Joe Nelson, Staff Writer
Posted: 05/29/2010 07:07:15 AM PDT

Staff at Arrowhead Regional Medical in Colton failed to properly screen children for abuse, overmedicated patients with antipsychotic drugs and painkillers and failed to follow proper guidelines for restraining patients, according to a recently released federal investigative report.

An inspection by the Centers for Medicare and Medicaid Services (CMS) in November also determined that one physician’s assistant was allowed to work at the county hospital for nearly six months without certification, another ordered medication for a patient without a doctor’s approval, and that a doctor removed the appendix of a patient without her consent.

Department heads stand by the quality of care at Arrowhead. They say that certain medical practices scrutinized by the federal agency are common throughout the state and at no time was patient safety at risk.

The county hospital submitted its corrective plan of action to CMS on May 17, but corrected many of the violations in the wake of the inspection, hospital CEO Patrick Petre said.

CMS is expected to re-inspect the hospital by July for compliance.

“For us, we think it was a good experience because it’s going to make the hospital much better. We spent a lot of time on the corrective action,” Petre said.

In one case, investigators learned a doctor failed to immediately examine a 3-year-old girl whose mother claimed she had been molested. A nurse shuffled the two into a waiting room, and the two left without the child being examined.

Hospital spokesman Jorge Valencia said the hospital’s emergency room was bustling that day with trauma patients, and that the mother and daughter left the hospital after waiting only five minutes. He said Colton police were subsequently notified.

The news comes amid complaints from doctors who allege conflicts of interest at the hospital and the way contracts are negotiated and terminated. It has stoked further concerns that the quality of patient care is suffering as a result.

On Tuesday, about 100 doctors clad in white coats gathered at the Board of Supervisors meeting in downtown San Bernardino to voice support of their hospital and the way it is governed.

“We are very passionate about the quality of care we deliver. We will continue to provide exemplary care to the citizens of San Bernardino County,” said Dr. David Lanum, the hospital’s chief of staff.

Supervisor Josie Gonzales, who sits on the county’s joint conference committee for Arrowhead, said she was “heartbroken” that the situation has risen to the level it has and that doctors are fighting their battle in the public arena.

“You must remember that in this life, when the elephants fight, it is the grass that gets trampled,” Gonzales said. “And it is the grass, it is the people who look to you as the giants, that need the respect that seems to be lacking at the present time.”

In April, CMS warned Arrowhead it was in danger of losing its contract for Medicaid and Medi-Cal services if its corrective plan didn’t pass muster. More than half the hospital’s budget comes from Medicare and Medi-Cal funding.

During the November inspection, investigators also learned that nurses repeatedly failed to rule out child abuse on hospital triage forms. Cited cases included a toddler with a 5-day-old fracture, an 8-year-old boy with pain in his genitalia, a 12-year-old boy with a bruised eye and a 1-year-old boy who had ingested rat poison.

None of the children suffered abuse, said Dr. Rodney Borger, who heads the hospital’s emergency department.

“There wasn’t one case of child abuse that’s come through our emergency department that we didn’t properly report,” Borger said. He said nurses are now required to screen for child abuse in all cases, involving pediatric injuries.

In September 2009, a woman complaining of abdominal pain consented to a surgery that could have resulted in the removal of her ovaries and fallopian tubes. When no abnormalities were found during surgery, the doctor removed the woman’s appendix as a precautionary measure, according to the report.

Dr. Dev GnanaDev, the hospital’s medical director, said the procedure is very routine at hospitals, but inspectors wanted the hospital to change its procedure regardless. Patient consent forms have since been amended.

Arrowhead officials say that CMS has been tougher in its scrutiny of hospitals and patient care in the last year, and that the hospital hasn’t had an inspection of such magnitude in about 10 years.

They say their sentiments are echoed by hospital administrators statewide.

“We’ve been hearing more and more of this in the last eight to 10 months,” said Jim Lott, vice president of the Hospital Association of Southern California, the regional trade organization that oversees hospitals. “We’re hearing from a lot of hospitals that that is the case – that representatives have began to take a much harder line in their reviews of hospitals.”

Steven Chickering, associate regional administrator of CMS’s survey and certification program, said the agency has not changed the way it conducts its investigations, which average around 40 a year statewide and are fueled by complaints.

“The process has not changed. The survey frequency is based on the number of complaints and other information that we feel warrants an investigation,” Chickering said.

He said his agency hasn’t seen an increase in complaints this year over previous years.

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