County-USC Hospital Put on Accreditation Probation

Citing a wide range of deficiencies in fire safety and the ability to monitor the quality of medical care, the nation’s major hospital review organization has placed Los Angeles County-USC Medical Center on conditional accreditation.

This is the second major county hospital to be placed on conditional accreditation. Martin Luther King Jr./Drew Medical Center was placed on the same probationary status earlier this year.

“Among public hospitals, it is not uncommon to see this degree of difficulty in meeting the accreditation standards,” said Dr. William Jessee, the organization’s vice president for accreditation surveys. “It is a sad commentary on the decaying infrastructure of public medical care in large cities.”

In a related action, the Joint Commission on the Accreditation of Healthcare Organizations also put Queen of Angels-Hollywood Presbyterian Medical Center, a private, nonprofit hospital, on conditional accreditation.

Conditional accreditation is reserved for hospitals with significant problems in meeting the commission’s quality of care and safety standards. Such facilities typically have problems with their quality assurance programs and medical staff monitoring systems, which are designed to minimize the risk that patients will be harmed in the hospital or cared for by unqualified individuals.

A hospital that loses its accreditation jeopardizes its participation in the Medicare and Medi-Cal programs. In addition, a teaching hospital jeopardizes the status of its residency programs.

During a weeklong inspection last September, Joint Commission officials found the behemoth County-USC deficient in 19 of the 54 key areas it rates. The medical center has 2,045 licensed beds but only 1,398 are in use.

The actions were taken last month by the Oakwood Terrace, Ill.-based organization. Both County-USC and Queen of Angels have been asked to submit plans of correction.

Queen of Angels officials have submitted their plan and County-USC officials expect to submit theirs in about a week. Each hospital will undergo another inspection in about six months.

Harvey Kern, a special assistant to County-USC’s executive director, acknowledged serious fire hazards, particularly in the main General Hospital building which dates to 1932. There is no sprinkler system.

Kern said the hospital, under pressure from federal health officials and city and county fire officials, is spending $500,000 a year for a 24-hour fire watch in which employees walk the halls of the 19-story main building looking for fires and potentially hazardous conditions.

Stopgap repairs may be overtaken by other actions. In mid-September, county health officials expect to submit a master plan to the Board of Supervisors for replacing County-USC entirely, Kern said. Independent of the Joint Commission report, replacement is being seriously considered as an alternative to bringing the aging facility into full compliance with modern fire safety standards. Retrofitting the four hospitals that make up the County-USC medical complex with fire alarms and sprinklers could cost up to $100 million.

Kern said County-USC would also request $2.6 million from the county to correct deficiencies in other areas, including physician evaluation, the organization of the medical staff, surgical case review and medical records.

During an inspection of Queen of Angels last November, the Joint Commission found problems with medical records and maintenance procedures, according to Ron Dahlgren, the hospital’s president.

The 433-bed Queen of Angels facility has had financial difficulties since it merged with Hollywood Presbyterian in January, 1989. The hospital serves a disproportionate number of poor and minority patients, many of whom lack health insurance.

County officials are exploring the purchase of the the merged facility as a part of a plan for replacing County-USC Medical Center. But Dahlgren said the hospital’s financial condition had improved in recent months and there was no interest in selling.

“We had the impression that (the joint commission) wanted more months of experience as a merged institution before they gave us a non-conditional accreditation,” Dahlgren said. “Everything we were told indicated that they were happy with the progress we had made since the merger.”

Since the Joint Commission began releasing the names of conditionally accredited facilities last year, 15 California facilities have been so designated. The other California hospitals conditionally accredited in June are the Veterans Affairs medical centers in Fresno, Livermore and Palo Alto, and Pacific Coast Hospital in San Francisco.

There are now 10 VA hospitals in the West on conditional accreditation, including the VA medical centers in Long Beach and Sepulveda.

Of the 1,800 hospitals inspected by the organization each year, only 5% to 8% are conditionally accredited, according to commission officials. Between 1% and 2% of hospitals are not accredited and the others are fully accredited for a three-year period. County-USC was last fully accredited in 1986.