Psychiatric Hospital Is Probed After 3 Deaths

State health authorities launched a comprehensive investigation this month of a private psychiatric hospital in east Hollywood after three male patients in their 30s died within five weeks.

The state found “major systems problems” at 61-bed Edgemont Hospital while looking into the deaths, then got federal authorization for a full-scale probe into whether the hospital meets standards for government-funded insurance programs, said Brenda Klutz. She is in charge of licensing for the state Department of Health Services.

According to Klutz, the first patient, a 39-year-old homeless man, died Dec. 21; the second, 36, died two days later. The third patient, 34 and homeless, died Jan. 23, three days after the state dispatched investigators to look into the first two deaths.

Citing concern for patient safety, the Los Angeles County Department of Mental Health has suspended the hospital’s authority to admit any more involuntarily committed patients, while its Office of Patient Rights has embarked on its own investigation.

More than 50 patients remain at the hospital, just two or three of whom were committed involuntarily. The patients who died had admitted themselves to Edgemont, which treats many psychiatrically disabled Medicare patients, some of whom can’t get care elsewhere.

The hospital’s attorney considers officials’ reactions unfair and overblown, saying they are part of a pattern of “extraordinary scrutiny” the hospital has received over the years.

The lawyer, Tom Gibilisco, said the patients, two of whom had AIDS and all of whom had histories of substance abuse, died as a result of the “natural course of their disease process.” The spate of deaths “is a statistical aberration, nothing more,” he said.

While state officials declined to discuss the circumstances of the deaths, Gibilisco said officials “immediately jumped to the conclusion” that the deaths were related to methadone or other medications. The three patients, whose identities were not released by the state or the hospital, were being treated for pain with methadone.

Gibilisco strongly disputed the “methadone death” theory, citing sworn declarations from five independent experts hired by the hospital to review the patients’ medical records. The statements from the physicians were filed in Los Angeles County Superior Court to prevent the state from suspending the hospital’s license.

“In each case, these independent experts found nothing the hospital or the medical staff did or did not do caused or contributed to these deaths,” Gibilisco said in a written statement he gave The Times. He noted that the hospital reported each death to the state as required.

Klutz said the succession of deaths “definitely sent up red flags.” She said the cases were referred to the Los Angeles County coroner’s office, which is performing chemical tests to determine the causes of death.

State inspectors were sufficiently concerned about patients’ health and safety that they were preparing to suspend the hospital’s license and shut it down, Klutz said. But the hospital took the matter to a Los Angeles County Superior Court judge, who on Feb. 4 enjoined the state from suspending the license or removing patients until a court hearing can be held.

In response to the state’s actions, county mental health director Marvin Southard informed Edgemont earlier this month that his department had “become aware of serious and credible evidence of clinically dangerous practices and a lack of adequate attending staff supervision at Edgemont Hospital. The danger inherent in these practices is immediate and further involuntary admissions present unacceptable clinical risks. . . . “

Southard said that he knows of no other hospital that has been subject to such an action in the last year.

The officials’ actions came after seven years of conflict between Edgemont and state licensing authorities. Twice in the last four years, the state health services department has investigated complaints and threatened to remove the hospital’s certification for participation in Medicare, Gibilisco said. Both times, the state did not proceed, he said.

Gibilisco said the complaints were unfounded. He believes that the hospital has been singled out unfairly by patients’ rights advocates opposed to psychiatric treatment.

“We know the importance of patients’ rights,” he wrote in his statement. “We also know that many advance under the guise of patients’ rights [an] agenda aderse to treatment.”

In the case of the patients who died in December and January, the experts the hospital hired found no negligence or medication errors.

“I am confident that none of the three expired due to methadone overdose, and equally confident that none of the other medications administered caused or contributed to their deaths,” said Dr. Jack Berger, director of pain management and palliative care at Los Angeles County/USC Medical Center, in a sworn declaration.

According to the doctors’ court statements, the first patient to die, a 39-year-old homeless man, admitted himself 15 days before his death for treatment of agitated depression.

The patient “died without any evidence of chronic or acute deterioration in his physical condition,” wrote Dr. Gerald I. Rozansky, a UCLA addiction medicine specialist. “But then one must consider his history of Hodgkin’s lymphoma, HIV and hepatitis C, combined with an apparent history of heavy alcohol and cocaine abuse.”

According to the declarations, the second patient, who died two days later, admitted himself for treatment of depression and suicidal thoughts. He had AIDS and a related painful nerve condition, and a history of tuberculosis, possible lung disease and substance abuse.

The day before he died, according to the declarations, the patient insisted on going to an outside doctor for an unspecified infusion treatment, which may have led to complications, according to the hospital’s experts.

The third man, who suffered from depression, was homeless and had a history of crack cocaine and alcohol abuse and possible lung disease, the declarations said. He was found in bed barely alive the morning of Jan. 23 and was rushed to an acute care hospital, where he died.

“Without the autopsy results it is difficult to determine what caused this patient’s death, but there is no evidence of negligence,” wrote Dr. Michael Chaikin, chief of staff at Century City Hospital, in his sworn statement on behalf of Edgemont.

Sources close to the state and county investigations say that even if the deaths were not the hospital’s responsibility, inspectors have uncovered some broader problems that need to be addressed.

According to the court declaration of Geri Beutler, Edgemont’s chief executive officer, hospital officials met with inspectors Feb. 10 and were told of their general concerns about the hospital. The most serious issues appear to be in the area of pharmacy management.

According to Beutler’s summary in her court declaration, inspectors found that a nurse practitioner--who has since left the hospital--was prescribing narcotics outside her authority. Also, they found that methadone was being prescribed in violation of Drug Enforcement Administration rules--a finding that a hospital-hired expert disputes.

Finally, they were concerned about the pharmacist’s competence, patients’ use of medications brought in from the outside, the lack of “basic” pharmacy safety policies and procedures. and the lack of availability of some drugs, according to the declaration.

In response to the inspectors’ concern about methadone, the drug was removed from use by the hospital’s staff for pain management this month, Beutler said, although “this deprives patients of appropriate and necessary pain management treatment.”

The inspectors are expected to submit a report today to the Health Care Financing Administration on whether Edgemont meets standards for continued participation in the Medicare and Medi-Cal programs, vital financial resources. The hospital, which has vowed to satisfy the state’s concerns, will have at least 23 days to prepare a plan of correction.

Edgemont, owned by HIA California Inc., has been ordered repeatedly in the last several years to correct problems in such areas as patient care and medication, housekeeping, staffing, record keeping and treatment planning, according to documents on file with the state health services department.

Last December, before the patient deaths, state records show that state licensing officials found fault with the hospital’s supervision when one patient accidentally set fire to his or her clothing while smoking on the patio and suffered second- and third-degree burns.

The previous March, the hospital’s nursing practices were deemed deficient in the case of three patients, according to state records. One of them was found face down in her food, returned to her room and, after her roommate noticed that she wasn’t breathing properly, transported by ambulance to another hospital for “treatment of accidental oversedation.”

Two months earlier, licensing officials determined that four patients were being overly sedated. One fell over a chair, causing an ear injury that required sutures.

The hospital termed the smoking accident an “isolated event” and vowed to correct any deficiencies in medication practices through staff training, the records show.

Gibilisco noted that the hospital remains fully accredited by the Joint Commission on Accreditation of Health Care Organizations.