In a move that could jeopardize the future of one of the most prestigious hospitals in Los Angeles County, the U.S. Health Care Financing Administration on Friday threatened to cut off $37 million in Medicare funding from St. John's Hospital and Health Center in Santa Monica over an incident last year in which the hospital turned away from its emergency room an elderly woman suffering from a brain injury.
The incident triggered an investigation by the county Department of Health Services in December, which reported serious emergency room and quality control deficiencies at the Westside medical center. The results of the investigation were then forwarded to the federal agency.
"Basically, we have concluded that the hospital no longer meets the conditions of participation (for Medicare funding)," said Jerry Moskowitz, the Health Care Financing Administration's regional director. "The verification of that one incident by itself is certainly grounds for the termination of funding."
Moskowitz said the agency sent a letter Thursday night informing the hospital that it will shut off Medicare funds on March 6 unless the medical center can correct the problems by that date. The loss of Medicare funding could be a death blow to the facility, since more than 50% of its patients are insured by Medicare.
Paulette Weir, a spokeswoman for St. John's, said hospital officials could not comment on the action until they receive the letter. She also declined to comment on the Department of Health Services report.
According to the report, an 85-year-old nursing home resident suffering from a brain injury, heart and respiratory problems was rushed by ambulance to St. John's on Oct. 19. A nurse at the hospital told ambulance attendants that they should take the woman to another hospital nearby. The nurse took the action "without first evaluating the patient to determine if an emergency medical condition existed," the report said.
"On arrival at the emergency department of the second hospital," the report stated, "a physician determined that the patient did have an emergency medical condition which made her unsafe for transport," especially since there was no paramedic traveling in the ambulance.
The woman was treated and later transferred to another hospital and subsequently returned to the nursing home.
A subsequent county investigation of the hospital found that St. John's had no quality control programs for reviewing prescriptions supplied in the emergency room, and had no plan for reviewing medical, surgical or nursing services provided there.
The investigators also found poor documentation on 14 of 25 patient records surveyed, included a case where the hospital failed to report to authorities a suspected case of child abuse involving a 12-year-old girl.
Founded in 1942 by the Sisters of Charity from Leavenworth, Kan., the 551-bed acute care hospital has long been considered one of the finest medical facilities in the county and has treated hundreds of Westside celebrities over the years.
The hospital, still operated by the Sisters of Charity, has about 2,200 employees and 1,000 physicians. Recently, however, the hospital has struggled financially as a result of direct competition for patients with neighboring Santa Monica Hospital.
"For any hospital this large and with the portion of Medicare funding that it has, losing Medicare funding would be disastrous," said David Langness, a spokesman for the Hospital Council of Southern California..