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From the Journal Inquirer (CT)
March 29, 2016

Prospect Unclean, Feds Find

The for-profit suitor of Eastern Connecticut Health Network is facing possible sanctions against its California hospitals after a recent inspection resulted in an eight-day shutdown of a surgical unit.

The hospital also was placed on immediate jeopardy status due to a widespread pattern of ineffective cleaning, disinfecting, or preventing the spread of infection, according to recent reports from federal investigators.

The status means there is an immediate or potential threat to patients or the community, and requires urgent redress while federal inspectors remain on site, Eric Creer, California Department of Public Health spokesman, said Monday.

The reports, which were the result of complaints and site inspections in November and December, also show a pattern of shabby and incomplete record keeping on such things as medical mistakes, consent forms, prescriptions including narcotics and compounded medicines, and the failure to note suicide risks among some psychiatric patients. Ripped or untested lead shields for radiology tests were also found, as was improper storage of medications in the pharmacy and medical unit crash carts — items needed in an emergency situation.

Intensive care and medical ambulatory care units also were found to be inappropriately staffed as nurses could be caring for two acute patients separated by walls and doors and out of view while tending to one or the other.

From Dec. 11-17, that practice occurred at least 19 times, the report notes.

When shown the staff assignment sheet for that week, hospital officials said they didn’t know this was happening.

Cease and desist for surgery

The survey of Southern California Hospital at Hollywood which is owned by Prospect Medical Holdings Inc., the prospective buyer of Manchester Memorial and Rockville General hospitals was completed Dec. 22, by the federal Department of Health and Human Services, Centers for Medicare and Medicaid.

Prospect officials did not return calls seeking comment.

There are three campuses united under a single health license for the Southern California Hospital, including Culver City with 225 patient beds, Hollywood with 41 beds, and Van Nuys with 56 beds.

According to the reports, Culver City was ordered to cease all elective surgeries and procedures on Dec. 14 at 5:15 a.m. and undergo an immediate cleaning from top to bottom of the decontamination and all sterile processing unit areas and surgical instruments and suites.

Surgery wasn’t allowed to resume until Dec. 22 at 1:06 p.m., after the emergency was abated.

The investigation showed that many of the surgical instruments, such as retractors used by surgeons to hold incisions and body cavities open, were discolored with a film build-up and improperly stored in absorbent towels stacked one upon the other.

Operation room suites were equally unsanitary, the report states, and the sterile processing room was found with dust and debris throughout the unit.

One complete set of about 50 hinged surgical tools were splotched with reddish, yellow and black color substances, and each subsequent tray of supposedly sterile instruments appeared to be in a similar condition, the report states.

Staff agreed that this was the typical condition of the instruments and were unaware of the facilities policy and procedure for packing surgical instruments for sterilization. They were seen walking back and forth between decontamination areas and sterile storage rooms wearing the same scrubs and not donning sterile clothing or washing their hands, per nationally accepted standards.

When questioned by inspectors, hospital staff said it was as the autoclave sterilizing machines weren’t running at the time.

Other serious infractions

Furthermore, Southern California facilities owned by Prospect Medical showed improper storage of biohazard waste, lab specimens, and oxygen tanks. And on one instance a defibrillator on a crash cart was left unplugged, and unable to sustain a charge in the event of a power outage, records show.

On Dec. 15 hospital records noted that seven out of eight patients on a step down unit were catheterized without a doctors order. Most of those patients didn’t need the invasive devices that bring a potential risk of infection, the report notes.

Facilities also failed to ensure correct pain, antibiotic, and heart medications were administered according to doctors orders for randomly observed patients or to keep records of doctor visits.

Medical patients are suppose to be seen daily by a doctor, and psychiatric patients monthly, but the review indicated severe lapses, including one psychiatric patient who, according to hospital records, saw a doctor for just two out of six months.

The physical plant itself had an air-handling unit that left patients constantly complaining of the cold, with temperatures measuring more than 10 degrees below the state regulation of 70 to 75 degrees.

In one patient room, the temperature was recorded at 58 degrees, the report states.

Inspectors also found pharmaceutical biohazard bins stored in a public parking lot, overflowing biohazard waste bins in a utility room, and another biohazard tub left open and unsecured.

Staff, meanwhile are required to wear either a sticker on their nametag or a mask if they hadn’t yet received a flu shot, according to hospital policy. But the facility ran out of stickers, making it difficult to tell who had been vaccinated.

The cumulative effect of these problems added to the widespread infection control problem, federal officials say.

There also were issues with how anesthesia was administered, and by whom. And follow-up outpatient psychiatric care was lacking for patients, as the facility didn’t have enough therapists on staff.

Prospect Los Angeles facilities also problematic

At the Prospect-owned Los Angeles Community Hospital at Bellflower and at Norwalk, which also are part of a consolidated health license, inspectors found that there was no means to ensure the medical staff were professionally qualified for the positions to which they were appointed and for the performance of privileges granted.

The hospital also failed to have a governing body that would take full legal responsibility for implementing bylaws governing medical staff membership, reappointment, and competence appraisals.

Some doctors were allowed to practice without having gone through a proctoring requirement whereby they undergo a six-month observation and evaluation, or a certain number of clinical cases, before given full staff privileges. Others were reappointed after losing privileges without undergoing a competency check, the report notes.

In one stark example, a staff physician failed to follow the terms of his probation to not enter a patients room alone, as he was required to have another health care provider accompany him.

The doctor faced suspension if he was found to conduct rounds without a chaperone, yet on Nov. 9, at least three patients told investigators he examined them privately within a 30-minute period. Nurses confirmed that sometimes this doctor entered rooms and conducted patient exams alone.

The hospital CEO stated that compliance was not as tight as it should be on the nursing side.

This practice has the potential for patient abuse, investigators wrote in the report.

Hospital staff agreed that the credential files had been out of order for some time and that the chronic problems had been brought to the attention of medical staff leadership, but the problems persisted as physicians were uncooperative in addressing the issue.

Problems also were found with dialysis treatments at the Los Angeles facilities, with the reports showing a lack of care plans and paperwork for some patients or of documents showing competency for six contracted dialysis nurses. Those contract nurses also were not oriented to the hospital, providing a potential lack in qualified care, the report states.

Doctors failed to sign verbal medication orders within 48 hours for four out of 26 patients sampled, including one order for morphine, a narcotic painkiller that took five days to obtain a physician signature.

Cleanliness also was an issue in Los Angeles, the report states, as inspectors found a dialysis machine in a storage room with a brownish substance, and an open and exposed linen closet filled with uncovered sterile supplies. A screen divider in the recovery room was ripped, and three patient mattresses were found stored outside a north entry. Inspectors also found a blue cart blocking an exit; a white bucket containing an unknown black liquid substance; a gurney with a white sheet stored outside; and an ICU dialysis machine leaking clear liquid onto a towel on the floor.

Staff were seen going into rooms clearly marked isolation contact precautions without wearing the necessary gown, gloves, and mask, and using less expensive, and less effective department store cleansers on dialysis equipment rather than the standard practice of using diluted bleach solutions.

Dialysis is the process of removing waste and excess water from the blood, primarily for patients who have lost kidney function.

The hospital failed to maintain the hospital ground in a clean and orderly manner which had potential to provide an unsafe environment for its patients, visitors, and staff, investigators wrote.