Hospital Problems Flagged by State

During a surprise visit this week, state health inspectors were unable to substantiate doctors’ claims that treatment delays had led to several patient deaths at Los Angeles County-USC Medical Center, county officials said Friday.

But the team from the California Department of Health Services found a range of problems, including slow processing of laboratory tests, staffing shortages, incomplete medical charts, poor infection control practices and a lack of patient privacy. The preliminary findings were summarized by a top county health official in a memo to county supervisors on Friday.

Inspectors arrived at the hospital this week after The Times reported that County-USC doctors -- including the interim chairman of the emergency department -- attributed at least four patient deaths to long waits in the hospital. Their sworn statements were included in a lawsuit filed by patient advocates trying to keep 100 hospital beds from being closed as a cost-saving measure.

State regulators would not comment on the findings until their federal counterparts approved the report and the county’s plan for fixing any problems.

Lea Brooks, a spokeswoman for the state health department, said inspectors might need to return for additional information.

The summary of inspectors’ findings, submitted to the board by Fred Leaf, the health department’s chief operating officer, was based on what hospital staff members had gleaned from discussions with the inspectors.

Supervisor Zev Yaroslavsky expressed frustration with doctors who, in sworn declarations, attributed deaths to treatment delays.

“There’s enough to be said about our health system that is critical without exaggeration and getting people hysterical,” Yaroslavsky said.

Supervisor Gloria Molina, whose district includes the hospital, said there was a “night and day difference” between reality and the doctors’ published claims.

“I understand the high drama that’s necessary to convince a judge, and I understand the tactics that are being used,” she said.

“But it does unfortunately demonstrate irresponsibility” to incorrectly attribute patients’ deaths to treatment delays.

Even so, Molina said she can understand the tremendous stress doctors are under at the hospital and their desire to help their patients.

“It’s a tough situation,” she said. “If you’ve ever been in the emergency room on Thursday, Friday and Saturday, these guys are under unbelievable stress. They didn’t come on the job for all the dollars involved. They’re very concerned about these cutbacks, as we all should be.”

Dr. Edward Newton, who is serving as interim chairman of County-USC’s emergency department, said in a sworn declaration in January that a patient with shortness of breath had “died before we were able to help him. Had we had the capacity to diagnose him earlier, his life would have been saved.”

In an interview Thursday, however, Newton said the “delays did not cause the deaths” of the two patients mentioned in his declarations, but that delays may have hastened the deaths.

In both cases he cited, Newton said, the patients would have died very soon anyway.

Newton said his concern is that the delays in care fell below acceptable standards.

On Friday, Newton said he had been told to direct press calls to a county spokesman.

Dr. Kate Savage, a second physician who referred to two preventable patient deaths in a sworn statement, could not be reached Friday.

The most serious problems found by the state appear to have been in the laboratory, which may not meet federal regulations, according to the health department memo to the Board of Supervisors.

The Times reported last week that it took several hours to process urgent blood work for two days last month when new computer systems were implemented in the hospital.

At the state’s request, the hospital is compiling more detailed data on the waits for lab results after the new computer systems were installed, according to a county health department spokesman, John Wallace.

Inspectors also cited shortages in the nursing and janitorial staffs and incomplete information in patients’ charts, particularly in the emergency room, the county memo said.

The state found a series of infection control problems, including the failure to adequately isolate a patient with a contagious antibiotic-resistant staph infection, which causes skin boils and lesions. That patient had been isolated for a time but left the hospital to smoke a cigarette outside, said Miguel Santana, a spokesman for Molina.

Before the state’s findings are made public, the inspectors must submit their report to the federal Centers for Medicare & Medicaid Services.

The county will then receive a list of deficiencies and must come up with a plan of correction within 10 days.

In rare instances, hospitals with persistent problems can lose their certification for Medicare and Medicaid reimbursement.

Dr. Thomas Garthwaite, director of the county Department of Health Services, said he was satisfied with the preliminary inspection findings.

However, he said, he plans to ask an outside reviewer to study the patient deaths and to determine whether their care was proper.

“We’re anxious to take our own look at the cases to make sure we concur with that,” Garthwaite said.

The state credited the hospital with making improvements in its system for monitoring the adequacy of patient care, particularly in the area of providing dialysis services, county officials said.

In 2001, The Times reported that doctors blamed delays in emergency dialysis for the deaths of three patients.

As a result of that report, government health inspectors launched an inquiry that found deficiencies “so serious they substantially limit your capacity to give adequate care,” according to a 2001 letter from federal regulators to the county.

The federal government also determined that the hospital no longer met the conditions required to participate in Medicare.

By December 2001, the county had made changes to meet federal requirements by training more nurses to provide dialysis.

The hospital passed a subsequent inspection.