Calexico Stands By Hospital Despite Health Violations : Medicine: Residents voted a tax hike to keep facility afloat. State says it must meet minimum standards.

Maria de la Rosa, who is 62 and just had bladder surgery at Calexico Hospital, says “the men from San Diego” must be stopped from shutting down the cinder-block hospital that has served this impoverished border town for 40 years.

“We need our hospital,” she said in Spanish. “It’s always been here for us. They cannot do this to us.”

Her daughter, Norma, 35, is equally adamant. She came to Calexico Hospital for help after she gave birth by Cesarean at another hospital and developed a severe infection.

“Those men from the state should worry more about people from Calexico than their rules,” she said. “The hospital makes us well.”

That may be true, but the one-story hospital also has a litany of recurring health violations that has put it on the brink of losing its state license.

It is a desperate hospital in a place where a hospital is desperately needed.

In a series of inspections over 10 months, state health inspectors have found, among other violations: insect droppings in the kitchen, nurses with lapsed licenses, shoddy maintenance of vital equipment such as autoclaves and heart monitors, incomplete patient records, drugs that were outdated and haphazardly stored, and a chaotic management style where seemingly no one was in control.

Faced with punitive action by the state Department of Health Services, the hospital on Feb. 1 voluntarily withdrew from the Medicare and Medi-Cal programs, which for years provided the bulk of its patients and income.

The hospital board also closed the intensive care unit and restricted the emergency room to only those patients who would die en route to the next closest hospital, 12 miles away in El Centro.

The net result is that a hospital that used to be busy tending to the medical needs of elderly patients on Medicare, children from poor families covered by Medi-Cal, and farm workers with occupational ailments and injuries is now virtually deserted.

Caught in the crunch are 20,000 residents of one of the poorest cities in one of the poorest counties in California: A city where unemployment hovers at 40%, the economy is perilously dependent on agriculture and shoppers from Mexicali, and a third of families live below the federal poverty level.

More than a medical necessity, the 34-bed hospital is part of Calexico’s hardscrabble identity. The hospital allows this economically depressed city to feel superior to the more prosperous Imperial Valley cities of El Centro and Brawley.

Calexico residents so revere their hospital that last spring they did something extraordinary. They voted by 75% in a special election to add a half-cent to the local sales tax to keep the hospital afloat, making it the only hospital in California supported by such a tax.

“We may not have a movie theater, but we have a hospital,” said Hildy Carrillo-Rivera, who was born at Calexico Hospital and is a member of the hospital board, as well as managing editor of the Calexico Chronicle.

“I just think they (the state) think we’re just nobodies and it’s not going to matter if the hospital closes,” she said. “But if we don’t take a stand, how can we live with ourselves? If we’re going down, we’re going to go down fighting.”

From such fealty has come a furious--if so far, ineffectual--effort to keep the hospital open while its shortcomings are corrected and the Medicare and Medi-Cal certification is reclaimed.

Urgent appeals have been made to the media and to major politicians, including Gov. Pete Wilson. Carrillo-Rivera also sent faxed pleas to First Lady Hillary Rodham Clinton and McDonald’s hamburger chain owner Joan Kroc (on the strength of Kroc’s reputation as a humanitarian and a friend of Wilson).

Board members chartered a plane to San Francisco to plead with Medicare higher-ups. State health inspectors were invited to a City Council meeting to hear the pleas of residents. In a town that is 90% Latino, many of the residents spoke in Spanish, but their views were lost on the inspectors, who spoke only English.

Carrillo-Rivera and others complain bitterly that Calexico Hospital is being strangled by a bureaucratic system that puts regulations above health care. They ask plaintively: Is it fair to expect a hospital in a poor community such as Calexico to meet the same standards as a hospital in La Jolla or some other affluent place?

But Nelsen Ford, the Department of Health Services supervisor from the regional office in San Diego who is overseeing the Calexico case, said that the standards being applied to Calexico Hospital are minimum standards for cleanliness, record-keeping, medical quality assurance and staffing competency.

He turns the question around: Can the state have one set of health standards for the affluent and a lower standard for the poor? He answers his own question: “The people in Calexico deserve our protection as much as those in La Jolla.”

Just how bad had things gotten at Calexico Hospital? So bad that, had the hospital board not acted voluntarily, the health department was prepared to take the extraordinarily rare step of terminating the hospital’s right to treat Medicare and Medi-Cal patients.

Of 556 hospitals in California that are authorized to treat Medicare and Medi-Cal patients, only two in the past two years have been booted from the programs for repeated health violations. Calexico would have been the third.

It would not have been a surprise to anyone familiar with the troubled history of the hospital, which was founded in 1951 as a city-run facility.

Money problems and management problems have been constant, outside management firms have been hired with mixed results, and administrators have come and gone. One management firm left after declaring bankruptcy; another fled when it decided that the hospital would always be unprofitable.

The cash-poor City Council, unable or unwilling to be a deep pocket, turned the hospital over to an independently elected board of directors. Still, the council continues to lend the hospital board money.

Bond issues have failed. A doctor left in the mid-1970s after being discovered abusing his female patients. The maternity wing has been closed since 1986 because the hospital cannot afford malpractice insurance for obstetrics.

The hospital has been slapped for lack of fire insurance, failing to pay into the workers’ compensation fund for its employees and for not paying its bills. The hospital has fallen years behind in its water bill.

Through it all, the humble little hospital survived.

“It’s like a mom-and-pop hospital, like the old days,” said Calexico Mayor Patrick Hashem, who remembers being treated at the hospital after getting injured playing football for Calexico High. “It was a personal thing. They didn’t run the hospital by regulations. They ran it from the heart.”

The hospital’s durability may have led locals to believe in its invincibility. When the state issued its first negative report on the hospital in May, hospital board members were not moved.

“Because of its history--somehow the hospital has always survived--we didn’t see the severity of it,” said Carrillo-Rivera.

To Carrillo-Rivera, the timing of the first state inspection, just three days after Calexico voters had approved the sales tax boost, is more than suspicious.

“We celebrated for a day and a half (after voters approved the tax),” Carrillo-Rivera said. “When we got over our hangover, we started to celebrate again. Midday on the third day, the state came knocking at our back door. It’s been hell ever since.”

Ford said the timing of the inspection had nothing to do with the sales tax vote. He said his office decided to make an unannounced inspection, the first in five years, after receiving information--accurate, as it turned out--that some nurses and emergency room personnel at Calexico Hospital did not have up-to-date state licenses.

The first inspection report, done by a team of doctors, nurses and public health specialists, could hardly have been more damning. The hospital flunked in 14 of 16 categories.

There was no quality assurance procedure where doctors review the treatment provided by other doctors. Patient records were incomplete and filed haphazardly.

Outdated drugs were found throughout the hospital (in some cases, the expiration dates had been fudged to show falsely that the drugs were still effective). There was no staff dietitian and little concern for the special diet needs of patients.

Machines such as the cardiac monitor were long past due for calibration, making their reliability suspect. Autoclaves, which sterilize medical instruments, were not maintained. Call lights in many rooms were broken. The roof sagged.

Cockroaches and insect droppings were found in the kitchen and food storage area: “Three cockroaches crawled out of the recipe book when opened,” the report said. The water in the dishwasher was not hot enough for proper sterilization.

The hospital board had seemingly abdicated its responsibility to check on the credentials of medical personnel. Half the nurses had expired licenses.

In their summary, inspectors concluded that the hospital board and administration had “failed to maintain the facility in a clean, orderly and attractive manner.”

Dr. Amalia Katsigeanis, who was medical chief of staff at the time of the first inspection, does not dispute that the hospital had problems. But she said all the problems stem from a lack of money to hire staff and she defies the state to prove that patients were not being well served.

“There’s no way I’d admit 400 to 500 patients a year if I thought they were being killed or harmed,” she said. “It takes money to enforce these regulations and carry them out. That’s a fact of life, and this hospital is serving a community of people who are recent arrivals, low-income, high unemployment. We’ve had very little to work with but what we’ve had, we’ve done well.”

Ford concedes that the April inspection, and three subsequent inspections, did not find cases of patients being treated poorly. But he adds: “Certainly the potential was there.”

Ford points out that incomplete medical records can lead to serious, even deadly, consequences if treatment is attempted by a nurse or doctor who is unfamiliar with the patient’s diagnosis, his or her past treatment, and what drugs have been prescribed.

When the board members realized that the hospital was in desperate shape, they did what they had done in the past. They hired outsiders to clean up the mess.

A medical management firm from Northern California swept into town and conducted what it called its “tequila blitz.” By January, when Ford’s crew conducted its fourth inspection, the problem areas had been whittled from 14 to five.

But those five areas were key: the governing body, quality assurance, medical records, the pharmacy and physical environment. More important, the inspectors’ patience had worn thin.

“We gave them every reasonable benefit of the doubt,” said Ford’s boss, Ernest Trujillo. “We were back at the hospital in April . . . July, September and now January.”

A notation on top of the January inspection report says the hospital “failed to meet standards for licensing by the California Department of Health Services.” Trujillo said any decision to strip the hospital of its license would be made after further inspections, with time allowed for the hospital to clean up its act.

Only if the regional office believed that the hospital was irredeemably dangerous to patients would a recommendation be made to the department director in Sacramento that the license be lifted.

Hospital administrator Robert Trautman, hired out of Orange County in December, is convinced things will never get that far. He hopes to have the hospital ready for reinspection this month so that the Medicare and Medi-Cal certification can be reclaimed and the hospital’s cash flow resumed.

“This is not the same hospital it was a year ago, or even a month ago,” Trautman said.

There are doubters, though. Mayor Hashem said the hospital board--which consists of Carrillo-Rivera, a liquor store owner, an auto parts dealer, a retired banker and a pesticide inspector--is not up to the task and that the hospital will be in constant trouble until it is run by people who know more about medicine and modern management.

Although the board is publicly elected, it has a history of members quitting in midterm and being replaced by appointment. Without much of a professional or middle class, it is not uncommon in Calexico for no one to sign up to challenge the incumbents at the polls, in which case the incumbents are given another four years on the board.

A local conspiracy theory holds that Calexico Hospital is somehow being punished by the state government because Calexico residents were uppity enough to pass the sales tax.

Trautman does not believe it. But he does say that maybe the sales tax election reminded the health inspectors of the existence of the tiny hospital at the bottom of the state: “It might just have been that we woke up a sleeping dog.”

Embattled Hospital

If forced to shut down, Calexico Hospital would have to send its patients to hospitals in El Centro and Brawley. The one-story hospital in Calexico has a litany of recurring health violations.