Four U.S. Navy health centers in Southern California have minimized chronic "inefficiency and turmoil" and improved their medical care but remain hampered by major deficiencies in such critical areas as emergency room service and medical quality control, according to a new internal inspection report released Tuesday.
And at the largest of the four hospitals, the regional Navy Hospital in San Diego's Balboa Park, a Navy inspector general's investigation concluded that attempts at reform are frustrated by "hard-core holdouts" among senior military doctors "who are resistant to monitoring and documenting patient care."
The inspection focused on the San Diego, Camp Pendleton and Long Beach Navy hospitals and the clinic at the Marine Corps Air-Ground Combat Center at Twentynine Palms.
The 30-bed clinic at Twentynine Palms drew the harshest assessment. Inspectors concluded that the base health clinic "is a clear example of an institution requiring greatly increased oversight in order to meet expected health care standards."
For example, at the clinic, Navy investigators found that from 4:30 p.m. until 7 a.m. daily there is just a single nurse on duty to provide care in the emergency room, delivery room and nursery. The clinic provides health care for 21,500 military personnel and their dependents and must rely for backup assistance on the hospital at Camp Pendleton, 138 miles away.
Potential for Crisis Cited
Noting that major live-fire training exercises using regular and reserve Marine personnel are carried out at the base, the report concluded that "the potential for multiple, severe casualties is ever present" and could precipitate a crisis for the isolated hospital, which is the only medical facility within a 50-mile radius that is theoretically capable of stabilizing and treating severe trauma victims.
The new report, dated March 23 and released Tuesday by U.S. Sen. Pete Wilson (R-Calif.), was based on visits by military inspectors to several Southern California Navy hospitals in late February. It was the latest in a series of inspections of Navy hospitals in the area.
The inspection team found local Navy hospitals had made significant progress in improving the quality of patient care, emergency service, quality assurance and verifying the credentials of Navy physicians. But it cautioned that service-wide shortages of physicians and other health care personnel have slowed attempts at further reform.
"The Navy's health care system cannot provide consistently high quality health care to active duty (personnel), dependents of active duty, retired and their dependent beneficiaries without increased resources," the inspection report concluded.
Inspectors praised commanding officers of the four health centers for successfully working to assign qualified medical professionals to the most crucial jobs, saying the policy "minimizes the inefficiency and turmoil described in previous inspections."
The investigation report also concluded that the Navy's Long Beach hospital emergency room is staffed by physicians without significant emergency medicine experience who serve without a department head. "The (quality review and risk management) program in the emergency room is virtually non-existent," Navy inspectors concluded.
Release of the 58-page document follows disclosures by The Times last year of more than 200 malpractice incidents, including 25 extremely serious cases in which 13 patients died and 12 were left with disabling injuries. Settlements in malpractice cases were found to total $10.8 million in the last three years.
In a telephone interview Tuesday evening, Wilson called the results of the new Navy investigation report "mixed," noting that "in fairness, this does indicate improvement, but it also indicates that the improvement is somewhat erratic and that the reception to reform efforts in some quarters has been less than enthusiastic."
A Navy spokesman in San Diego said regional medical commanders were aware that Wilson planned to release the report, but they declined to comment on the findings.