Federal regulators investigating serious failings in UC Irvine Medical Center's anesthesiology department threatened to cut off Medicare funding after identifying dozens of new problems within the hospital.
In a 127-page report, regulators described repeated examples of poor oversight and inadequate systems to protect patients.
In one case, a psychiatric patient urinated on a pile of bed linens because the audio equipment used to monitor seclusion rooms was not working, according to the report. No one heard her shouting that she had to go to the restroom. Another patient developed blisters on both buttocks when she was not turned during a four-day stay for knee surgery.
In a letter dated Dec. 19, the U.S. Centers for Medicare and Medicaid Services (CMS) gave the Orange-based teaching hospital 10 days to show it had corrected the deficiencies or face losing its funding. That deadline was extended to last Friday so that the hospital could prepare a detailed plan of correction.
Dr. David Bailey, UCI's vice chancellor for health affairs, said the hospital was disappointed to learn of new deficiencies but welcomed the opportunity to improve. He said the hospital had remedied every issue by the time the plan was submitted last week.
"I was surprised, but on the other hand, I was also gratified because these were all things that were fixable and correctable," Bailey said.
"We really believe that we offer outstanding healthcare . . . and we don't want to see one slip-up for any patient."
The federal scrutiny began last year, when UCI was placed under state supervision because of its anesthesiology department's "inability to provide quality healthcare in a safe environment." Among the most serious findings was a practice of filling out medical records in advance, indicating specific outcomes before procedures were done.
That problem was resolved by installing an electronic anesthesia information monitoring system, which tracks the timing of entries, Bailey said.
In October, 14 inspectors returned to perform a full review of the hospital. Their report, given to The Times by the hospital, concludes that UCI Medical Center was not meeting standards in six of the 23 areas evaluated, including patient rights, quality assurance and infection control.
To avoid future problems, Bailey said the hospital had revamped procedures, including requiring weekly sweeps through the hospital by senior managers. The hospital also defended itself against some of the criticisms, saying, for instance, that staffers had visited the secluded psychiatric patient in person every two hours and asked if she needed to use the restroom.
If the federal government accepts the hospital's latest correction plan, it will authorize another inspection, said Rufus Arther, a manager for CMS' certification branch. The findings come at an inopportune time for the hospital, where officials were hoping to receive a clean bill of health before moving staff and patients into a new facility next month.
In a letter to hospital staff Thursday, Bailey emphasized that "no deficiencies were found for anesthesiology."
Even so, some practices in the anesthesiology service were criticized in the latest report. For instance, two nurse anesthetists were observed repeatedly injecting drugs through patients' IV lines without first using an alcohol wipe to clean the access ports.
Three staff members, who asked not to be identified for fear of retaliation, said the nurses either did not notice or did not understand a pager message reminding everyone to "clean your ports." It was one of many sent during the inspection to alert staffers of investigators' interests and whereabouts, they said.
"When everything is working as it is supposed to be working, there is no need to send out messages like that," one staff member said.
Another employee added: "It's kind of sad actually. They just want to get through the inspection: they don't want to change the culture."
Bailey said the messages were intended to ensure that staff were on hand to answer the inspectors' questions.
Other deficiencies noted in the report included:
Not assigning enough nurses in the neonatal intensive care unit to ensure that the most acutely ill newborns received one-on-one care.
Failing to properly maintain medical equipment and storing oxygen too close to combustible materials.
Allowing nurses to adjust medicine doses without instructions or standing orders from a physician, and allowing dietitians to draw up meal plans without consulting the doctor.
Failing to store and handle food safely.
The controversy in the anesthesiology department was the latest in a series of high-profile scandals that have beset the hospital over the last 14 years.
In 2005, the hospital shut down its liver transplant program after The Times reported that 32 people died awaiting livers in 2004 and 2005, even as doctors turned down organs that later were successfully transplanted elsewhere. In 1999 and 2000, the university's Willed Body Program came under fire after its director sold parts of cadavers and did unauthorized autopsies. And in 1995, a team of fertility doctors at the school's Center for Reproductive Health was accused of stealing patients' eggs or embryos and implanting them in other patients without permission.