After more than a decade of criticizing California's nursing home operators, the Little Hoover Commission turned its spotlight on medical doctors at a public hearing Friday, accusing physicians of neglect and poor treatment of rest home patients.
Doctors were accused by the state commission of making rushed "gang visits" to as many as 50 patients in an hour while charging Medi-Cal for the services, practicing "phone call medicine" rather than visiting patients, and condoning "excessive drugging" of the elderly.
The watchdog group--formally called the Commission on California State Government Organization and Economy--has no official powers, but has been instrumental over the years in the creation of regulations aimed at reforming the state's nursing home industry, which is notorious for poor care.
"The facilities are bearing the brunt of the criticism," said Robert T. O'Neill, executive director of the commission, "and I'm wondering how much of that criticism . . . should be redirected at physicians."
Witnesses at the hearing in the downtown State Office Building auditorium did indeed direct criticism at physicians in sometimes emotional and sometimes bitter remarks.
Mary Sue Sagor, who was awarded nearly $200,000 by a Superior Court jury last January in a wrongful-death suit against a nursing home chain, Beverly Enterprises, told of watching her father physically deteriorate and die from neglect after developing gangrenous bed sores while his physician allegedly ignored her repeated calls for help. The jury absolved the physician in the case, Sagor said, because he had met the letter of the law by visiting her father once during his monthlong stay at Beverly Manor Convalescent Hospital in Canoga Park before the 80-year-old patient was transferred to an acute care hospital.
Ralph Lopez, head of licensing inspection for the Los Angeles County Department of Health Services, told the commission that of the 16,000 complaints against nursing homes received by his office over the last 10 years, no more than a dozen came from physicians concerned about patients.
"The physicians' (lack of) ability to realize that they are part of this community . . . is absolutely shameful," Lopez said.
At one point, Commissioner Albert Gersten Jr. sharply questioned Dr. Eugene Ellis, president of the state Board of Medical Quality Assurance, over that agency's role in disciplining negligent doctors.
After pointing to figures showing that since 1986 only two medical doctors had been disciplined by the board for poor medical practices in nursing homes, Gersten said:
"It sounds like you're the most inefficient group that's been put on the Earth. . . . You're not doing any work in an area where people are dying. . . . You're results are a grand zero."
"You're entitled to your opinion, sir," snapped Ellis, who later told The Times that he considered that neglected bedsores are "a nursing problem."
'Passing the Ball'
Dr. Wing Y. Mar, representing the California Medical Assn., accused the commission of "passing the ball" in its approach to the problem of medical care in nursing homes and insisted that "it's society's problem."
He also recommended in a paper submitted to the commission that compensation to physicians attending nursing home patients be increased. Mar and other witnesses recommended that "physician extenders," such as nurse practitioners, should be used for many medical needs of patients in nursing homes.
Dr. Donald N. Re Ville, past president of the California Assn. of Medical Directors, insisted that only a minority of physicians attending nursing home patients are guilty of providing poor care. Re Ville and other witnesses recommended a system of "peer review"--evaluations of doctors by other doctors--to assure quality care.
The commission is scheduled to hold another public hearing on the issue June 29 in Sacramento.