Hospital Could Lose Millions in Medicare for Violations

Hollywood Community Hospital has been accused by Los Angeles County health inspectors of starving elderly patients, performing surgery without valid consent and failing to investigate obvious medical problems.

Based on a partial review of the hospital’s operations last month, county health officials said they have formally recommended barring the hospital from receiving millions of dollars a year from Medicare, the federal program that subsidizes health care for the elderly.

Medicare dollars account for about 35% of the hospital’s approximately $19 million in annual revenue, according to the latest available state statistics.

The 91-bed hospital at 6245 De Longpre Ave. generates an additional 4% of its revenue from the Medi-Cal program, the state’s insurance program for the poor. These Medi-Cal funds also would most likely be cut off, if the federal Health Care Financing Administration adopts the county’s recommendation to terminate Hollywood Community Hospital’s Medicare funding.

Hospital administrator Rick Lerner said Wednesday that within 10 days he will prepare a response to the allegations as well as a plan of action that he believes will satisfy county and federal health officials.

In response to a recent anonymous complaint about patient care at the hospital, inspectors from the county Department of Health Services looked into five areas of the hospital’s operation: surgical and anesthesia services, quality assurance, medical staff and governing body. “They flunked every one,” said Bud Pate, supervisor of the health department’s hospital inspection unit.

He said that during the last year, he has recommended that four of the 156 hospitals in Los Angeles County be stripped of their Medicare funding. HCFA has so far moved to terminate one--Inglewood Women’s Hospital, where inspectors cited inadequate care of patients and unsanitary conditions during abortions.

Hollywood Community is one of 20 hospitals run by the Pasadena-based Paracelsus Healthcare Corp., which is owned by a West German doctor. Ten of the hospitals are located in Southern California. Two years ago, the corporation pleaded guilty to a charge of mail fraud in connection with its filing of Medicare cost reports that failed to disclose business activities with related companies. The corporation reimbursed the government $4.45 million under its plea agreement.

The recent health care problems at Hollywood Community relate in part to the treatment of some of the 175 elderly patients referred to the hospital by nursing homes during the last six months.

Many of them were suffering from gaping, ulcerous bedsores that required surgery, including amputation. Health inspectors charged that hospital records show that these patients, who were tube-fed during recovery, “consistently do not receive a sufficient intake to promote wound healing.”

One 93-year-old patient, for example, was fed one-third of the nutrients she needed. Other patients were released too early or discharged to inappropriate nursing facilities.

Health inspectors also cited the hospital for failing to obtain proper consent before performing surgery.

“There is consistent lack of appropriate consents for surgical procedures. Consents for non-emergency procedures are not obtained from the relatives of patients with documented senile dementia,” the health inspectors charged in a 46-page report detailing hospital deficiencies.

Surgeons determined that cataract surgery should be performed on one senile 75-year-old woman in order to “improve the patient’s quality of life,” according to the report. Yet there is no indication that there was an attempt to get consent for the operation from the patient’s brother, the report stated.

The report took aim at the hospital’s treatment of non-elderly patients too.

A special consent form that is required of women undergoing sterilization was reported to have been absent in four of the five cases spot-checked by inspectors.

A fundamental problem, inspectors noted, was the absence at the hospital of necessary internal controls to assure quality care.

They pointed out that, when one patient had his gallbladder removed and the surgeons left gallstones behind, this care was nevertheless deemed “appropriate” by the hospital’s internal monitoring committee that reviewed the matter.

In one instance, an anesthesiologist, who had been suspended from another hospital--and was given temporary staff membership at Hollywood Community on the condition that he be monitored--was administering anesthesia without supervision, the health report charged.

Action ‘Just Step One’

About nine months ago, hospital staff members informed the hospital’s governing board of “serious concerns regarding specific members of the staff.” But health inspectors reported that “significant and effective action” had not been taken when they made an unannounced visit March 9.

“We view these issues as very serious,” said Pate, the county health supervisor. “The action we have taken is just step one.”

He said that, for example, federal health officials may ask the county to do an exhaustive survey of the hospital’s entire operation. He said his staff is now looking into whether nursing homes were to blame for the condition in which some of the elderly patients arrived at Hollywood Community.

He said that during the last year, the county recommended cutting off Medicare funds to French Hospital of Los Angeles, Sherman Oaks Community Hospital, and Panorama Community Hospital.

Deficiencies Corrected

Deficiencies in a peer review program at French Hospital in downtown Los Angeles have since been corrected and the hospital is no longer in jeopardy of losing its Medicare funds, Pate said. He said there has been no resolution of problems at Sherman Oaks Community Hospital, which was cited for deficiencies in its emergency care and dietary program, or at Panorama Community Hospital, where deficiencies were found in the physical environment.

A spokesman at Panorama said the most recent survey of the hospital by the health department showed the hospital to be in full compliance with Medicare standards.