Treatment Delays Probed at County-USC

State investigators this week are combing through records at Los Angeles County-USC Medical Center in response to a Times report on potentially lethal delays in emergency treatment.

The inspectors arrived Tuesday and are focusing on delays in emergency dialysis that doctors believe were a factor in the deaths of three patients, as well as other backups in the emergency room, according to a county memorandum. But they have leeway to inspect other patient records and probe any aspect of health care at the medical center, the West’s largest public hospital.

Such probes “can go anywhere they find problems,” said Stan Marcisz, an official at the San Francisco branch of the federal Center for Medicare and Medicaid Services, which contracts with the state for hospital inspections and determines sanctions. He would not discuss the County-USC inspection specifically.

The state health department is responsible for ensuring that hospitals comply with federal health regulations. In extreme circumstances, violations can result in termination of Medicare and Medicaid funds. But more often, cited hospitals are given up to 90 days to correct the problems.

“Everyone gets a chance to fix things,” Marcisz said.

County-USC Executive Director Shawn Bolouki, who took over July 1, did not return a call seeking comment. Acting county health director Fred Leaf, in a memo to supervisors Tuesday, wrote that County-USC “is cooperating fully with the state inspectors, who estimate that their on-site survey will be completed this week.”

Marcisz said state inspectors typically have 10 days to forward their findings to federal regulators. Federal officials decide whether to require correction of problems, then reinspect to ensure compliance, he said.

The Times report that sparked this week’s probe showed the hospital was unable at times to provide emergency dialysis during off-hours because of a shortage of trained nurses.

Though doctors and nurses pleaded with administrators to fix the problem and a number of top health officials at the county and the university medical school knew about it, a solution was not found until three patients died after lengthy waits, doctors said. Starting in late January, nurses were required to provide 24-hour coverage.

The hospital did not report the dialysis deaths to state health inspectors, as required by law, state officials said.

The Times report also documented waits of 24 hours or more in the medical center’s overwhelmed emergency room. In one case, doctors say, a seriously ill patient lingered 84 hours before moving to a hospital bed. Though patients were treated during their waits in the ER, they generally could not receive the sort of attention available in the wards upstairs.

The state has already cited the hospital for violating federal regulations in its separate psychiatric emergency room, which is designed for eight patients but routinely houses more than 20. After a Times report on the overcrowding and a stinging grand jury report on the issue, the county Board of Supervisors ordered the health department to prepare a plan that would open 39 beds at Olive View-UCLA Medical Center in Sylmar to accommodate the excess patients.

Though supervisors demanded that the health department present the plan by July 17, the department still has not done so. Acting director Leaf has said the department is still reviewing data to nail down the cost of such a move.

Meanwhile, also in response to the Times report, the health department has begun funding a program to train nurses to provide dialysis. The county has $40 million in federal money it could draw on for such a program, but the funding has been held up because of a power struggle between the Board of Supervisors and the county’s largest union.

The county accelerated the dialysis training program last month, and the board on Tuesday approved moving forward to spend the rest of the $40 million on other types of work force training.