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Hospital cited for poor care

Times Staff Writer

An Anaheim hospital that treats a large share of poor patients in the region has been slapped with dozens of citations by two independent sets of regulators for inadequate staffing and poor medical care.

The findings have placed the hospital’s public and private funding at risk. Although the hospital is not expected to close down and is currently appealing the decisions, it must correct the extensive problems that regulators found to ensure that it remains open.

The unusually harsh rebukes preceded by several months a lawsuit filed Wednesday against the owner of Anaheim General Hospital, Tustin-based Pacific Health Corp.

Los Angeles City Atty. Rocky Delgadillo filed the suit contending that the company and two of its hospitals -- but not Anaheim General -- were part of a “scheme to defraud the Medi-Cal and Medicare programs out of millions of dollars.”

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The findings by regulators and the lawsuit come as the company also wages a fight to buy Anaheim Memorial Medical Center, a larger hospital six miles across town. California Atty. Gen. Jerry Brown, who has to approve the sale, is expected to announce a decision this month.

Pacific Health issued a statement Wednesday saying it has been cooperating with authorities and it believes that it will be cleared of any illegal actions.

President Jim Young, asked previously about the Anaheim General findings by regulators, said the hospital had corrected all the issues that regulators had cited. The hospital’s “current state is excellent,” he said.

According to one report by the federal Centers for Medicare and Medicaid Services, Anaheim General put patients “at immediate jeopardy” by not having life-saving medications available, having insufficient food and water for patients in the event of an emergency and failing to ensure the safety of its psychiatric patients. The hospital said it corrected those problems as soon as they were discovered.

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The report also found that the hospital kept too low a number of nurses on staff and failed to maintain adequate levels of doctors available on site at all times.

Both reports came after regulators made surprise visits in February and March.

The Medicare report singled out two patient deaths early this year that the agency said might have been linked to inadequate patient care. In addition, it highlighted a third death that occurred after a patient in renal failure did not receive adequate dialysis treatment for more than 16 hours.

The report said the death occurred after an unresolved mechanical breakdown, which the hospital said was the fault of a subcontractor. Regulators did not conclude that the hospital was responsible in the case.

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Young said Anaheim General was not to blame in any of the deaths and could not comment on the cases because of privacy issues. “No action or inaction on the part of the medical staff contributed to the patients’ deaths,” he said.

In a second report, the Joint Commission, a national hospital accreditation group, found 47 safety deficiencies at the hospital -- an unusually high number for such surveys, say local hospital experts. Hospitals must have fewer than 18 deficiencies to keep their full accreditation, according to the group’s guidelines.

Among the safety issues Joint Commission surveyors found: inadequate procedures for preventing the development of healthcare-associated infections within the hospital, poorly inspected medical equipment, fire safety violations and improperly stored medications.

Young said the hospital held an in-person meeting in Chicago with the Joint Commission last month to appeal its accreditation status and is awaiting a decision.

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If a hospital loses its Joint Commission accreditation, which happens only a few times each year across the country, a hospital “could lose its ability to treat commercially insured patients,” said Jim Lott, executive vice president of the Hospital Assn. of Southern California.

“In 20 years, I have never heard of so many deficiencies for one hospital. They got hammered,” said Cameron Bruce, a Northern California hospital compliance consultant. “They have a huge, huge task in front of them.”

Young said Anaheim General had submitted a corrective plan to the federal Medicare agency. Federal regulators revisited the hospital in July and the hospital is waiting for the outcome of that updated review, Young said.

A lot is riding on what the regulators decide. The federal Medicare agency, which funds and oversees a large portion of the national healthcare system, said in a May letter to the hospital that it might pull its funding this summer. Such actions are rare but can happen if a hospital’s problems aren’t fixed quickly or adequately.

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The chain also owns Buena Park Medical Center, Bellflower Medical Center and two others -- Los Angeles Metropolitan Medical Center and Tustin Hospital and Medical Center -- swarmed by agents Wednesday in connection with the legal action filed.

The suit said the hospitals used unfair practices to fill empty beds by paying people on skid row to stay in the hospitals.

Anaheim General faces the most challenges to get back into regulatory compliance, hospital experts say.

According to the Medicare report, two of the patients who died early this year did so after medical staff failed to give them a blood transfusion in a “timely manner.” The report said the actions “possibly contributed to their deaths.”

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In both cases, doctors had ordered blood transfusions for the acutely sick patients, who didn’t receive them for unknown reasons and later died.

In the third case, regulators found a patient in renal failure who died in February after not receiving timely dialysis, the report shows. The report reached no conclusion about who was at fault.

According to the report, “Patient #16" was admitted in early February through the emergency room with a fever and in an altered mental state. The patient later was admitted to the hospital and was diagnosed with renal failure. Doctors “urgently requested” dialysis several days later at 6:25 a.m., according to the report. Treatment was started that morning but was stopped after two hours when a catheter used to hook the patient up to a dialysis machine malfunctioned.

A new dialysis catheter was found and inserted at 6 p.m., but the dialysis was delayed again, medical records show. Two hours later, a “dialysis nurse was contacted . . . about the urgent need for dialysis.”

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Again, at 10:30 p.m., “the dialysis nurse was contacted twice but there was no response.” The patient went into arrest just after midnight and “was pronounced dead at 12:24 a.m.,” the report shows.

According to the report, in an interview with regulators, the hospital’s chief medical officer stated that he had heard about the incident but did not fully investigate it. He said a firm that the hospital contracts with to provide dialysis was responsible for the delay, which was “not the responsibility of the hospital,” the report shows.

Young said the company has hired several outside consultants to help deal with the hospital’s safety issues and get it back into compliance.

“By and large we have corrected everything the regulators asked us to. We have changed the way we monitor nurses, how we monitor our safety measures,” he said. “We’ve changed a lot.”

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daniel.costello@latimes.com

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Times staff writer Cara Mia DiMassa contributed to this report.

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RELATED STORIES

Suit: Pacific Health is accused of fraud. Page A1

Hospital: Purchase plan meets resistance. Page C4

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