In another attack on Los Angeles County's beleaguered health care system, state inspectors Friday cited a county-run nursing home at Rancho Los Amigos Medical Center for violating new federal regulations that restrict the drugging and physical restraint of patients and for providing so little supervision that some patients were found wandering along a highway.
The 93-page report by state inspectors cited the 40-bed skilled nursing facility in Downey for flunking five of 15 major performance areas. A facility must meet all the criteria in order to continue receiving Medicare and Medi-Cal funds.
Inspectors described the facility as reeking from a "musty, fetid" odor. Floors were debris-strewn and sticky from spills and messes. A drainage bag of body fluids was found on the floor of one room. Feeding pumps and suction canisters were encrusted with secretions. In another room, a restraining device used to tie down patients was covered with ants.
Stinking, bedridden patients in dirty hospital gowns were routinely left unbathed, according to inspectors who visited the facility for several days in January. Inspectors charged that nursing home staff failed to rotate patients every two hours to prevent development of painful bedsores and that they helped patients out of bed and into wheelchairs only every other day.
Inspectors observed one patient whose fingernails had grown so long he could not push a button to operate a mechanical device and another patient who was left in bed for four days, clothed only in a diaper.
Inspectors reported that call bells went unanswered for one to two hours. In numerous cases, patients had tracheotomy breathing tubes that were left unsuctioned, so they became clogged and gurgled with "bubbling mucus," the inspectors found.
The facility lacks any system to prevent patients from wandering off, inspectors said. Two patients have been found up to a mile away on busy Imperial Highway. During a visit on Jan. 28, inspectors reported that when one patient wandered off, nursing home staff was informed but failed to respond.
The nursing home, established in 1983, has a large number of patients who cannot move without help, and 10 who the courts have found mentally incompetent. Affiliated with the county's rehabilitative hospital, Rancho Los Amigos Medical Center in Downey, the nursing home receives many patients with special medical needs, often involving neurological damage. Most patients are in their 30s.
Armando Diaz, administrator of the nursing home, said the Medi-Cal program pays the bills for 84% of patients--or a daily rate of $202 per patient. The nursing home's budget for 1992, he said, is $6 million.
Diaz acknowledged that he has "a lot of work to do," but vowed that the institution will take whatever steps necessary to meet performance standards set by the federal government and ensure continued federal funding.
"We know what the deficiencies are. . . . We are very concerned," he said. "We are going to comply."
According to state health inspectors, the Rancho nursing home has flagrantly disregarded new federal nursing home regulations, implemented last year, that are aimed at improving the quality of life for patients nationwide. The regulations require nursing home staff to stimulate patients "to attain the highest practicable physical, mental and psycho-social well-being."
Inspectors also faulted the nursing home staff for failing to adhere to new regulations that strictly govern the use of psychoactive drugs and physical restraints. To prevent these restraints from being used for discipline or the convenience of staff, the new law requires that less restrictive measures be tried before restraints are used. Also, patients must give their consent and be informed of the risks of psychoactive drugs.
Inspectors found "no evidence" that the staff at Rancho had followed these rules before tying down or drugging patients. They witnessed one patient who was strapped so that the restraints tightened around his genitals. In another case, a patient given psychoactive drugs suffered permanent neurological damage as a result of the medication.
The nursing home also was found to have no mechanism for ensuring the safety of patient property. In one case, inspectors reported that unauthorized withdrawals had been made from the bank account of a patient who had entrusted his money to the home.
State health officials also released a report charging health violations in the emergency department at Los Angeles County/USC Medical Center. Health officials inspected the emergency department Jan. 23, after reports in The Times that sick patients were lying naked and in restraints on gurneys in the public corridors.
On Friday, inspectors cited the hospital for failing to provide sufficient personnel and for improperly monitoring patients who have been placed in restraints. It was cited in December on similar charges.