More problems discovered at UCI Medical Center

Federal investigators found scores of problems at UC Irvine Medical Center during a fall inspection that again put the troubled hospital’s Medicare funding at risk, according to report released Thursday.

In an 85-page report on their surprise October inspection, regulators said they observed poor oversight and mistakes by UCI doctors, nurses and pharmacists, leading to inadequate care that in some cases harmed patients.

Among the findings:

* An 82-year-old man was mistakenly given a narcotic patch by a medical resident, without approval of doctors or pharmacists. The patch led to an overdose that required emergency intervention and may have contributed to his death a week later.

* A patient in the neuropsychiatric unit fell twice in three days and despite yelling “Help me, doctor, help me,” suffered a head injury and had to be taken to intensive care.

* An on-call resident did not respond to repeated emergency pages from nurses in the neurological intensive care unit, where a patient with an irregular heartbeat languished for more than an hour.

* Pharmacists failed to monitor and store drugs correctly, allowing nurses to carry narcotics in their pockets and inject patients without proper oversight.

The report comes a year after investigators from the Centers for Medicare and Medicaid Services documented repeated examples of poor oversight at the hospital and threatened to cut Medicare funding.

In July, Medicare officials issued a finding of immediate jeopardy after investigators discovered that five UCI patients had received overdoses because nurses using pain medication pumps were not properly trained. UCI officials immediately began training nurses to use the pumps, the finding was lifted within 24 hours and the hospital submitted a plan of correction.

UCI nurses said Thursday that many of the latest problems stem from understaffing and other cost-cutting, even as the facility turned a $54.2-million profit last year and the chief executive earned an $83,250 bonus.

“This is a problem of money. To provide extra training, extra staffing, is money,” said Beth Kean, California Nursing Assn. director for UC nurses, including 1,000 at UCI.

Terry A. Belmont, who took over as the hospital’s chief executive last year, disputed that the facility was understaffed.

Belmont, who summarized inspectors’ findings in an e-mail to his staff, said hospital officials corrected some of the problems within a month of the inspection. They are working to remedy the rest with random audits and other improvements, he said.

Earlier this week, hospital officials submitted their latest plan of correction to federal regulators. Once it is approved, federal officials will return for another surprise inspection, according to Jack Cheevers, a spokesman for the Centers for Medicare and Medicaid Services western region.

Belmont said he has worked to create a culture of cooperation and accountability among physicians and staff since becoming interim chief executive in March. He was hired permanently last month.

“This organization has been in transition,” Belmont said. “Our big issue now is how do we prevent human error from occurring, how do we catch it before it creates problems for our patients.”

For instance, after the narcotic patch overdose, the hospital trained pharmacists to complete new forms verifying how the drugs are dispensed and mandated daily audits to prevent errors.

“Everybody’s fallible. We just have to make sure we have the right processes in place” to catch errors, said Dr. Eugene Spiritus, UCI Medical Center’s chief medical officer.

Spiritus also defended the compensation for hospital managers, saying they need to stay competitive in order to attract and keep talented managers, especially given the cost of living in California.

Still, Belmont said, hospital officials are considering whether managers’ future bonuses should depend on passing inspections, “so that people feel more accountable for doing the right thing.”

Hospital leaders have struggled to overcome a series of high-profile scandals during the last 15 years.

In 2005, the hospital closed its liver transplant program after The Times reported 32 people died awaiting livers in 2004 and 2005, even as doctors turned down organs later successfully transplanted elsewhere. In 1999 and 2000, the university’s Willed Body Program drew criticism after its director performed unauthorized autopsies and sold body parts. In 1995, a team of fertility doctors at the school’s Center for Reproductive Health was accused of stealing patients’ eggs and embryos and implanting them in other patients without permission.