Care of Elderly Is Rated About Average : Health Officials Give Motion Picture Home a Passing Grade

Founded and supported by Hollywood luminaries, from the late Mary Pickford to Bob Hope, the Motion Picture and Television Country House and Hospital is home to 275 retired actors, directors and entertainment-industry technicians.

Its bucolic setting--41 acres of majestic oaks and well-tended gardens--belies the controversy that has beset the 46-year-old Woodland Hills facility in recent months.

In the past year, the hospital has been rocked by a series of well-publicized lawsuits filed by former employees and patients, and by a continuing federal investigation into allegations of Medicare fraud.

But, despite all that, the health and social service officials who regularly survey the Motion Picture and Television Country House and Hospital and investigate complaints about the facility recently gave it passing grades.

“It’s an average facility,” said Claude Pate, a supervisor for the Los Angeles County Health Services Department, which inspects hospitals for the state. “There are problems typical of most facilities. We’re not closely watching them.”

‘Not a Problem Facility’

Donna Mandelstam of the state Department of Social Services, which licenses residences for the elderly, offered a similar assessment: “They are substantially in compliance and they are not a problem facility.”

County health department records show that, since 1985, 17 complaints have been received about the home at Mulholland Drive and Calabasas Road.

“That’s not a lot of complaints,” Pate said. “It’s well within normal limits.”

Six complaints involving patient care and the physical plant were substantiated, seven could not be verified, two were dismissed because they did not allege violations of regulations and two remain under investigation. None has been serious enough to bring a citation.

Administrators of the facility report that they have eliminated most of the deficiencies or are in the process of correcting them. They have gone to court to challenge the county’s most serious allegation of misconduct--improper care of a patient with Alzheimer’s disease.

And administrators also proudly point to a December, 1986, decision by the independent Joint Commission on Accreditation of Hospitals to certify the hospital for three years. The commission, which surveys 85% of the nation’s hospitals, applies “a Good Housekeeping seal of approval,” certifying that the facility meets hundreds of standards, said spokesman Ed Fry.

Construction Program

Despite the relatively clean bill of health, the timing of the controversy has been particularly unsettling to hospital administrators because they are in the midst of an ambitious $30-million construction program to remodel, upgrade and expand. Among other improvements, the program will increase the hospital’s capacity by 42%.

The home offers residents a wide range of care, including 58 white-brick cottages for those who are self-reliant, the 51-room Frances Goldwyn Lodge for those needing some assistance and the 176-bed hospital, with its four-bed intensive-care unit and 10-bed Alzheimer’s wing. The motto is: “We take care of our own.”

The campuslike grounds also boast the 250-seat Louis B. Mayer Theater, Douglas Fairbanks Lounge and John Ford Chapel, each named after its primary donor.

But, even with the passing grades from state and county officials, the Motion Picture and Television Home still has been cited for violations of health standards, a review of state records shows. However, officials report that most of the deficiencies are commonly found in hospitals.

The shortcomings cited by county inspectors most often during the past three years include improper handling of drugs, problems with the hospital plant, failure to document medical care adequately and faulty disposal of hazardous wastes. At least one of these issues, mislabeling of drugs, also was mentioned in the lawsuits filed by ex-employees.

In the most recent survey, conducted in May and June, inspectors found that drugs were improperly administered 15% of the time. Medication prescribed for a patient’s right eye was applied to the left, two prescribed drugs were not taken by the patient with the medication nurse present as required, and “one drug was dispensed and labeled with the wrong directions and quantity.”

Overall, “the survey team observed 11 medication errors out of a possible 71 drugs to be administered to 24 patients,” according to the inspection report.

Nurses sometimes did not notify physicians about potentially significant changes in patients’ conditions. In one case, a patient’s blood pressure shot up and, in another, the skin around stitches turned red. A state inspector also observed a patient “being wheeled down the hall in a shower chair with the patient’s buttocks exposed.”

Administrator Robert D. Tonry said that each of these problems has been rectified and that the hospital has also instituted its own internal monitoring system to pinpoint deficiencies.

Problems Corrected

Pharmacy director Meico Eyer said the drug dispensing problems have been corrected with increased training for the nursing staff and tighter internal controls over distribution of medications.

The gravest charge against the hospital, one that led to a $7,000 fine, concerned the care of a woman with progressively debilitating Alzheimer’s disease, which is incurable. The woman was in a locked unit heavily staffed with specially trained employees.

County inspectors cited the hospital for refusing to restrain her with postural supports--a soft protective vest used to strap a patient to a bed or chair. They charged that failure to use restraints “presented an imminent danger or a substantial probability that serious physical harm would result to this patient.”

Persons suffering from Alzheimer’s lose perception and motor skills and are prone to falls.

Even after the decision was made not to use the restraints, the county inspection report said, “continuing unexplained bruises, falls, swollen eyes” and a subsequent fracture “should have alerted nursing and other staff of the need for closer observation and possible reinstatement of postural supports to preclude further injuries.”

The hospital, which claims its treatment was proper, lost an appeal in a county health department hearing. The home has since taken the unusual step of appealing to Los Angeles Superior Court. The case is pending.

“We have a deep philosophical difference” with health authorities about care of Alzheimer’s patients, Tonry said. “To restrain them is to give up any better life for these people. This is a test case for a whole concept” in treatment.

County health inspectors also have repeatedly cited the hospital for placing “skilled-nursing patients”--those requiring long-term care--in beds licensed for acute medical care. In the probe of allegations of Medicare fraud, the Office of Inspector General of the U.S. Department of Health and Human Services apparently is looking at whether these beds were misused.

County inspectors reported on May 27 that “22 skilled-nursing patients were being housed in beds licensed to provide acute care,” a violation also cited in an April 1, 1986, survey.

Hospitals are reimbursed at significantly higher rates for acute-care patients, whose medical needs are greater, than they are for skilled-nursing patients. State regulations also require more space for feeding and other activities for long-term nursing patients than for acute-care patients.

Audrey O’Donnell, the facility’s former nursing director who filed a $7.5-million lawsuit against the institution and its administrators last year, charges in court papers that she was fired nine days after she questioned whether the hospital’s placement of patients in the acute-care ward wasn’t tantamount to Medicare fraud.

(The hospital administration has denied O’Donnell’s charges and said in a prepared statement that she was fired because “she was unable to work cooperatively with subordinates, other department heads or the administration.”)

O’Donnell claims that she was told by hospital officials that the federal audit, which is focusing on Medicare reports for 1982 through 1985, could mean “millions of dollars that the fund would not have to pay because Medicare would not cover the service.”

Hospital administrator Tonry acknowledged that skilled-nursing patients are routinely treated in the acute-care unit and said the reason is a lack of available skilled-nursing beds. He emphasized, however, that the patients are billed at the skilled-nursing rate rather than at the higher acute-care cost.

County health officials support Tonry’s claim about the Medicare billing practices.

Problem Possible

“I understand they’re billing for skilled nursing,” said Victor Arkin, long-term care program manager for the county health department.

But Arkin said the hospital could face a problem if Medicare determines that it does not have to reimburse the hospital for care of individuals not treated in properly licensed beds.

In an effort to sidestep further problems with the beds, Tonry said, the hospital is relicensing its beds to rectify the longtime imbalance. There are now 67 acute- and 105 skilled-nursing beds. When the renovation and expansion are completed, there will be 20 acute beds and 226 skilled.

In the interim, a wing of the hospital is being renovated, with the approval of state licensing officials, to provide more skilled-nursing beds separate from acute-care patients, Tonry said. The remodeling should be finished in 60 days, he said.

A spokeswoman for the Office of Inspector General will only say that the Medicare investigation still is under way.

Another problem for the hospital has been its disposal of infectious waste. It was cited by county health inspectors after a tip led them to a red bag labeled “infectious waste” that had been discarded in a vacant lot in Canoga Park in July, 1985.

Under state law, infectious waste--which includes blood, urine, human or animal tissues or any possibly infection-carrying materials such as cotton swabs or soiled dressing--must be transported to a certified waste disposal area and destroyed.

But, in the 1985 incident, Tonry said, the hospital’s own investigators found that a lab technician had given a housekeeping aide vials of blood taken from patients for laboratory tests. The housekeeping aide, believing that she could better nourish her exotic plants with human blood, took the vials home, the administrator said.

However, the woman’s husband became angry when he saw the containers and threw them over the fence into the vacant lot, hospital authorities were told.

After admitting what they had done, the aide and technician were fired, Tonry said.

“It was an act of stupidity by two people,” he added. “It was a lesson learned by all.”