Inspectors Cite Shortcomings at ‘Improved’ Navy Hospitals

Four U.S. Navy health centers in Southern California have significantly improved their medical care but continue to have serious shortcomings, according to a new internal inspection report released Tuesday.

At the Navy Hospital in San Diego’s Balboa Park, a Navy inspector general’s investigation said attempts to reform emergency medical service are frustrated by “hard-core holdouts” among senior military doctors “who are resistant to monitoring and documenting patient care.”

The inspection focused on the San Diego, Camp Pendleton and Long Beach Navy hospitals and the clinic at the Marine Corps Air-Ground Combat Center at Twenty-nine Palms.

The 30-bed clinic at Twenty-nine Palms drew the harshest assessment. At the clinic, Navy investigators found that from 4:30 p.m. until 7 a.m. daily there is just a single nurse on duty to provide care in the emergency room, delivery room and nursery. The clinic provides health care for 21,500 military personnel and their dependents and must rely on backup assistance from Camp Pendleton, 138 miles away.

Noting that major, live-fire training exercises using regular and reserve Marine personnel are carried out at the base, the report concluded that “the potential for multiple, severe casualties is ever present” and could precipitate a crisis for the isolated hospital, which is the only medical facility within a 50-mile radius that is theoretically capable of stabilizing and treating severe trauma victims.

The March 23 report, released Tuesday by Sen. Pete Wilson (R-Calif.), was based on visits in February by military inspectors.

The inspection team found the Navy hospitals had made significant progress in improving the quality of patient care, emergency service, quality assurance and verifying the credentials of Navy physicians. But it cautioned that servicewide shortages of physicians and other health care personnel have slowed attempts at further reform.

“The Navy’s health care system cannot provide consistently high-quality health care to active duty (personnel), dependents of active duty, retired and their dependent beneficiaries without increased resources,” the report concluded. Inspectors praised commanding officers of the four health centers for successfully working to assign qualified medical professionals to the most crucial jobs, saying the policy “minimizes the inefficiency and turmoil described in previous inspections.”

The investigation report also concluded that the Navy’s Long Beach hospital emergency room is staffed by physicians without significant emergency medicine experience who serve without a department head. “The (quality review and risk management) program in the emergency room is virtually nonexistent,” Navy inspectors concluded.

Release of the 58-page document follows disclosures by The Times last year of more than 200 incidents of purported malpractice, including 25 cases in which 13 patients died and 12 were left with disabling injuries. Settlements in malpractice cases total $10.8 million in the last three years.

Documents released last year under the Freedom of Information Act showed that at the Navy hospital in San Diego, three of 15 physician training programs were on probation--a higher proportion than at any other teaching hospital in Southern California.

Wilson called the results of the new Navy investigation report “mixed.”

“In fairness, this does indicate improvement, but it also indicates that the improvement is somewhat erratic and that the reception to reform efforts in some quarters has been less than enthusiastic,” Wilson said.

Wilson said he was “both amused but also a little angry” at the pointed criticisms of senior Navy officers who have actively resisted pressures to improve patient care. “I have the feeling the Navy inspector general was less than amused” by the comments, Wilson added.

A Navy spokesman in San Diego declined to comment on the findings.

The report also warned that serious security deficiencies threaten the San Diego and Long Beach Navy hospitals, both of which are located outside of major military bases. Navy inspectors found security guards poorly trained and unarmed and found that access to facilities was not adequately controlled.

Inspectors also found the two hospitals lacked mutual aid agreements with local civilian law enforcement agencies that could bring help “in the event of an emergency situation requiring the use of force.”

The report also indicated that at least 10 senior San Diego physicians who have been assigned to the hospital for more than 10 years each should be reassigned, including two physicians that local commanders have attempted to transfer repeatedly, without success.