Riverside General Hospital Accused of Improper Patient Care, Feeding

Riverside General Hospital was accused this week by state health officials of improperly medicating and underfeeding sick patients, as well as violating standard hospital practices necessary to prevent infection and assure quality medical care.

An investigation of the 352-bed county hospital in Riverside was undertaken after an analysis of nationwide Medicare mortality data ranked Riverside and several other California hospitals in the bottom 50 of 5,577 hospitals nationwide. The state released a report of its investigation this week.

Riverside General and one other hospital--Martin Luther King Jr./Drew Medical Center in Watts--were targeted as the two public hospitals in California with “exceptionally high risk-adjusted mortality,” according to analysis of federal mortality data by the Chicago-based consulting firm of Michael Pine and Associates. State inspectors have not yet released their findings on King.

Analysis Called ‘Flawed’

Ken Cohen, administrator at Riverside, called the Pine analysis “flawed” and also said that he plans to challenge some of the deficiencies cited this week by state inspectors.

But he said the hospital does not want to be in “hot water” and that he plans to remedy 80% of the deficiencies within three to four months. Numerous problems arising from the hospital’s antiquated facilities, he said, will be harder to resolve.

Riverside General, affiliated with Loma Linda University, has outgrown its plant, which was built in 1918 and now spills over into a “series of Quonset huts and trailers,” Cohen said. The county is borrowing $210 million to build a replacement facility.

During a one-week survey of the hospital in April, state health inspectors compiled information for a 68-page report listing hundreds of pharmaceutical, nutritional, quality control, nursing, housekeeping and physical plant deficiencies.

They documented instances where patients were given the wrong medication or drugs they were allergic to. Medicine carts used in emergencies to treat patients with sudden heart failure were stocked with outdated medicine or not properly safeguarded, according to the report. Controlled substances--drugs, including some narcotics, that are supposed to be locked up--were stored in carts with broken locks or other unlocked areas that were readily accessible, even to the public.

The nutritional needs of high-risk patients were not met, according to inspectors. Nurses, for example, did not monitor patients’ food intake or measure their weight loss. Among five bad cases of nutritional neglect cited in the report: a 74-year-old patient being tube-fed was given insufficient formula over 11 days to meet the minimum daily requirement of nutrients.

Lack of Documentation

Many of the deficiencies arose from a lack of documentation that important procedures had been followed. Two women were sterilized, for example, without their valid consents on file.

In other cases, there was no documentation that equipment had received regular maintenance checks, that doctors’ orders for patients were actually carried out, or that “adverse events” in the departments of surgery and anesthesiology, for example, were investigated.

“If it wasn’t written down, the assumption we have to make is that it wasn’t done,” said Stan Roman, assistant chief of the licensing division of the Department of Health Services. Documentation, he said, is “pretty basic.”

Housekeeping practices throughout the hospital needed improvement, according to the report. The kitchen suffered from an accumulation of grease, grime and mildew. A dusty fan whirred away directly over a table used for food preparation. The refrigerator shelves were corroded and rusted. Drawers were stuck shut, and food preparation equipment was encrusted with food residue.

Elsewhere in the hospital, inspectors noted that a hose bib at the infectious waste sterilizer was not equipped with a valve to prevent infectious waste water from being back-siphoned into the clean drinking water supply.

Roman described the findings as a snapshot of the hospital taken during a one-week period that serves as “a pretty good indication of what happens there.”

“They have their work cut out for them,” he said.

A lot of the problems there, he added, could have been prevented “if they had a good quality assurance program. . . . Quality assurance is the system that makes or breaks a hospital.”

Cohen acknowledged the hospital has had difficulty “implementing” its quality assurance program due to difficulty in hiring a program director.

Personnel Shortage

He said a shortage of dietitians and nurses has also hampered patient care. But he denied that medicine was outdated or that drugs were improperly safeguarded.

He also said that he believed the hospital had been given “tacit approval” by the state during earlier inspections for some of the remodeling that was challenged in the latest report.

The report charged that the hospital has repeatedly failed to obtain authorization to convert space from one use to another. Walls between patient rooms, for example, were knocked down to form a makeshift intensive care unit. And a portion of the newborn intensive care unit was blocked off for storage, with too many sick infants crammed into the remaining space.

Cohen said that making corrections will prove costly.

It will be up to the county supervisors, he said, to strike a balance between “investing in this facility for the short-run and investing in the new facility for the long-run.”

As for overall patient care at the hospital, he said: “We don’t think we’re doing anything exceptionally better or worse than other county facilities. We’re doing an exceptionally good job, given the volume (of patients) we’ve got.”