive war that is especially furious in the Long Beach area, where Community--an operation of considerable size and scope--finds itself struggling in third place in beds behind 1,000-bed Memorial Medical Center and 540-bed St. Mary Medical Center.

Because the government now limits the amount of money it will pay for the care of Medicare patients, hospitals are eager to treat them more quickly so they don’t encounter costs that can’t be recovered. Therefore, census figures most everywhere have declined because patients are being hospitalized for shorter periods.

The 61-year-old, nonprofit hospital--distinguished for an innovative Alzheimer’s disease center, among other things--occasionally saw its balance sheet slump even before the critical publicity. (Folklore has it that in the mid-1920s, founder Fillmore Condit sometimes dipped into his personal bank account to help the hospital meet payroll.)

For a while, said board member Smith, there was talk of merging in some fashion with either giant Memorial or Catholic St. Mary. “We had decided a number of years back that over the long run we could not survive as a free-standing institution,” she said.

So in April, 1984, Community joined the HealthWest Foundation, a network of eight hospitals--all but one in Southern California--that have pooled their expenses to create an economy of scale while retaining the tax benefits of nonprofit status.

The persistent headlines since, however, have “multiplied the impact of all the other changes in the health industry,” said Smith. “It has made it more difficult for us to respond to the kinds of changes all hospitals are going through.”

Financial Prognosis Unclear

The current state of Community’s financial health is unclear. Over the past six months, Smith said, the hospital has “done a considerable amount of belt tightening” to trim expenses, but HealthWest officials decline to release specific revenue figures.

Of the 250 beds considered “operational,” officials said, about 150 are filled with patients--about the state average. Roughly half of those are typically Medicare patients.

For the fiscal quarter that ended last December--when the kidney malpractice suit publicity was at its peak--the hospital also averaged about 150 patients and lost about $1 million, according to records maintained by the state.

But Community officials say they expect operations to take a decided turn for the better starting Monday, when a new chief executive officer officially arrives on the medical campus at 1720 Termino Ave. He is Paul S. Viviano, a lanky, bearded Los Angeles native said to have administrative skill and wisdom beyond his 32 years. (Former chief executive G. Michael Jenike will become chief operating officer.)

“We talked to, I’ll bet, 100 people (vying for the job) . . . and Paul was by far the superior candidate in every category,” said Howard Le Vant, a HealthWest regional vice president. “He’s a little bit younger than the average, but he’s just a superior individual who’s gone up very quickly.”

Viviano is the former executive director of 173-bed Los Alamitos Medical Center, one of 14 Southern California hospitals operated by National Medical Enterprises, a respected and aggressive for-profit chain.

(While a nonprofit hospital such as Community plows excess revenue back into its operations so it can attract a widening patient base, a for-profit hospital operated by a public company must keep stockholders happy by paying out some revenue in the form of dividends.)

For-Profit Experience

Viviano said the tough business sense he developed from seven years of for-profit experience may have been a factor in his winning the Community job.

“I think the distinction between for-profit and nonprofit hospitals is blurring as we move into the 1980s and 90s,” he said. “I believe that a certain amount of business expertise can be developed in a non-profit setting. . . . This is a nonprofit hospital but yet it does have a debt service it needs to address, it does have future expansion requirements.”

But Smith said Viviano’s for-profit background was really incidental. She said Community neither wants nor needs to place too much emphasis on financial performance. “The bottom line for us is still the quality of (patient) care,” she said.

“One of the things that prompted him to leave the for-profit system,” she said, “was his sense that the budget and the bottom line considerations were ultimately going to compromise care.” At a family hospital such as Community, she said, “you don’t lose your priorities.”

Among Viviano’s first chores will be trimming what he regards as a top-heavy management structure and streamlining as many operations as possible.

‘Still Perceived Highly’

But not the least of his priorities will be to polish the hospital’s public image, he said, even though “my perception is that the hospital is still perceived very highly.”

Viviano believes that most people realize that a botched kidney operation could occur in any hospital. Several of the physicians sued at Community, in fact, were also on the staffs of Memorial and St. Mary.

“It could have happened at the Mayo Clinic,” Viviano contends.

Board member Smith said steps have also been taken to guard against future baby kidnapings. Nurses and doctors are now required to wear photo identification name tags and visitors must sign in and out. “The obvious thing they can’t do,” she said, “is turn the maternity ward into a jail.”

As for the past year’s battering publicity, Smith is philosophical. “It’s one of those things you just have to live through.

“Time will take care of it, and if we continue to provide quality care we’ll get past that. . . . In time, that (quality care) will win out.”