Regulators found blood-spotted chairs and walls, nurses who failed to change gloves or wash their hands and equipment that was rusted or held together by tape in a surprise November inspection of UC Irvine's dialysis center according to letters and reports obtained by The Times on Monday. The findings, federal regulators have warned, could jeopardize Medicare funding for the facility that serves about 120 patients.
In a 70-page report, state investigators said they observed poor oversight and mistakes at the center that posed a danger to patients. UCI officials said Monday that they "appreciate the seriousness of issues raised" and already have taken numerous steps to improve conditions.
Among the inspectors findings:
•Nurses and staff failed to monitor patients' dialysis fluid.
•The center had become unsanitary — dialysis chairs and walls were spotted with blood, and nurses and staff failed to disinfect syringe stoppers, chairs, dialysis machines, thermometers, IV poles and other equipment
•Dialysis equipment was rusted, a dialysis piping system was held together with gray tape and staff failed to clean the facility's water treatment system.
•Nurses failed to change gloves, wash their hands and wear protective gowns while treating patients. Some were not trained in infection control.
The center's administrator was notified Feb. 10 that she had 90 days to submit a plan of correction or the center would lose its Medicare funding, according to a letter from the California Department of Public Health.
UCI spokesman John Murray said Monday that after the inspection, the center's staff was overhauled and retrained, including the appointment of a new medical director and nurse manager. In addition, equipment has been repaired or replaced in advance of an extensive upgrade scheduled to be completed next year, according to a plan of correction UCI officials submitted to regulators Friday.
"We appreciate the seriousness of the issues raised and believe that you will find our response and accomplishments to date to be comprehensive," Dr. Alpesh Amin, head of the medical school's department of medicine, wrote to regulators. Amin said the regulators' findings had "helped us become better."
Patients will be notified about the facility's response when they visit the center for treatment this week, Murray said.
UCI Chief Executive Officer Terry Belmont and Dr. Ralph V. Clayman, dean of the medical school, defended the dialysis center in a letter to faculty and staff Monday and cited the center's record as providing better care than others in California and the nation.
"Its annual observed mortality rate is the lowest in Orange County and better than state and the national averages — 11% at UC Irvine compared to 18% in California and 20% nationally," they wrote. "In addition, its patient infection rates are among the lowest in Orange County and are below state and county averages. Patient coverage provided by faculty physicians and fellows exceeds Medicare standards."
State regulators were reviewing the center's plan of correction Monday, according to Ralph Montano, a spokesman for the California Department of Public Health. Regulators plan to return to the center within 30 to 45 days for a follow-up inspection, according to the Feb. 10 letter.
The center is located on the campus of UC Irvine Medical Center in Orange, but is licensed separately and administered by the UCI School of Medicine as a physician practice, Murray said. It had not been inspected since Jan. 4, 2003, and state regulators had not received any complaints since that inspection, Montano said.
There are about 500 dialysis centers statewide, according to federal records. Federal regulators provide state investigators with a list of dialysis centers with a history of complaints and other problems and require them to inspect 10% of the list annually, which they have, according to federal officials.
Federal regulators also require state officials to inspect each dialysis center every three years, but Montano said "limited resources and competing priorities" have prevented them from doing so.
In December, the Southern California Renal Disease Council warned dialysis centers, including UCI's, that federal regulators had received "numerous referrals and patient complaints" and that many facilities had violated infection control regulations. They recommended, "an immediate check of your facilities for cleanliness."
Montano said state investigators will be increasing inspections of dialysis centers later this year.
"By June 2011, all of our district office staff will have trained surveyors to conduct these surveys," he said. "As a result, we hope to do more surveys in the future."