4 Hospitals Get Surprise Inspections

Reviewers from a national accrediting agency arrived Monday for unannounced inspections of four hospitals run by Los Angeles County to see if they are experiencing the same problems as the embattled Martin Luther King Jr./Drew Medical Center.

The teams are examining patient charts and other aspects of care at County-USC Medical Center in Boyle Heights, Harbor-UCLA Medical Center near Torrance, Olive View-UCLA Medical Center in Sylmar and Rancho Los Amigos National Rehabilitation Center in Downey.

The inspections come just days after the president of the Joint Commission on Accreditation of Healthcare Organizations sent a scathing letter to the county Board of Supervisors, unequivocally blaming it for serious lapses in patient care at King/Drew.

The long-troubled hospital in Willowbrook, near Watts, has been cited by health regulators in the last year for nursing negligence that contributed to five patient deaths, rampant medication errors and the use of Taser stun guns on psychiatric patients.

“I wish to be clear that the responsibility for these failures -- whose effect has been to place a uniquely vulnerable patient population in harm’s way -- by definition lies with the County of Los Angeles Board of Supervisors,” wrote Dr. Dennis S. O’Leary, president of the joint commission, in an Oct. 14 letter faxed to each supervisor.

“It is just as clear that the responsibility, and indeed the opportunity, to restore the reputation and the reality of King/Drew Medical Center as a trusted, respected provider of healthcare services in its community also belongs to the Board of Supervisors,” O’Leary wrote in the letter, copied to other local politicians.

The commission has recommended pulling its seal of approval from King/Drew, an extremely rare action signaling the depth of the hospital’s problems and its repeated failure to correct them despite multiple warnings. The hospital is appealing the move.

Monday’s inspections signal that the agency also wants to assess the quality of care at other public hospitals overseen by the county Board of Supervisors.

An official with the commission said Dr. Thomas Garthwaite, director of the county Department of Health Services, invited the reviewers to visit.

“He had suggested to us, and we agree, that perhaps it would be a good point in time to benchmark all of the other facilities” and ensure that King/Drew’s problems weren’t happening throughout the system, said Joe Cappiello, the commission’s vice president for accreditation field operations.

Garthwaite said he hoped the commission reviews would “assure the public that the things found at King/Drew are not rampant, are not a problem at our other facilities.”

“I don’t think that fair, honest inspection is anything but helpful to improve the quality of our care,” he said.

The unannounced visits are expected to be completed today, and the results will be discussed with hospital leaders.

King/Drew is being reinspected as well, even though the joint commission visited last week to investigate a 28-year-old patient’s death in the intensive care unit. The patient died after a nurse turned down the volume on his heart monitor on Oct. 7, then failed to notice his distress, according to county health officials.

The review of so many hospitals at once is not without precedent. Last year, the commission inspected 19 hospitals owned by Tenet Healthcare Corp. after questions arose about whether unnecessary cardiac procedures had been performed at Tenet’s Redding Medical Center.

Hospitals are not required to be accredited by the commission. But the agency’s endorsement is highly desirable, and some programs and funding depend upon it. If King/Drew loses its accreditation, it might be forced to close its physician training programs and lose nearly $15 million in private insurance revenue.

Asked about his letter to the supervisors, O’Leary said he has rarely delivered such personal rebukes to a hospital’s overseers. He said he does so only when he feels it would increase the likelihood of decisive actions. Such was the case last year with Greater Southeast Community Hospital in Washington, D.C.

The Los Angeles County supervisors said they understood O’Leary’s message about King/Drew.

“At the end of the day, we’re the ones that are responsible,” Supervisor Gloria Molina said.

Supervisor Zev Yaroslavsky agreed. “There’s plenty of blame to go around, and the board certainly deserves its share,” he said.

But he added that the board and health department should stay focused on fixing the problems at King/Drew, not on who is to blame for them.

Supervisor Yvonne Brathwaite Burke, whose district includes King/Drew, said she was upset that King/Drew had been unable to shake its problems in the last year. She questioned the work done by county health officials who have taken charge of the hospital, as well as an outside firm hired to improve its nursing department.

“I’m very disappointed that the people we put there have not accomplished anything,” she said. “It’s hardly a pleasant situation. It’s a crisis-ridden situation, and we’re trying to correct it and to move forward.”

In an interview Monday, O’Leary lent his support to the supervisors’ controversial proposal -- opposed solely by Burke -- to close King/Drew’s trauma center this year so resources could be devoted to fixing a myriad other problems.

“The hospital has limited capabilities in providing basic care,” O’Leary said. “It should divert the most demanding cases to other hospitals in its community until it’s able to provide basic care and then rebuild its trauma capability. This is a temporary, very rational step to buy time for investing in basic improvements.”

Community activists, hospital staffers and political leaders including Mayor James K. Hahn, U.S. Rep. Maxine Waters (D-Los Angeles) and Assemblyman Mervyn Dymally (D-Compton) have objected strongly to the proposed closure, saying it would force patients with life-threatening injuries to travel farther for care.

Some have said that the county is betraying the mostly poor, minority population served by King/Drew.

In both his letter and interview, O’Leary said supervisors should not be swayed by the protests. He said they have created a “very politically charged atmosphere with accusations of racism and everything else imaginable.”

“Those have nothing to do with anything, in my opinion,” he said. “I’m sure that the people who are rallying and putting up websites are all well intended, but they are not behaving as part of the solution.”

Dymally said Monday that he was disappointed in O’Leary’s comments.

“Those of us who hold public office have been criticized for posturing, but I don’t know what else one can do,” he said. “If you represent a community in distress, your responsibility is to represent the community. I think we’ve been very constructive in our approach.”

The commission has consistently found problems with King/Drew over the last decade, O’Leary said, but until now, the problems had been corrected quickly and had not risen to the level of jeopardizing accreditation.