Hospital Makes a Remarkable Recovery : Health care: Once on the brink of closure for its abysmal care, county-run Edgemoor now has officials seeking funds to save the aging Santee facility.

By any standard, 1985 was not a good year for Edgemoor Geriatric Hospital.

The aging Santee facility, underfunded and neglected for years by county officials, came under the intense scrutiny of the state health department’s licensing and certification team.

State officials delivered a scathing critique of the county-run hospital and slapped it with a string of citations for medical improprieties, among them: giving penicillin to an allergic patient; roughing up a patient for sleeping during a meeting; leaving a paralyzed patient unattended in a bathtub. The patient drowned.

The hospital was on the verge of being shut down.

But today, Edgemoor staffers say the haunting memories of those woeful times are fading fast. The reason: the arrival of a new administrator and the infusion of long-overdue county funds that officials say have turned around the 323-bed hospital that houses elderly, handicapped and mentally ill patients who have nowhere else to turn.

Medical records, once left stacked to gather dust in a corner, are now properly filed and kept confidential in accordance with state guidelines. A limited hospital menu that at one time soured appetites--many residents lost weight--now offers a wide selection, with each meal receiving a dietitian’s stamp of approval. Residents, previously left to wilt in their beds, are now encouraged to participate in physical rehabilitation.

Amid the public outcry that followed the release of the 1985 San Diego County Grand Jury report that said, “ . . . (the Grand Jury) can find no kind words for the county hierarchy which has permitted the unwanted to be swept under the rug of isolation at faraway Edgemoor,” county officials hired Florence McCarthy.

Since McCarthy became Edgemoor’s administrator in March, 1986, the hospital has consistently received better marks in the state health department’s annual evaluation.

According to state records, Edgemoor received a score of 65 in its January, 1987, evaluation. The tally, in essence, counts deficiencies in a hospital. The higher the number, the worse the facility.

Slightly more than a year later, in February, 1988, Edgemoor scored a 37. And in January, 1989, the hospital lowered its score again, to 35. The results of the most recent survey conducted two months ago have yet to be released.

“The care has been dramatically improved since 1985,” said Ernest Trujillo, district administrator of the state health department’s licensing and certification division. The licensing division surveys medical facilities and evaluates health care practices to ensure compliance with standards set by Medi-Cal and Medicare. Edgemoor’s deficiencies in the mid-1980s almost caused it to lose federal funds, which pay for the bulk of the hospital’s operations.

“The county took some necessary measures, and the change in administration has allowed Edgemoor to come a long way,” Trujillo added.

But maybe not far enough.

Although Edgemoor’s medical care is vastly improved, a new county grand jury report notes that the physical condition of the aging facility--some buildings were built in 1929--is deteriorating “at an alarming rate.”

The report states that “tunnels containing steam, hot and cold water and hydrant lines to the facility are on the brink of collapse. Sewer lines are in disrepair and portions of roads around the facility had to be closed to prevent accidents.”

If the building continues to deteriorate, hospital and county officials worry that Edgemoor may once again be threatened with closure. The county has financed some repairs, but officials agree that the only way to address all the deficiencies is to rebuild.

“The maintenance costs for a facility that is 60 years old are exorbitant,” said Paul Simms, county deputy director of physical health services. “We’re talking about replacing entire plumbing systems, electrical systems. We don’t have running water in the wards. The care rendered by the staff is second to none, but the employees are doing that in prehistoric conditions.”

Deteriorating physical conditions have already caused one injury. In 1987, a boiler room mixing valve that controls the release of hot and cold water failed. When a nursing assistant turned on a faucet, hot steam came out, scalding the foot and ankle of a patient who was being bathed. The hospital was slapped with a major citation--the only one Edgemoor has received under McCarthy’s tenure.

Although the county’s current fiscal crisis complicates rebuilding plans, concerns about other accidents have intensified county efforts to find money for a new hospital.

“The prospects of rebuilding Edgemoor look better than they have before,” Simms said. “Through a change in (hospital classification), it is conceivable that additional resources will be made available so that reconstruction could be pursued without direct cost to local taxpayers or the county.”

Previously, Edgemoor was classified as a skilled nursing facility and received only $55 per patient per day in Medi-Cal reimbursements. But county officials argued that Edgemoor provides more complex care, and it recently earned an upgraded designation entitling the county to receive $149 per patient per day.

Simms hopes that the additional revenue can be used to finance a bond issue for rebuilding. The project, which would add 80 beds, would cost about $50 million. Simms plans to introduce a financing plan to the County Board of Supervisors within 30 days.

Such a plan is likely to win the quick support of Supervisor George Bailey, who has pushed for Edgemoor improvements.

“Frankly, its a bunch of old buildings,” Bailey said. “We can’t wait forever. We need to get some kind of plan moving . . . hopefully by the end of the year.”

Although concerned about the hospital’s physical condition, McCarthy--who has already overcome many obstacles in steering Edgemoor toward respectability--remains optimistic. For starters, she is eagerly pursuing the idea of a fund-raiser to help finance rebuilding.

Tackling problems with such a “rolled-up sleeve” approach is typical McCarthy management style, but McCarthy acknowledges that, soon after taking over, she found herself questioning her decision to accept the job.

“The very first day I walked in, I had a visit from the state surveyor (health inspector), who said, ‘I’m really sorry to do this to you,’ but then proceeded to slap me with a $25,000 citation,’ ” McCarthy said. The $25,000 citation stemmed from a 1986 incident in which an elderly patient died after a nurse inserted a feeding tube into her windpipe, instead of its intended target, the esophagus.

“Reporters were falling out of trees,” McCarthy says of those tumultuous years when it seemed as if new problems were being uncovered every day. “As you can imagine, that didn’t do much for morale.”

And boosting morale is where McCarthy may have had the greatest impact.

Although many credit McCarthy with the hospital’s turnaround, she attributes the improvements to money the county poured into the hospital. Criticized by the county grand jury and fearing the loss of federal funds, the county spent about $3 million and added 125 new staff positions in 1985.

Clearly, the addition of dietitians, therapists, physical maintenance crews and medical records staff helped cure many deficiencies.

But Supervisor Bailey adds, “Edgemoor was a mess, and we did give it extra funds, but what the staff did there . . . Well, that kind of leadership, morale . . . that’s something money can’t buy.”

McCarthy’s supporters say her enthusiasm and energy is contagious. Although McCarthy expects a lot from her staff, she hardly seems demanding. Instead, supporters say, McCarthy delivers constructive criticism in the form of a gentle nudge toward better performance. McCarthy’s eagerness to share credit for improvements, supporters say, has also infused the staff with pride.

“ ‘You’re doing a great job, but maybe, if you did it this way, you could do it even better . . . ‘ those are the things I hear (McCarthy) saying (to her staff) while I’m visiting,” said a San Carlos man who regularly visits his 49-year-old brother, suffering from Huntington’s disease. He also credits McCarthy with implementing an employee-of-the-month program that recognizes outstanding work.

“Things like that may seem like no big deal, but it is,” the San Carlos man said. “It makes everybody try just a little bit harder. And I assure you, that’s appreciated.”

McCarthy also boosted staff and residents’ morale in 1986, when she organized a “Senior Prom.” Hospital staff, volunteers and community supporters spent months planning what has become an annual event--residents are dressed in donated formal attire and treated to a gala event in the hospital’s dining room-turned-ballroom.

Such events have been instrumental in turning around Edgemoor, which Chuck Thurman, the hospital’s executive housekeeper, says was “atrocious” when he was hired five years ago to work in the medical record department.

“When I accepted the job, I assumed there was a department to join, but, when I got here, I discovered that I was the department,” Thurman said.

Patients’ charts were often incomplete, Thurman said, because the understaffed nursing corps “was too busy running around taking care of the residents.”

No one had time to properly fill out charts, Thurman said. “You can imagine what kind of trouble that got us into, because unless treatment is documented, it’s assumed that it wasn’t done.”

Although criticism of medical care was often severe, McCarthy and other staff members say the problems were not the result of negligence but of an overworked staff.

“You just ran out of steam,” said Mary Kendricks, a 25-year Edgemoor veteran, referring to the workload during Edgemoor’s troubled days. Kendricks, who worked as a certified nursing assistant, is now a hospital administrator. In the mid-1980s, Kendricks said one nursing assistant was responsible for eight bed-ridden residents; now, the staffing ratio is one nursing assistant to four or five residents.

But hardship also produced some benefits, such as strengthening the resolve of Edgemoor’s auxiliary, a band of 135 volunteers who help provide care in a number of ways, including wheeling and walking patients, organizing bingo and sing-alongs and writing letters for residents.

Helen Field, 75, a volunteer for 29 years, proudly states that no one deserted the auxiliary during Edgemoor’s darkest days.

“No one left,” Field said. “In fact, it glued us together because we felt that we were needed more than ever before.

“We have to keep Edgemoor going,” Field added, “because one day I may need to come here.”