Burbank Hospital Must Offer Plan on Deficiencies or Risk Being Closed

If Burbank Community Hospital administrators do not submit a plan to correct numerous deficiencies in health care and staffing by today, county health officials said they may initiate steps to shut the hospital down.

Ralph Lopez, director of the health facilities division of the Los Angeles County Department of Health Services, said Friday that hospital administrators had been given 10 working days since Sept. 21 to respond to an investigation that found them deficient in administration, staff procedures, emergency treatment and quality medical assurance.

Despite the warning, Burbank Community Hospital Director Jurral Rhee said he would not be submitting anything today to county health authorities.

“We will not have our responses by then,” Rhee said Friday of the Monday deadline. “We never received a cover letter telling us of any deadline. They should have sent a letter with the survey they performed. They screwed up.”

Lopez and other officials, however, insisted that the hospital had received official notification about the deadline for a plan of correction in a letter sent on Sept. 21. He said unless something extraordinary happened, there would be no grace period.

Bitter Tug of War

The dispute is indicative of a bitter tug of war that appears to be developing between Burbank Community and the county health department.

Rhee has denied any wrongdoing by him or his staff. He has called county health officials “overzealous” and accused them of launching personal attacks against him. He said deficiencies such as the ones mentioned in the report on Burbank Community would be found at even “the Cadillac of hospitals.”

But Lopez said Rhee apparently does not realize the seriousness of the county’s findings against the hospital. He said the report indicated a breakdown in the hospital’s administration and monitoring of medical care.

“It’s rare that you find systems that are broken down,” Lopez said. “It takes leadership and commitment to turn that around.

“This is not an academic exercise. This place is going to find itself in compliance one way or the other. The only issue is how. No one jerks my chain and forgets it. I better have a plan of correction on my desk by Monday, or know the reason why.”

Lopez continued, “If we don’t have a report by Monday evening, we will be having an office disciplinary conference before Wednesday to discuss action. We’ll just go to the next step. I will meet with Mr. Rhee to tell him what I’m doing, then I will meet with state health department heads to talk about options to deal with this.”

Lopez said one of the options included the shutdown of the hospital. “We could definitely ask the state to shut it down,” he said.

David Childress, supervisor of the enforcement and surveillance unit of the county health agency, said, “With the kinds of deficiencies this hospital has, I would not take my family there. It’s very unusual for a hospital to have these kinds of problems. I’ve seen worse, but it’s not a good sign.”

Lopez said hospital administrators had known about medical and administrative deficiencies since a report more than two years ago by a Chicago-based medical professional group.

He added that the problems in Burbank Community reflected violations at California Gardena Hospital that eventually led to its closure. California Gardena Hospital voluntarily agreed to having its license suspended in 1982 because of what county health officials called “life-threatening deficiencies.”

“That hospital started like this,” Lopez said. “One thing led to another and deteriorated. Before you know it, you have a closed hospital.”

List of 22 Deficiencies

The county investigation results released late last month listed 22 deficiencies at Burbank Community. It said that the hospital “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 report also stated that there was little documentation to show that the hospital staff was acting responsibly in reviewing the quality of health care at the facility.

Rhee and the hospital’s board of trustees were ineffective administrators, the investigation concluded. It said Rhee did not properly manage the hospital and that the board of trustees did not act to remedy serious problems. In addition, Rhee did not always inform trustees of problems at the hospital.

The county has already recommended to federal health authorities that the hospital’s status as a Medicare provider be removed until the problems are corrected. Federal officials are still reviewing the recommendation.

Paramedics have also been ordered by the county to not transport patients to Burbank Community’s emergency room.

Lopez said he could not understand why Rhee and administrators were taking so long to respond to the report’s conclusions, because many of the deficiencies mentioned in the report were similar to another evaluation done about two years by the Joint Commission on Accreditation of Hospitals, a Chicago-based volunteer group composed of members of the American Medical Assn., the American Dental Assn. and other medically oriented bodies.

Medicare Suitability

The commission conducts inspections of hospitals about once every three years to determine their suitability for Medicare accreditation, and has the federal authorization to issue that accreditation.

Although he declined to discuss specifics, Lopez indicated that the commission’s last survey of Burbank Community contained many of the same current deficiencies.

“It almost turns out we’re living history all over again,” Lopez said. “None of the deficiencies we’re talking about should have surprised them.”

Lopez said the number of deficiencies seemed to indicate “a breakdown in the system with the governing body and the staff of the hospital.” He said the hospital is in violation of federal and state health and safety codes.

Rhee said he would respond to specific charges at a news conference this week.

Lopez said Rhee should be responding to him instead of the press.

“I’m surprised. This is not what you normally find in typical hospital responses,” Lopez said. “It seems like they’re covering up the sun with their hands. There’s lots of rhetoric.”

Response Usually Prompt

He said hospitals usually respond promptly to critical evaluations by county health officials. “Usually we get a lot of information” that turns out to be inadequate, he said, adding that Rhee seemed unable to understand he was acting with the authorization of the state. “He seems to believe this is just the county against the hospital,” he said. “The board of trustees is also misinformed.”

An investigation into the hospital’s operation intensified after a transient, Robert Parks, taken to Burbank Community when police found him covered with lice, was found collapsed outside the hospital a day after he was admitted.

Burbank Community physicians refused to readmit Parks, saying he already had been properly treated. Police transported Parks to County-USC Medical Center. Doctors said he was suffering from dehydration, anemia, malnutrition and alcoholic withdrawal, and listed him in serious condition.

Investigators also studied at least four other cases where indigent patients died at the hospital, were denied help or needed hospitalization soon after doctors released them.