Health Inspectors Cite ‘Deficiencies’ at Ailing Hospital

Los Angeles County health officials found “serious deficiencies” with a “potential impact on the quality of patient care” during two recent inspections of Hollywood Presbyterian Medical Center in Los Angeles.

The deficiencies at the financially troubled facility, which is in the process of completing a merger with nearby Queen of Angels Medical Center, included the presence of expired drugs throughout the hospital, an “inadequate” supply of surgical instruments for routine cases, shoddy record keeping and a weak quality assurance program, according to county documents reviewed by The Times. Some of the deficiencies have remained uncorrected for several years, the inspectors noted.

Dr. Robert Karp, program manager for the health facilities division of the county Department of Health Services, said the latest inspection, in early December, showed that Hollywood Presbyterian had made substantial improvements since the first inspection in September, but that “significant deficiencies” remained, particularly in the pharmacy and the infection-control program.

“We were very concerned about what we found, particularly in September,” Karp said. Both inspections revealed “serious deficiencies . . . with a potential impact on the quality of care.” He explained: “I am not saying the deficiencies indicated there was poor quality care, but some of these deficiencies indicated the potential for a quality-of-care problem.”

The problems identified by the September inspection were considered sufficiently important that county officials recommended that the U.S. Health Care Financing Administration “terminate” Hollywood Presbyterian’s participation in the Medicare and Medi-Cal insurance programs. This recommendation was never carried out because “the hospital corrected the things that got them in trouble,” said Stan Marcis of the federal agency’s regional office in San Francisco. Hollywood Presbyterian, however, remains on a special “monitoring” status, he said.

Allene Nungesser, chief executive officer of the 395-bed nonprofit facility, played down the significance of the county’s findings. She said they largely represented deficiencies in keeping records, not deficiencies that might affect patient care.

The county found “no evidence that we were delivering poor quality care,” she said. “We did not have the documentation that they felt was adequate for their review processes. . . . We feel that we are making strong progress so that the documentation of (quality care) will be available.”

County officials said the inspections were triggered by an article in The Times last August, in which physicians at Hollywood Presbyterian cited examples of what they said were cost-cutting measures and misguided priorities that were jeopardizing the quality of patient care. Health officials received a confidential complaint about the facility as well.

The September survey found numerous problems with the hospital’s quality-assurance program, which Karp said was “the area of prime concern.” Such programs, which are required at all hospitals, are designed to monitor the quality of care and to prevent situations that might harm patients from arising in the first place. Their goal is to identify problems, make plans to correct them, and then determine whether, in fact, they have been corrected.

The hospital was chastised for failing to act on four out of five “potential problem areas” within the cardiac surgery program that had been identified by outside reviewers nearly a year previously and for inadequate efforts to both monitor and prevent hospital-acquired infectious diseases.

In September, the inspectors also determined that an “inadequate supply of general surgical instrumentation” was available for routine cases and that “outdated” surgical supplies were found “available for use” in a surgery storage area.

Hollywood Presbyterian’s medical staff executive board and the hospital’s trustees were criticized for repeated failures to make sure that identified deficiencies were corrected. This was because in an August, 1986, survey similar deficiencies had been found, for example, in infection control and surgical equipment, the report said.

Some deficiencies remained uncorrected since that earlier survey. The inspectors also noted that between September, 1987, and September, 1988, “not a single opportunity to improve care was identified through the quality assurance/peer review process.”

As a result of these findings, Nungesser said, the hospital has strengthened its quality-assurance procedures and record keeping and purchased additional surgical instruments.

In the December report, the surveyors also cited multiple problems with the handling of drugs, including the presence of expired drugs “in almost all areas of the hospital.” For example, outdated drugs were found on five carts of anesthetic medications, including one medication that had expired in June, 1985, and a vial of medication that had become “contaminated.”

One surveyor observed a pharmacist making two errors in dispensing medications, including counting the wrong number of pills and dispensing a tablet as opposed to the liquid medication that had been ordered by a physician. “It is evident by the deficiencies found in drug storage, labeling, dispensing and use of medications, that more in-depth inspections are necessary,” the December report said.

When asked about these findings, John Frank, Hollywood Presbyterian’s vice president of clinical services, said: “To the best of our knowledge, there are no outdated medications in the hospital at this time. . . . We are increasing our programs for reviewing all of these areas.”