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Hospital's treatment of critically ill infants scrutinized

Questions have arisen over whether Olive View-UCLA continued treating such patients after being told by the state to transfer them.

May 07, 2010|By Molly Hennessy-Fiske and Rong-Gong Lin II, Los Angeles Times

Serious questions have emerged about whether Olive View- UCLA Medical Center in Sylmar has continued treating critically ill babies long after state officials said the hospital lacked the doctors to do so properly and told the facility to transfer such high-risk patients.

State officials said they had downgraded the county hospital's neonatal intensive care unit, or NICU, in late 2008. Since then, Olive View has been required to transfer babies needing a ventilator for more than four hours to a hospital that could provide a higher level of care, according to California Department of Health Care Services officials.

"We took action to ensure that sick neonatal babies were not in that facility," said Norman Williams, spokesman for the department. "They were required to be transferred."

Williams said the state acted on Nov. 20, 2008, because the hospital had only one neonatologist who met state requirements and some of the doctors working in the unit were not board-certified in pediatrics.

Los Angeles County officials, informed of the state's timeline of events, expressed shock Thursday, saying they became aware of the downgrade only in January.

Even after that date, however, the hospital appears to have continued to treat babies who spent far more than four hours on a ventilator. According to family members and medical records reviewed by The Times, Olive View treated at least two infants since January who spent well over a month on a ventilator. Another newborn remained on a ventilator for five months last year, according to the family and medical records.

County officials — who this week launched an investigation into complaints that NICU nurses did manicures atop medical equipment, among other allegations — had insisted Wednesday that Olive View was following all regulations and had been promptly transferring infants who required ventilators for more than the time permitted.

Informed Thursday of the patients identified by The Times, top county health services officials said they were unfamiliar with the cases and needed to investigate.

Asked whether the hospital had violated regulations, Dr. Gail V. Anderson Jr., interim chief medical officer of the county's Department of Health Services, said, "We're going to have to check into that."

Carol Meyer, the department's chief network officer, described the situation as "very complex."

"We have nothing to hide here," Meyer said. "We're just trying to uncover information as well so we can clearly understand."

Williams said the 24-bed NICU's status was downgraded from "community" to "intermediate," the lowest level recognized by his department, which pays for the care of needy children who are seriously ill under the California Children's Services program. The highest level of care is provided by a "regional" facility, typically associated with universities.

The state sent notifications of the downgrade to Olive View's medical director, chief administrator and NICU director, Williams said.

Dr. Maureen Sims, who retired as Olive View's NICU director in September, said that to her knowledge the hospital and state never limited how long the unit could treat babies on ventilators. Sims, who worked at the hospital for 15 years, said she believed she had resolved the staffing issues raised by the state in 2008.

"We treated without restriction," she said.

Williams, however, said the downgrade took effect in 2008. In January of this year, officials reaffirmed their decision to downgrade Olive View's NICU after again determining that the unit failed to meet physician requirements, among other issues.

The NICU's current director, Dr. Richard Findlay, did not return calls Thursday. Neither did the hospital's medical director or chief executive.

Three mothers of high-risk newborns told The Times their children were on ventilators in Olive View's NICU for periods that far exceeded four hours.

Antonio de Jesus Rincon, who was born at the hospital March 21, was transferred late Tuesday to Ronald Reagan-UCLA Medical Center in Westwood. By then, his mother, Martina Rincon, said her son, who had breathing problems and low blood pressure, had been on a ventilator since his birth.

Rincon, 46, of Newhall, was covered by Medi-Cal and said she had been transferred to Olive View from Henry Mayo Newhall Memorial Hospital because she was told she would receive a higher level of care for her high-risk pregnancy.

As her son's condition worsened, Rincon, a K-Mart maintenance worker, said she began to question the care he was receiving.

Louis Rincon, her 22-year-old son, said his brother suffered frequent seizures.

"They were giving him blood transfusions and he had tubes sticking out of everywhere. His face was so swollen, his chin was cracking open and there was blooding coming out," Louis Rincon said. "As soon as I put my hand on him, the seizures started."

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