Inquiry Lifts Cloud Cast on Hospital Care in Valencia

After a lengthy investigation of allegations that cutbacks in respiratory care at Henry Mayo Newhall Memorial Hospital endangered patients, county health officials on Friday gave the hospital a clean bill of health.

Bud Pate, a supervising inspector for the Health Facilities Division of the county Department of Health Services, said he told hospital administrators that no new citations would be forthcoming.

In August, the county had cited Henry Mayo for four deficiencies in its respiratory care stemming from staffing changes at the hospital.

The investigation resumed in October, prompted by a complaint about a case in which a patient went into cardiac arrest when a ventilator assisting her breathing malfunctioned. Some staff members at the hospital complained that nurses were not adequately trained to handle that equipment.

“I feel terrific,” said Leann Strasen, a Henry Mayo vice president and director of nursing, after learning that the hospital had passed the latest inspections.

The controversy dates back to June, when, in an effort to cut costs, the 133-bed Valencia hospital halved its staff of respiratory therapists, specialists who operate equipment that assists patients’ breathing. The number of therapists per shift was reduced from three to one, and nurses were told to take on most of the respiratory-therapy duties.

The staff changes were harshly criticized at the time by physicians, nurses and respiratory therapists at the hospital.

‘Plan of Correction’

One of the most serious deficiencies noted by the county in August was that, as long as one month after the staff changes, only half of the hospital’s nurses had received training in their new respiratory duties. The hospital filed a “plan of correction” with the county in September, rebutting each point or outlining planned corrections.

Investigators returned to the hospital in October after receiving a complaint about the treatment of a Gardena woman hospitalized after a traffic accident. No respiratory therapists were available when the woman, Betty Saiki, 58, suffered heart failure after her ventilator malfunctioned. She was resuscitated but died five days later of injuries received in the accident.

After the incident, the director of intensive care nursing, Joyce Akse, filed a memorandum with administrators, saying that nurses present at the time did not realize that Saiki’s ventilator was malfunctioning and that “this had a significant impact on this patient’s condition.”

But county inspectors found that the nurses had received training on ventilators, said Robert Karp, program manager for the Health Facilities Division. Thus, the hospital was in compliance with licensing regulations, he said.

“As far as I’m concerned, we’re satisfied now that the functioning of the nurses within the respiratory care department meets our standards,” Karp said.

But Karp said investigators did not try to determine whether there was any negligence in the patient’s death. “It is not directly our charge to try to establish negligence,” he said.

“The only question we had . . . was whether they had been oriented to the equipment being used,” Karp said of the nurses who treated Saiki.

Before Christmas, Pate had said that health officials were planning to cite the hospital for several new violations of respiratory-care guidelines. But, because the decision could set a precedent for other hospitals considering similar staff changes, the department reconsidered, he said.

Difficult Decision

“It was tough to come up with the decision,” Pate said, because state law is not clear on when nurses can administer respiratory care. The state administrative code allows nurses to operate ventilators and take on other respiratory duties if they have been “adequately” trained, he said.

The California Society for Respiratory Care and other professional organizations have argued that nurses assigned respiratory duties should take the same certification examination that is required of respiratory therapists, said Mel Welch, who teaches respiratory therapy at UCLA and is president of the California group.

In 1985, California became the first state to certify respiratory therapists with several years of training as licensed professionals, putting them in a category similar to nurses.

Welch said the California society, which represents the state’s 10,000 respiratory therapists, plans to file a formal complaint with the health department about “inadequate training of nurses” at Henry Mayo.