Staff Assails Leaders, Cuts at Hollywood Presbyterian

Doctors at the venerable Hollywood Presbyterian Medical Center in Los Angeles have taken an extraordinary vote of “no confidence” in the hospital’s leadership, to condemn what they say are cost-cutting measures and misguided priorities that are jeopardizing the quality of patient care.

Top physicians told The Times of shortages in such basic items as operating tables and suturing kits, as well as long delays in maintaining and upgrading hospital equipment due to financial restrictions imposed by creditors.

The hospital administration’s failure to remedy the problems prompted the 15-member executive committee of the hospital’s medical staff to take their nearly unanimous no-confidence vote last Thursday, according to several committee members.

Hollywood Presbyterian’s Board of Governors has scheduled an emergency meeting with doctors Friday to discuss the vote. Several members Tuesday voiced support for the hospital administration.

While the vote carries no legal authority, it poses a further threat to the financial health of the hospital, which is heavily dependent on the approximately 700 physicians on its medical staff to admit private patients there. Most of the time, about half of the hospital’s beds are empty, according to hospital officials.

Dr. Samy Farag, chief of staff of the hospital, said many doctors are already recommending that their private patients go to other hospitals, a trend that other physicians predicted would intensify if changes are not made.

“Many members of the medical staff are concerned about the quality of care their patients receive and have expressed dissatisfaction about deterioration in services,” Farag said. “In spite of numerous attempts to bring these deficiencies to the attention of hospital administration, there has been no improvement.”

Dr. Allene Nungesser, chief executive officer of the hospital, defended the quality of care and said the hospital’s “long-term commitment is to be a survivor in a very stressful environment.”

Hollywood Presbyterian, a 395-bed nonprofit hospital was founded in 1924 and soon developed a reputation as a high-quality facility serving the famous and affluent community of Hollywood. But it has fallen on hard times in recent years, as changing demographics have brought the hospital wavesof indigent and uninsured patients.

The hospital’s most recent financial disclosure reports show that it lost $7.9 million during a two-year period ending in June, 1987. Further losses through the first half of 1988 are expected, according to Nungesser.

Care Called Acceptable

Despite ongoing cost-cutting measures, Nungesser maintained in a telephone interview Tuesday that “the quality of care being rendered in this facility is acceptable. . . . If people are discussing circumstances where we haven’t been able to reasonably service our patients, I think that is a misstatement.”

She said that doctor discontent reflects “a frustration point on the part of some of our staff” who need a “more in-depth appreciation for the things that can and cannot be done.”

Physician unrest appears to be most intense in key departments such as surgery, anesthesia, and radiology. Some physicians are said to resent a massive reorganization recently of cardiology services, including the hiring of a new director of cardiology and commitment of nearly $500,000 to upgrade cardiac care equipment.

Dr. Andrew Scharf, chairman of surgery, said in an interview that purchasing holds on the hospital have prevented the replacement of basic supplies for operating rooms, such as needles and thread, lights, tables, gurneys and autoclaves used to sterilize surgical equipment.

Furthermore, he said that while the hospital has a wide array of sophisticated equipment including CT-Scan and MRI machines that are used in radiology, regular maintenance of equipment has sometimes been thwarted by credit holds on the hospital.

No Payment, No Work

Dr. Marshall Sands, chairman of the department of anesthesia, refused to comment on reported problems with equipment maintenance in his department. But Dr. Carl Hauser, a surgeon, said that in one instance the company that supplied the hospital with a machine used to administer anesthetics “refused to do routine maintenance because their payment had not come through.”

“At some point,” Hauser said, “the risk is that something that is used isn’t safe because there’s nothing else around.”

Nungesser said she knows of only one such instance of delayed maintenance, which she attributed to a misplaced invoice.

“There’s surgery going on at Hollywood Presbyterian each day,” Nungesser said. “We wouldn’t be able to do that if we didn’t have needles and thread.”

She continued, “I’m not going to sit here and say it wouldn’t be wonderful to replace tables and lights and remodel and rebuild, but the pragmatic reality is that with the financial circumstances today, there are very few hospitals that have that luxury.”

Dr. Nachman Brautbar, chairman of the department of medicine, said he was shocked to learn of the “significant” problems in surgery, radiology and anesthesia.

The vote, he said, reflects dissatisfaction among the medical staff that “exploded in one day, but it’s been accumulating over a year.”

Church Affiliation

The doctors forwarded their vote of no confidence to the hospital’s Board of Governors, which includes a number of members affiliated with the Presbyterian Church.

Board Chairman Ray Wilson, a retired construction executive, said Tuesday that he was surprised by the vote.

Board member Milton Brock Jr., a retired builder, said, “These doctors really have a hard time understanding our basic problem. They want new equipment all the time and . . . we’re not able to buy it.”

According to a health care attorney, the board is now in the predicament of a baseball team owner whose team is in last place.

“The owner is forced to choose between changing managers or changing the entire lineup of the team,” said the attorney.

A veteran neurosurgeon at Hollywood Presbyterian, Dr. John McRae, said the problems at the hospital are deep-seated. At a time when the administrators and doctors should be pulling together, their relationship has been marked by “an atmosphere of mutual distrust that has disintegrated into outright disrespect,” he said.

Supply shortages and lack of regular equipment maintenance, McRae said, are symptomatic of much larger problems at the medical center that are similarly affecting other inner-city hospitals.

‘Tremendous Tensions’

“There are tremendous tensions related to the population in this general area,” McRae said. “. . . We’re called upon to care for a large indigent population” with inadequate reimbursement.

The changing patient population has occurred at the same time that harsh new economic restraints have been imposed on hospitals nationwide due to government and private insurance efforts to control health care costs.

McRae said Hollywood Presbyterian is continuing to “attempt to transfer a large amount of hospital cost to private-paying patients” by overcharging them “100% to 125%” to make up for the losses of patients who cannot pay their bills.

Overcharging Disputed

Nungesser disputed McRae’s claim. She said the hospital’s rates are competitive and added, “We do not think we are 125% out of the ballpark from the rest of the world we compete with.”

In 1986, the hospital opened a new building at a cost of more than $56 million.

The medical center was forced to close its trauma center in early 1987, citing financial losses totaling about $5 million during its two-year operation. The hospital continues to operate a 24-hour-a-day emergency room that accepts about 450 public ambulance runs per month, including many patients who are too poor to pay their bills. Nungesser said the hospital is losing about $3.5 million a year on its emergency room. The county Board of Supervisors recently awarded the hospital a subsidy of $111,375 to support the emergency room operation through Oct. 1.