Grim Scenes Greeted Inspectors

Food and linens ran critically low, putrid trash and infectious wastes overflowed onto floors, and at least one patient was left gasping for breath outside the locked emergency room doors.

It was scenes such as these that greeted state inspectors during the last days of San Diego General Hospital.

In reports released this week, hospital licensing inspectors fined the hospital $2,000 for violations that often resulted from shortages of staff and supplies because the hospital hadn’t paid its bills.

The reports also reveal for the first time that the hospital’s request to have its emergency room downgraded to standby status came two days after an inspector was called to the facility to investigate the case of a woman who was denied care there.

“A sign was posted on the emergency room doors, ‘ER closed--phone 911 for emergency,’ ” the inspector wrote of the Feb. 5 incident. “A middle-age female, acutely short of breath, was sitting outside the door in the ambulance breezeway.”

An ambulance attendant had arrived to give the 47-year-old woman oxygen and transfer her to another hospital, the report says.

“When asked why . . . this obviously distressed lady was outside in the cold airway, the nursing staff indicated that they did not have an ER physician on duty, since he refused to work without malpractice insurance, which had lapsed at 12:01 a.m.,” it says.

Two days later, the hospital put its emergency room on standby status--available for first aid for walk-ins only--and eventually shut it down altogether.

Meanwhile, inspectors began visiting San Diego General daily in an attempt to ensure that the hospital’s potential death throes were not harming patients. It was on those visits that inspectors found other scenes for concern:

* On Feb. 11, the kitchen trash bins were overflowing with open bags of waste, with a foul-smelling ooze coming from the bottom. Garbage was also piled on the loading dock where food was delivered. The hauler had refused to come because of unpaid bills.

* On Feb. 18, 10 days’ worth of infectious waste spilled from barrels inside an enclosure next to the food loading dock. Rodents and insects had easy access to the waste. That hauler also had not been paid.

* On Feb. 18, food in the hospital kitchen consisted of a large can of ketchup, a large box of mashed potatoes, two days’ worth of bread, four heads of wilted lettuce and six gallons of outdated milk.

“Staple and perishable foods have been low due to the fact that the hospital has been in arrears with a number of vendors providing food supplies. All supplies and deliveries are on C.O.D,” the inspector wrote.

* On Feb. 24, the trash dumpsters were caked with black, sticky debris and sitting atop spilled milk.

* One of the main hospital elevators was inoperable for about three weeks.

* The hospital was about to lay off the people in charge of making sure essential machines worked--its maintenance supervisor and biomedical engineer--until inspectors objected.

* The Feb. 5 inspection found that prescription drugs were openly accessible on storage carts, instead of locked up. Emergency room drugs were locked, but there was no reliable record of their distribution.

“When the pharmacist in charge was asked about the implementation of procedures for distribution, dispensing and use of drugs, he stated that, once the nurses picked up and signed for the drugs, he was not responsible for what happened to the drugs,” one report says.