Long List of Concerns at Hospital

A state inspector raised concerns about sanitation and patient safety at a Rancho Cucamonga hospital almost a year before it was ordered closed this month amid concerns that poor care had led to four deaths.

Last May, before Angels Hospital even opened its doors, a state Department of Heath Services inspector reported significant concerns about the lack of adequate staffing, unsanitary conditions and questionable dietary plans for patients.

Inspector Ranya Atiyeh, in an e-mail about the hospital’s application for a state license, also said the medical center did not have a policy on feeding tubes for patients, even though the facility “anticipates that 60% of population will be tube fed.”

State records show the hospital quickly corrected those deficiencies and was issued a license to open less than two weeks later.

But three months after opening, a second state inspection team found other problems, including patients being given improper dosages of drugs. Several other agencies learned of problems related to patient care and finances but failed to relay their concerns to state health regulators.

Some of those same concerns were cited in a recent investigation into four patients’ deaths at the hospital since early March

The hospital was ordered temporarily closed May 12 by the state Department of Health Services, and regulators said they may forward their findings to criminal prosecutors.

In its initial investigative report, the agency accused the staff at Angels Hospital of calling 911 on several occasions because no doctors were present, relying on paramedics to treat patients in life-threatening situations. Three of those patients died, according to Rancho Cucamonga fire officials.

State health regulators also alleged that the hospital tried to save money by not changing ventilator tubes until they were visibly soiled or contaminated, and turned down alarms on patients’ cardiac telemetry machines, which detect cardiac arrests.

“I think the system worked because as soon as we were aware of the significant problems we acted very quickly,” said Brenda Klutz, deputy director of licensing and certification for the state Department of Health Services which licenses hospitals. “The patients were out of there within 24 hours, they were not permitted to provide care for any other patients and we were able to gather documentation and serve the accusation within five days.”

On Wednesday, however, it became clear that several agencies were aware of problems at the hospital months before it was closed.

Stephanie Rasmussen of the Rancho Cucamonga Fire Protection District said that her agency had received at least four 911 calls from the hospital since January.

“We told them it was unusual,” she said of the hospital staff. “When they realized they were up to their armpits in alligators, they called us.”

Rasmussen said her staff was so concerned that they met with a hospital official Jan. 28 but did not report the incidents to the Department of Health Services.

Neither did the state Office of Statewide Health Planning and Development, which knew that the hospital was virtually empty much of last year, with only 3% of its beds occupied in the third quarter and 20% in the fourth -- possibly a sign of serious cash-flow problems.

“We don’t go on an active mode where we red-flag these type of situations and try to notify other state departments that this facility might be in trouble,” said Kenny Kwong, manager of the accounting and reporting systems section.

In January, officials at Angels Hospital canceled a visit by the Joint Commission on Accreditation of Healthcare Organizations, an agency whose seal of approval is regarded as essential to most hospitals.

“Accreditation is voluntary,” said Mark Forstneger, a spokesman for the group. “On its face, a decision to postpone a survey or withdraw your application doesn’t demonstrate anything about an organization’s quality of care.”

The hospital was founded last year to serve elderly patients in need of long-term care. Medicare would pay for most of the facility’s patients, according to an interview of Marylou Fernando, the hospital’s owner, in the Inland Valley Daily Bulletin.

Fernando could not be reached by The Times on Wednesday.

Dr. Anoop Maheshwari, medical director of Angels Hospital, said that the medical center began experiencing money problems even before admitting its first patient last June.

“There were financial problems with having funds readily available,” he said. “That was part of the majority of the problem.”

As to the lack of doctors at the hospital, Maheshwari said that a physician did live within a five-minute drive and that the doctor was always on call for emergencies. He said a doctor was not always needed on site because there were few patients and no emergency room.

The state requires that a physician be available but not necessarily on the premises of a hospital, said Robert Miller, a spokesman for the Department of Health Services.

Before the state will license a hospital, prospective owners are asked the names of the hospital’s officers and about other companies they own, Klutz said.

But because hospitals are expected to constantly be generating cash, she said, owners do not have to prove they have a set amount of financial reserves, unlike nursing home owners, who must prove that they have funds to operate for 45 days.

While reviewing the license application from Angels Hospital, Klutz said, the state did not examine records about Fernando’s husband, Rolando Fernando, who performed administrative duties at the facility but was not listed as an owner.

His medical license was revoked in November 2002 by the California Medical Board, which, among other things, claimed he botched a breast-implant surgery and then billed the woman’s insurer for a breast tumor removal.

“We have no legal authority to deny someone a license based on what may have happened to their husband or spouse,” said Klutz.

News of the hospital’s closure was greeted with relief by Jenny Stricklin, whose mother, Deifilia Flores, 81, died of renal failure at the hospital on March 29, two months and three days after she was admitted.

Flores suffered a stroke last December and required subsequent hospitalization for kidney dialysis and treatment of a lung infection, pneumonia and diabetes, said Stricklin.

Stricklin said she continually complained about her mother’s treatment by “cranky, understaffed” nurses, contending they missed scheduled medications, failed to treat her mother’s lung infection and would often forget to clean her after bowel movements.

Stricklin said she complained to the nursing supervisor often.

“I was disappointed, and I had to voice my opinion every time I was there,” said Stricklin. “I know they didn’t like seeing me come around, but someone had to take care of my mom.”

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Times staff writer Christina Sciaudone contributed to this report.