Riverside Hospital in Critical Condition

A rare disciplinary action by state and industry inspectors has put a Riverside hospital on the brink of failure by driving away funding, staff and patients.

Inspectors cited dramatic deficiencies in training, medical procedures and other matters at Parkview Community Hospital earlier this year. The result: Several Parkview departments, including the emergency room, are closed--and by Friday occupancy had dwindled to 27 of 193 beds.

Hospital officials contend the inspectors are overreacting in order to set an example.

“Which is not to say we don’t have problems,” Parkview spokesman David Jarrard said. “We readily admit there are things we could do better, but we don’t think the penalty fit the crime.”

Reports that detail the hospital’s inadequacies will not be public for weeks. But accreditation inspectors say that in general the hospital lacked effective leadership, had poor training for staffers and inadequate procedures to ensure appropriate decisions were being made for patient care. In a move that happens to less than 1% of all hospitals surveyed, the hospital received a temporary denial of accreditation.

The problems began after inspectors from the state Centers for Medicare and Medicaid Services and the private Joint Commission on Accreditation of Healthcare Organizations began a three-day visit Jan. 28. The two agencies conducted separate but simultaneous inspections under a pilot program designed to tighten hospital regulation standards.

In February, the state inspectors concluded the private nonprofit hospital had so many problems that it posed “immediate jeopardy” to patient safety. As a result, Parkview was stripped of its ability to bill Medi-Cal and Medicare programs.

The hospital organization followed suit, notifying Parkview officials Feb. 8 that it could lose accreditation, which is required to receive reimbursement under most health insurance contracts.

“It will be amazing if the hospital is able to survive this,” said Dr. William Jones, Parkview’s chief of staff. “We were already on the edge. Every dollar that came in went out. So this--this has been devastating.”

Since delivering the bad news, the state and accreditation agencies have given Parkview conditional reprieves. But state inspectors will return to the hospital May 15 and have warned that marked improvement must be shown if the hospital is to keep treating Medicare and Medi-Cal patients, who historically have made up nearly 70% of the hospital’s patients.

But it may be too late to undo the damage, Jarrard said. Fearful of layoffs to come, most of the hospital’s nursing staff took other jobs, forcing the hospital to close its emergency room, pediatric and cancer units.

Neighboring hospitals are scrambling to fill the gap. They’ve hired more employees, many from Parkview. Still, waits are as long as six to eight hours in some emergency rooms. Nearby Riverside Community Hospital sees an extra 20 emergency patients a day, said hospital spokeswoman Ann Matich.

The problem has become so dire that Riverside County is considering taking over Parkview’s emergency room--assuming the rest of the hospital can remain in business.

Hospital officials have responded to the crisis by lashing out at state inspectors. They charge that in an effort to set tough new standards, inspectors went overboard, inflating problems and delivering a punishment so harsh it amounts to a deathblow.

“When you damage the reputation of a hospital,” Jarrard said, “when you force it to close its ER, cut off [insurance reimbursement], you just about close a hospital.”

Parkview, caught in a cutthroat health-care market that has killed many other hospitals in the state, has been in financial decline for years. Since 1995 the hospital’s annual revenue has dropped by about $30 million, Jarrard said. Some suppliers refuse to do business with the hospital.

At the same time, Parkview has become increasingly important to uninsured patients in Riverside after the county general hospital moved in 1995 to the adjacent city of Moreno Valley.

Despite the struggles, organizations representing the county’s doctors and emergency medical personnel say the hospital has a solid reputation.

“They’ve always been a very good partner to this community,” said Deloris Green, executive director of the Riverside County Medical Assn., which represents more than 750 doctors. “Physicians have full confidence in Parkview. We wouldn’t have admitted patients there if we didn’t.”

“It’s hard to imagine not having Parkview around,” added Michael Osur, a paramedic and director of the Emergency Medical Services Agency. “They are a needed part of this community.”

Indeed, past inspections turned up no significant problems at Parkview. Hospital officials say the problems with the state and the Joint Commission appeared out of the blue.

Inspectors for the state told the hospital in a Feb. 14 letter that it had until March 4 to correct problems found in nursing services, pharmacy services, quality assurance and the medical staff. Unsatisfied with the hospital’s response, inspectors then forbade Parkview to participate in the government-funded health-care programs.

Overnight, Parkview lost the bulk of its funding. Private insurers were also forced to pull out since most of their contracts require the hospital to have Joint Commission accreditation and be eligible for the Medicare and Medicaid reimbursement. Medi-Cal is California’s version of Medicaid.

After much lobbying from hospital officials and local representatives, including Rep. Ken Calvert (R-Corona), state inspectors agreed earlier this month to take another look at Parkview. Inspectors agreed the most immediate dangers to patients had been removed and gave the hospital until May 15 to correct other problems, said Cindy Graunke, spokeswoman for the Centers for Medicare and Medicaid.

The Joint Commission also changed the hospital’s accreditation status to conditional approval, subject to further reviews in the coming year.

Hospital staffers, who have been wearing blue ribbons in a show of support for the hospital, said they are upset with the way the inspectors handled this year’s visit. Many contend that inspectors went out of their way to find fault because of a 1999 state report that urged them to more aggressively oversee accreditation inspections.

Problem areas cited were generally minor offenses, they said, and seemed to focus mainly on routine issues regarding how medicine was administered.

“All of this was supposedly done in the name of patient safety,” Jarrard said. “But by forcing the hospital to close its ER ... [inspectors] put patients at a much greater risk. That’s the irony.”