Veterans’ Hospital Is Criticized in Report : Medicine: Lack of smoke alarms, expired sterilized items and a general failure to meet quality standards are among deficiencies found at Long Beach facility. Center is already under investigation for suicides at its psychiatric unit.

The Veterans Affairs Medical Center in Long Beach, already under investigation for a rash of suicides in its psychiatric unit, failed to properly monitor the quality of patient care or meet fire safety codes during the last three years, according to a team of hospital inspectors.

A confidential report delivered to the hospital last March--and obtained by The Times through the Freedom of Information Act--cited a list of deficiencies found by the Joint Commission on the Accreditation of Healthcare Organizations in Oakbrook Terrace, Ill., a nonprofit agency that accredits 80% of the nation’s hospitals.

The report, based on inspections last July, cited a range of deficiencies, including a lack of smoke alarms, expired sterilized items and a general failure to meet quality assurance standards set to ensure high-level patient care.

The hospital, which was placed on probation in February for failing to meet commission standards, also earned the lowest possible score in life safety and was found to not comply with several National Fire Protection Assn. standards.

“None of the problems are of such gravity that the hospital isn’t safe for patients,” said Dr. William Jessee, the joint commission’s vice president for accreditation surveys. “But when you add them all up, there is reason for concern.”

Medical Center Director Dean Stordahl said in a written response to The Times that patients are receiving “high-quality care.” A hospital spokesman said a plan of correction began to be implemented months ago and that the hospital began addressing problems even before the inspection team left the premises.

“Our doctors, nurses and other health care providers meet all current licensure and credentialing requirements established by law. Our staff have professional qualifications equal to the best in private practice,” Stordahl wrote. “Maintaining quality care for veterans has the highest priority at our medical center.”

The 1,368-bed facility, which served 35,400 patients last year, will remain on probation until it comes into compliance with the commission’s standards, officials said. A follow-up inspection is expected to be conducted in late August.

Probation means that the hospital is in danger of losing its accreditation, according to Jessee. No sanctions--such as potential loss of funding--are associated with the loss of accreditation because it is a government-operated facility.

However, the Department of Veterans Affairs, as a matter of policy, has determined that all of its hospitals should be accredited. So the loss of that status would mean a loss of prestige and certain repercussions from Washington.

The Long Beach hospital is one of six veterans’ hospitals in the country on probation, a sanction exercised by the joint commission in only 5% to 8% of the 5,400 hospitals it inspects.

It was previously reported that the hospital had been placed on probation, but the reasons for that action have been kept confidential.

“This is an organization that has got problems,” Jessee said.

An eight-member team of doctors, nurses and other experts visited the hospital during a pre-announced inspection in July, 1989. Some of the most serious deficiencies were found in the process known as quality assurance--where hospitals vigorously monitor patient care practices in search of problems or ways to improve established procedures, Jessee said.

“What that means is this hospital is not doing an adequate job of evaluating its own care. It may or may not have actual quality of care problems, but we don’t believe they know the answer to that question,” Jessee said. “There is no single more important responsibility in a hospital than quality assurance.”

During the six-day inspection, surveyors checked records and found no evidence that the medical center had aggressively monitored the level of patient care in emergency services, cardiac care, surgical intensive care and medical intensive care units, among others.

Cases of death or disease that were reviewed were consistently labeled “justified,” rather than reviewed further to determine if procedures needed to be improved, the report said. Also, there was no documentation to show that doctors’ credentials had been thoroughly evaluated before they were permitted to practice on the medical staff.

In terms of fire safety, inspectors said smoke alarms were missing in some buildings and the hospital’s fire alarm system and extinguishers did not appear to have been properly inspected or maintained.

The medical center’s psychiatric unit is already under investigation by the Department of Veterans Affairs in Washington after a spate of patient suicides between March, 1989, and last April. Three men hanged themselves, one leaped from a hospital roof and a fifth shot himself in the mouth after he was allegedly denied admission to the psychiatric unit.

The joint commission, which inspects hospitals an average of every three years, cited no deficiencies in the hospital’s psychiatric unit. But the team concluded that several other areas in the expansive medical center--among the largest of 172 veterans’ hospitals in the nation--were not in full compliance with nationally accepted hospital standards.

The deficiencies cited by inspectors include:

- Only two departments in the hospital recorded greater than 50% attendance at mandatory continuing education classes for infection control policies in 1987. While attendance increased somewhat the next year, it was still woefully low in departments such as nuclear medicine, where documents indicated only 16% of the staff attended.

- Outdated sterilized items were found in medical intensive care and surgical intensive care units. In the ear, nose and throat clinic, there was no evidence that sterilizers had been tested between April, 1987, and May, 1989.

- The use of drugs was not properly monitored for possible adverse reactions. The only reviews conducted of drugs were audits to determine the cost of the medication and to identify which physician ordered costly drugs.

Stordahl said fire and safety regulations already had been updated since the review and equipment inspections would be made on time and documented.

Procedures that pay close attention to quality assurance were also already in place, he said, and the competence and experience of medical staff were being verified and documented before a physician is appointed or reappraised.

A recent study by the commission determined that the typical veterans’ hospital is considerably more likely than other hospitals to fail quality standards in key areas.