Supervisors Take Action to Control Deficiencies at County Nursing Home


The Board of Supervisors on Tuesday criticized top county health officials for keeping them in the dark about serious patient-care deficiencies at a county-run nursing home, and moved to place correction of these problems under the board's direct supervision.

The board also ordered health officials to investigate the possibility of reopening two closed wards at Psychiatric Hospital at Los Angeles County-USC Medical Center to alleviate severe overcrowding in the hospital's emergency room.

The supervisors' action followed reports in The Times last week detailing conditions at Psychiatric Hospital in Boyle Heights and at the 40-bed skilled nursing facility at Rancho Los Amigos Medical Center in Downey.

Based on an inspection conducted in January, state inspectors on Friday cited the nursing home for violations of 67 federal regulations governing patient care. Supervision was described in the inspectors' report as so lax that patients were found wandering along a highway. Ants were seen covering a device used to tie down patients and equipment was encrusted with bodily secretions. Inspectors also found a patient who had been left in bed for four days, clothed only in a diaper.

"These are heavy-duty charges," said Molina, who joined Supervisor Deane Dana in criticizing health officials for leaving them to learn of these conditions from the newspaper.

"Either we are going to be watching what is going on or the L.A. Times is going to be watching what is going on," Molina told Irving Cohen, deputy administrator of the county Department of Health Services, which runs the hospitals and the nursing home.

The board ordered Rancho Los Amigos administrator Armando Lopez Jr. to report weekly to the supervisors' health deputies on progress in correcting the deficiencies.

Lopez on Monday reassigned the nursing home's director to another position at the facility, but the supervisors said that was an inadequate response. The violations were severe enough, Dana said, to indicate "incompetency of the staff" at many levels.

"We can't just dismiss this as someone didn't clean up a spill," echoed Molina, adding that she considered county Health Director Robert Gates ultimately responsible. Gates was out of town Tuesday, leaving Cohen to represent the department.

The nursing facility is only one part of the medical center, which is the county's main rehabilitative hospital, serving 400 patients. The 9-year-old skilled nursing facility has patients who cannot move without help, are fed through tubes, or depend on tracheotomy tubes to breathe, among other handicapping conditions.

Based on the inspectors' report, the federal Health Care Financing Administration suspended the Rancho Los Amigos facility from the Medi-Cal and Medicare insurance programs, effective April 10. This would translate into an annual loss of $2 million in federal funds to the financially strapped county health care system.

Cohen assured the board that 38 of the 67 violations have been corrected and that all but two will be addressed by the end of the month. At that point, the department will request a reinspection, hoping to persuade federal officials to rescind their suspension order.

State inspectors enforce federal nursing home standards at county-run facilities in California.

The final two citations--pertaining to inadequate supervision of patients--require additional staff. Health officials estimate that they will need until June 1 to hire and train two more nurses, a therapist and two clerks.

The county's overloaded psychiatric emergency rooms also got the supervisors' attention Tuesday.

On a motion by Supervisor Mike Antonovich, the board ordered health and mental health officials to report next month on the cost of staffing for 40 beds now vacant in two wards at Psychiatric Hospital.

The wards were closed in the early 1980s, casualties of the first round of statewide cutbacks in mental health funding. An ever-tightening budget squeeze since then is widely blamed for inadequate public mental health services today, and for the number of severely mentally ill patients in Los Angeles County with no recourse but county psychiatric emergency rooms.

Dr. John Ray, associate medical director of Psychiatric Hospital, has described "near-riot" conditions in his emergency room because of the number of volatile patients jammed into a space designed and staffed for only half as many.

Cohen told the board that these conditions and other psychiatric patient-care inadequacies were directly related to insufficient funding.

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