King Hospital Deficiencies Cited by State

State health officials issued a 90-page report Tuesday citing serious deficiencies in health care practices at Martin Luther King Jr./Drew Medical Center. The deficiencies could threaten the hospital’s Medicare funding and its state license, according to federal and state officials.

King, a 430-bed hospital operated by Los Angeles County in Watts, was reported to have suffered major breakdowns in infection control, quality assurance, nursing, dietary care, and administration by state health inspectors who spent a week at King in June spot-checking the hospital’s entire operation.

The inspectors cited instances in which one patient developed malnutrition while in the hospital’s care and other patients languished for hours in the emergency room without care. Others, believed to have infectious diseases, were not properly isolated, it was reported.

Records Misfiled

Equipment had fallen into disrepair, and one piece was so filthy that the odor alerted investigators. There were cases in which drugs were left unattended, patient records were misfiled and inexperienced nursing students were called upon to care for acutely ill patients, according to the report.

Neither officials at King nor at the county Department of Health Services were available for comment on the report.

The investigation was prompted by a January report commissioned by the federal government that analyzed death rates of elderly Medicare patients and ranked King among the bottom 50 of 5,577 hospitals nationwide.

Theresa Hawkes, head of licensing and certification for the state Department of Health Services, said King will be required to submit a plan detailing how it will correct Health and Safety Code violations. The hospital’s license could be jeopardized otherwise.

She said King officials will also have to answer to the federal Health Care Finance Administration, which has the power to force corrections or, in drastic cases, terminate a hospital’s Medicare funding.

Peter Summers at the Health Care Finance Administration office in San Francisco said he has not yet received the state’s report, but that based on a briefing by state health officials, he believes that the findings are significant enough to warrant federal intervention.

He said state inspectors found a “major breakdown” in several key areas of patient care. A collapse in even one of these areas can threaten a hospital’s Medicare funding.

“It’s serious,” he said.

Series of Articles

Summers said his concerns about patient care at King were heightened recently by a series of articles about the medical center that were published in The Times.

“Quite frankly,” Summers said, “the articles were shocking.”

Concerned that the articles had made “serious charges of substandard health care” at King, the Los Angeles County Board of Supervisors asked the county health department last week to investigate problems at King involving “poor administration, a lack of highly skilled medical staff and a severe shortage of space, staff and funding to adequately deal with the hospital’s increasing patient load.”

However, the state report took aim at the supervisors themselves for neglecting King.

“Due to the amount and seriousness of the deficiencies cited in this survey, the governing body (the Board of Supervisors) is not effectively insuring the facility’s compliance with licensing requirements and regulations, safety procedures and federal standards for hospitals,” the report said.

Inspectors reported that the board failed to respond in a timely manner to correspondence from county health officials that included issues of quality assurance at the medical center. The board was also faulted for not reviewing hospital staff appointments.

Patient Care

In other cases, the supervisors were not told of evaluations of patient care at the hospital and did not hold the medical staff accountable for the quality of that care, the report found.

“The minutes of the governing body which did allude to the facility by name contained terse statements dealing only with fiscal, financial or capital expenditure issues,” the investigators noted in their report.

The report also noted many other problems at King which, in some cases, have already been cited in prior reports or audits.

For example, the hospital’s quality-assurance officials, charged with reviewing hospital deaths and questionable occurrences, were faulted by inspectors for having failed to take action on several unspecified “significant deficiencies.”

As for the hospital’s nursing services, a review of staffing patterns during a two-week period showed “a consistent shortage of registered nurses,” the report said. Nursing attendants and students were routinely called upon to care for acutely ill patients.

Of 40 cases sampled, inspectors cited 19 for nursing deficiencies. In one case, a patient with pneumonia was not prescribed a nursing plan of care until the day he died--three days after admission.

Vital Information

The hospital’s busy emergency room was faulted for poor record-keeping in which vital information was not kept or was improperly removed.

Inspectors also documented cases of apparent patient neglect in the emergency room, including an instance where a patient with a head and lung injury lingered six hours without any notation that he had received care.

In the area of infection control, the report also found numerous problems:

* Bedpans containing urine were found on so-called over-bed tables alongside food trays.

* Infectious waste containers were overfilled and uncovered.

* Intravenous tubes were unlabeled with the date when treatment was initiated, so that it was impossible to tell whether the tubes had been changed every 48 hours, as required.

* Tubing for connecting a patient to a ventilator was found draped over the patient’s bed five days after it had been disconnected. A suction tube nearby was “completely coated with dark brown, dried sero-mucous material.”

* In two rooms housing patients suspected of having tuberculosis, the doors were found standing open with no requirement of isolation.

* In the isolation room of the medical intensive-care unit, the walls stopped more than a foot short of the ceiling.

* Sterile supplies in one room were improperly stored below the sink drain, some protected only with dust covers, others with a paper wrapping. The report noted that “any malfunction of the sewerage system could result in contamination of this material.”

* The “morgue refrigerated holding box” had not been cleaned and appeared to contain body fluid. The conditions raised the possibility of health risks for personnel taking samples from cadavers stored in the box, the investigators said.

As for the hospital’s pharmaceutical practices, the report noted that medications were repeatedly given without evidence of proper orders. Some medication orders went unfilled, according to the hospital’s own records, the report revealed.

In repeated instances, the report said, drugs that should have been locked up were left out and unattended. In addition, investigators found some medications and equipment had expired as much as 15 months earlier.

The investigation found numerous failures to assess patients’ nutritional requirements, as is required under the hospital’s own rules. Even a woman found to have food poisoning upon admission for other conditions was never “nutritionally assessed,” according to the report.

Heart Disease

In another case, the condition of an 88-year-old woman admitted with pneumonia, a urinary tract infection, heart disease and numerous other conditions worsened over two months to include anemia, dehydration and “severe malnutrition,” the report said.

The study noted that information on some patients had been misfiled in other patients’ records.

The investigators found housekeeping problems, such as dirty floors, dust and litter in 25% of the approximately 150 rooms they visited. One piece of equipment was so “encrusted with filth” that the stench drew the investigators’ attention.

In one room used for disposing of linen or trash through a chute, the regulators found waste paper, a towel, soiled linen and a pair of men’s shorts filled with feces.

Other infractions reported included problems with general safety and maintenance, including inappropriate storage of hazardous materials. The regulators found equipment installed improperly, units poorly designed and inadequate testing of patient-care equipment.

Some critical-care equipment, such as heart monitors and defibrillators, had not been tested for approximately two years, the report stated. Five heart monitors in the neurosurgery intensive-care unit were labeled “DO NOT USE AFTER APRIL ‘89,” the investigators found in their June inspection.