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Report details risks to patients' lives

Recent incidents at King-Harbor, rather than being isolated cases, fit an entrenched pattern of failure, a federal agency says.

June 19, 2007|Charles Ornstein | Times Staff Writer

Martin Luther King Jr.-Harbor Hospital's recent woes, far from being isolated examples of poor care at a reformed institution, represent a continuing pattern of entrenched failings that risk patients' lives, according to a federal report released Monday.

According to a June 7 report from the U.S. Centers for Medicare and Medicaid Services, 17 patients, among 60 whose cases were reviewed, received substandard care at the hospital. Some were as recent as last month. Based on the findings, the Medicare agency declared that patients at King-Harbor in Willowbrook were in immediate jeopardy of harm or death.

The government gave the hospital, formerly known as King/Drew, 23 days to correct its problems or lose federal certification and funding once and for all. The hospital would probably be forced to close if funding were cut off.

Among the cases cited:

* One patient in King-Harbor's emergency room told a triage nurse on April 30 that he was seeing "aliens and devils" and that he was thinking about drinking bleach to commit suicide. He was left in the lobby for more than an hour and not seen by a physician for almost seven hours. A mental health evaluation was not completed for 17 hours after he arrived, according to the federal report.

At that time, the patient denied being suicidal and was discharged without receiving treatment.

* A female patient went to the emergency room on March 8 complaining of two weeks of stomach pain. She said she had nausea and rated her pain as a 10 on a scale of 1 to 10. "The patient identified that the pain she was experiencing was constant and that nothing provided relief."

Even so, she was given no treatment to alleviate pain or reduce her fever. Two hours later, she was checked again and again offered no treatment. She was not seen by a physician until nearly seven hours after she arrived. "The patient experienced severe pain throughout her [emergency stay]," the report said. Eleven hours after she arrived, she went to surgery.

* A patient went to the emergency room on May 11 complaining of spotting during pregnancy. An hour later, a triage nurse saw her, gave her a pregnancy test and sent her back to the waiting area. When staff called her name two hours later, she had left without being seen.

Three days later, the same woman returned to the hospital with complaints of vaginal bleeding and severe pain. A nurse didn't evaluate how much she was bleeding and had her wait four hours without pain medication. During an ultrasound, she had a miscarriage and was discharged a short time later.

In a letter to the hospital accompanying the report, the Medicare agency said it was "very concerned by MLK-Harbor's apparent incapacity" to meet minimum Medicare standards and to protect patients from the threat of harm. In several cases cited in the report, physician assistants performed medical screenings of the patients without proper oversight by doctors.

King-Harbor submitted its plan to correct its problems to the federal government late Monday.

In it, the hospital said it has counseled nurses and stopped using physician assistants to screen patients. In addition, it said it has redesigned its triage process to ensure patients receive proper screening and has trained emergency room nurses to contact physicians whenever a patient needs immediate treatment for pain. It said it is adding a specialized physician in the emergency room to manage internal medicine patients awaiting transfer or admission. That physician must assess each patient at the beginning of each shift.

"MLK-Harbor believes that significant, appropriate corrective actions have and will continue to be made which assure the safety and timely treatment of patients who present to its emergency department," hospital administrator Antionette Smith Epps wrote to the federal agency.

The supervisors are expected to discuss the problems at a meeting today.

The latest report was prompted by reports of poor care given to Juan Ponce, 38, who went to the emergency room on Feb. 28 complaining of headaches and nausea. A scan showed that he had a brain tumor and swelling in the brain.

Because King-Harbor no longer offers neurosurgery, Ponce was to be transferred to another hospital for care. However, inspectors found that no physician had talked to other hospitals about his condition. He was seen by a neurologist only once.

On his fourth day there, Ponce's family and friends took him out of King-Harbor against medical advice and drove him to Harbor-UCLA Medical Center near Torrance, where he received emergency surgery. His case was first reported last month by LA Weekly.

During the federal review, hospital staff told inspectors that the care Ponce received was "appropriate." Days later, inspectors were given an internal review conducted by the hospital that identified a failure of emergency room physicians to properly assess him. An outside contracting firm handles physician services in the emergency room.

Inspectors also found that a plan to streamline the transfer process between King-Harbor and other hospitals had never taken effect.

The hospital said Monday that it had implemented a new policy to speed the transfer of neurosurgical patients and ensure that high-level discussions are held whenever there is trouble transferring patients.

When questioned about some of the troubling cases during the inspection, King-Harbor officials acknowledged problems. One teenage boy who had severe abdominal pain waited 19 hours after arrival for laboratory results. He "fell through the cracks," medical staff admitted.

charles.ornstein@latimes.com

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To view the federal report go to www.latimes.com/kingharbor

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