Calling the atmosphere at the Motion Picture and Television Fund’s Woodland Hills health care facility “chaotic” and “disorganized,” a medical inspector for the state of California went on to give a scathing account of care provided at the hospital in a March report made public Tuesday.
The report is part of a state Department of Justice program, Operation Guardians, that conducts surprise inspections at nursing homes. After inspections are completed, evaluations of facilities’ quality of care and basic sanitation are filed. Each inspection generally generates two reports, one by the inspection team as a whole that assesses the general sanitation and care provided by the facility staff and a medical report written by a medical doctor who specializes in geriatrics. Care facilities are then given the opportunity to file a response for the public record.
The reports are not generally made available to the public; however, the California Advocates for Nursing Home Residents, or CANHR, made a Public Records Act request to obtain all reports issued from Jan. 1, 2010 through March 7 of this year and has subsequently posted the 14 reports it received to its website. Among the 14 facilities inspected was also the Tarzana Health and Rehabilitation Center, the only other San Fernando Valley hospital on the list.
In a statement to Patch, the Motion Picture and Television Fund said it is disappointed with the Operation Guardians findings, even more so that they were published without the benefit of a response from MPTF’s clinical care team.
“In many cases, we feel that the conclusions of the inspectors, on an abbreviated visit to the facility, represent half-truths and with the benefit of a longer and more comprehensive interaction with our care team, they might have seen a different picture,” the statement, written by Bob Beitcher, president and CEO of the Motion Picture and Television Fund, said.
At the Motion Pictures hospital, inspectors toured the long-term care unit, which is housed in the same building as the acute care hospital, and a unit called Harry’s Haven, the dementia special care unit, which is located in its own building, according to the report.
On the day before the inspection, second-floor residents had been moved to the first floor, causing the chaotic atmosphere the inspector referred to, according to Beitcher. The report confirms the recent move.
Disorganization due to the move aside, the state’s report sited a long list of concerns in regards to the state of the facility. Items listed range from soiled durable medical equipment, such as wheelchairs and feeding pump poles, which had “dry food particles and required deep cleaning,” as it is “a possible infection control issue” to peeling paint and wallpaper, a hole in a wall and an unlocked room housing loose, dangling cords and open electrical boxes.
The report took issue with the medical provider services at the facility as well. The inspecting physician, Kathryn Locatell, reviewed the closed clinical records of three recently deceased residents, examined two patients and reviewed the medication administrations records for all residents in Harry’s Haven and found “significant problems with the medical and nursing care being provided,” she wrote.
“The medical director serves as attending physician for all of the residents in both units. This physician appears to lack basic knowledge concerning standards applicable to geriatric patients, nursing home residents and those receiving palliative or end of life care,” she reported.
She cited a case where the doctor ordered painful intramuscular injections of morphine for a dying resident, even though it could have been given orally, which offers the advantage of almost instant absoption. The patient’s orders were changed once the investigating doctor brought it to the nurse practioner’s attention, but the patient died before the change was made.
Locatell went on to write that it appeared care is not coordinated with the nurse practictioner and nursing staff or patients’ families and that there is evidence of polypharmacy and unnecessary drug use.
In regards to the lack of coordination, Locatell sites a case where the doctor ordered an increase in the dose of a medication the nurse practitioner had discontinued a week prior to the physician’s visit.
Locatell reported numerous residents are receiving more than 10 medications, some more than 20, and “drugs to treat side effects of other drugs are added to the already-long list of medications these residents are burdened with, many of which are likely not benefiting the resident in any manner whatsoever.”
The inspector-physician pointed to an example where a patient was taking a drug to treat blood pressure drops when assuming an upright position; however, the patient was receiving medication known to cause the effect, which is potentially dangerous, as well as three different medications to lower her blood pressure.
“Rather than conduct a careful evaluation for the medical necessity of each drug, another was simply added on,” Locatell wrote.
Other concerns noted in the report had to do with nursing services, particularly in regards to pressure ulcers, also known as bed sores. One patient, for example, had what Locatell called a “severe, recent deep tissue injury” that she concluded could only have been caused by being left in one position for at least 12 hours without being repositioned.
“I consider the development of this wound to be a clear indicator of nursing neglect,” she wrote.
Though the hospital takes issue with the report, Beitcher said via his written statement it is taking each of the findings seriously and will be bringing in outside, experienced health care experts for a more extemsive review of its practices both in long-term and dementia care.
“Our goal remains to provide the highest quality of care for our industry’s most frail and vulnerable members and we strongly believe that today we do an outstanding job at that,” he wrote.
The California Advocates for Nursing Home Residents executive director, Pat McGinnis, called the Operation Guardians a valuable program in uncovering instances of elder abuse and neglect, but the organization finds fault with the program in two regards.
First, though reports are shared with the Department of Public Health for follow up and investigation, DPH has taken little subsequent enforcement action, the organization said in a statement issued Tuesday.
In the case of the Motion Picture hospital, McGinnis said her organization reviewed all of the available records for the facility six months up to the current date after the attorney general’s report and there are no files on the Department of Public Health’s website regarding it. She noted there was a citation issued to the facility in 2011 for patient care, but that would have been issued prior to this year’s March report.
“Since no other enforcement action has occurred, it is assumed that no enforcement actions have happened as a result of the report,” McGinnis said.
In fact, she said, as far as her group could determine, no enforcement action has been taken in regards to any of the 14 inspections and reports filed between Jan. 1, 2010 and March 7 of this year.
Calls to the Department of Justice by Patch were not returned.
The other problem CANHR sees with the Operation Guardians program is that its reports are not made public.
"Its findings are completely unknown to nursing home residents and their families," said McGinnis in a written statement. "We’re pleased to be able to publicize this information so residents and their loved ones can be better informed when choosing a nursing home.”