Report Raps Management of Burbank Hospital

Administrators and doctors at Burbank Community Hospital failed in recent months to ensure that the hospital was providing quality health care to its patients, Los Angeles County health authorities said Thursday.

An investigation by the Los Angeles County Department of Health Services determined that Burbank Community “failed to assure that properly trained and qualified personnel were assigned to the emergency department.” The hospital staff had allowed some physicians to administer emergency care without proper authorization, the report said.

The investigation determined there was little documentation to show that the hospital staff was acting responsibly in reviewing the quality of health care being provided.

Jurral Rhee, the hospital’s director, did not properly manage the facility, and the hospital’s board of trustees did not take steps to correct serious problems, the investigation concluded. In fact, Rhee did not always inform the board of trustees of problems at the hospital, investigators reported.

Robert Karp, program manager of the health facilities division of the Health Services Department, said Thursday he is recommending to federal health-care financing officials that the hospital lose its status as a provider of Medicare until it corrects its deficiencies.

If the recommendation is approved, Karp said, the hospital could still receive Medicare patients and be reimbursed by the government for their care. But it would not be officially deemed as a Medicare provider until the problems are corrected, he said.

Transient’s Treatment Questioned

A probe into the hospital’s operations intensified last month after a transient, Robert Parks, taken to Burbank Community after police found him covered with lice, was found collapsed on the ground outside the hospital a day after he was admitted.

Burbank Community physicians refused to readmit Parks, saying he already had been properly treated. Police took Parks to County-USC Medical Center, where he was admitted in serious condition. Doctors there said Parks was suffering from dehydration, anemia, malnutrition and alcohol withdrawal.

The investigation report said that Parks was refused treatment “by a member of the nursing staff without the exercise of reasonable care in determining the patient’s condition.”

County health officials ordered paramedics last week to stop taking patients to Burbank Community, an order that is still in effect, Karp said.

A county investigation into whether paramedics with the Burbank Fire Department acted properly in dealing with Parks is continuing, said Leonard Inch, chief of special programs for the department’s emergency medical services agency, which oversees procedures for prehospital care of patients.

Karp said Burbank Community has “serious problems that need to be taken care of as soon as possible.”

Rhee and other administrators declined to comment Thursday on the report, saying they had not had time to review it.

But Rhee said earlier that he felt the investigation into his hospital’s operation was unjustified and that his staff had done nothing wrong.

Investigators had been evaluating at least five cases in which indigent patients died at the hospital, were denied help or needed hospitalization soon after doctors there released them.

Besides Parks, the report did not mention the other indigent patients.

The report said that, even though the hospital is required under federal law to follow written criteria--known as a quality assurance plan--to determine the quality of medical care, there were monitoring lapses by the hospital staff.

For instance, the report said, there was no evidence that the quality assurance plan for the hospital’s nursing service was followed from July, 1986, to April, 1987.

Staff reviews did not cover the full range of treatment provided to patients, and did not focus on improvement of patient care, the report said.

Administrators took inordinate time to process the applications of physicians applying to practice at Burbank Community, and did not conduct performance appraisals of staff members seeking reappointment, the report said.

At least six doctors at the hospital in recent months were performing hands-on medical treatment without valid staff appointments while their applications were being processed, the report said.

On Sept. 16, the first day of the investigation, the credentials and proper authorization of eight doctors working at the hospital could not be located, investigators noted in the report. Those doctors practiced between Jan. 1 and March 7, and one of them continued to perform hands-on treatment during the investigation, according to the report.