Medicare Funding for Hospital Is Withdrawn

Federal officials Wednesday took the rare step of withdrawing Medicare funding from an East Hollywood psychiatric hospital that had been under investigation since February after three patients died within five weeks.

The county coroner determined that the three Edgemont Hospital patients died of natural causes, but inspectors looking into the deaths uncovered other problems that were so serious that rapid action was warranted, said Brenda Klutz, deputy director for licensing and certification at the California Department of Health Services. The state agency inspects hospitals for the federal government.

Klutz described termination of Medicare funds for an acute psychiatric facility as “very rare.” She said the problems were related mostly to severe deficiencies in nursing care.

The Medicare funds cover not just the elderly but also seriously disabled patients. Many Edgemont patients suffer both psychiatric and physical disabilities.

The cutoff throws the hospital’s future into doubt. According to the state, it has about 40 patients, all of whom are on Medicare. The facility will not be able to accept new Medicare patients and will be able to collect payments on the current patients for just 30 more days.

State officials say that with the help of the county Department of Mental Health, they will monitor Edgemont as it prepares to discharge or transfer all Medicare patients.

In a prepared statement released Wednesday, the hospital vowed to stay open.

“We are committed to service as an organization and we are confident we will continue to serve this community. We have appeal rights and other remedies that we are exploring.”

The statement noted that the hospital’s license to operate remains intact, even if its federal funding does not.

According to documents released by the state Wednesday, Edgemont failed to ensure that all necessary care was furnished or supervised by a registered nurse. It also failed to ensure that treatment followed doctors’ orders, that nurses developed care plans according to patient needs, and that drugs were prepared and administered according to the law, the documents state.

State inspectors alleged numerous examples of lapses in the planning and provision of patient care: a short-of-breath patient with chronic obstructive pulmonary disease who ran out of physician-ordered oxygen; a patient who couldn’t get to an outside medical appointment because no transportation was available; repeated instances in which patients undergoing detoxification did not have vital signs consistently monitored; inadequate handling of patients who “went AWOL.”

One patient was allowed to make repeated outside trips to see his girlfriend, go shopping and run other errands before he decided not to come back at all, the documents say. The hospital had no evidence that any of his numerous excursions had therapeutic value, according to the documents.

In another case, the documents say, a 36-year-old patient refused all medication and group sessions but was allowed to remain in the hospital for three months with no active treatment.

In a letter announcing that funds would be cut off, federal officials said the problems could “limit Edgemont’s capacity to furnish adequate care or [could] adversely affect the health and safety of patients.”

The termination of Medicare payments caps several tumultuous months at the hospital. The state initiated an investigation there after three patients died between Dec. 21 and Jan. 23. Klutz said at the time that the deaths, all among men in their 30s, sent up “red flags.”

Subsequently, the county coroner’s office determined that all three men died of serious medical conditions. One had an enlarged heart, another had a heart condition and AIDS, and a third had pneumonia and AIDS. Records suggest that they had histories of substance abuse.

But Klutz said the state’s February inspection revealed “major systems problems” at the hospital. Edgemont was put on a “fast track,” meaning that it had a limited amount of time to correct the problems. The hospital failed to pass a follow-up inspection in April, Klutz said, which led to Wednesday’s federal action.