State halts some pediatric intensive care admissions at Santa Barbara hospital

A key unit at Santa Barbara Cottage Hospital has been restricted from accepting new patients under a California program for chronically ill children until it addresses dozens of concerns raised by state regulators.

The California Department of Health Care Services found that the pediatric intensive care unit at Santa Barbara Cottage Hospital had fallen short of standards for the California Children’s Services program, which serves young people up to age 21 with chronic conditions such as cancer, heart disease, cerebral palsy, traumatic injuries and hemophilia — a group that the agency called “our youngest and most vulnerable Californians.”

Among its findings and recommendations: The pediatric intensive care unit needed more staffing with critical care physicians. State reviewers wrote that at its level of staffing, particularly with the medical director needing to take on administrative tasks, “this is not a safe working environment for the physicians and thus not a safe patient care environment.”

Critical care physicians told the state agency there were times when they wanted to transport a patient elsewhere for care — including some whose condition “portended decline that would unnecessarily endanger the patient if not transported” — but were prevented from doing so or faced “disciplinary actions” for it, according to a state report on the findings.

Among “the most egregious findings” were concerns about the pediatric intensive care unit operating outside of the program standards; inadequate policies and procedures; and failures to discuss problems in an organized way and act on findings to prevent future issues, the department said in a statement to The Times.

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The Department of Health Care Services said the Santa Barbara hospital had submitted a plan to address such concerns in late July, the details of which the agency is still reviewing.

New admissions to the pediatric intensive care unit for patients enrolled in the California Children’s Services program — often abbreviated as CCS — will continue to be restricted “until the department has assurances that the corrective actions will address deficiencies, especially those that are most egregious and require immediate action.”

Hospital officials said they were working to implement the state recommendations so that they can get its approval to reopen the unit to new patients in the CCS program, who usually make up roughly a fifth of patients in its pediatric intensive care unit.

In the meantime, the unit is continuing to care for young patients who are not in the CCS program. “We are confident that these findings and the recommendations are just going to make us stronger,” Cottage Health vice president of patient care services and chief nursing officer Laura Canfield said.

Santa Barbara Cottage Hospital officials also defended their performance and disputed some of the specific findings in the report. For instance, when asked about physicians being prevented from transferring patients to other facilities for care, Canfield said, “We don’t have any data that supports that narrative at all.” In reaction to staffing concerns, officials said the unit has been staffed around the clock by critical care physicians.

The state review also indicated that there was no pediatric neurosurgeon who met CCS program requirements on staff. Dr. Miriam Parsa, chief pediatric medical officer at the hospital, said it had a neurosurgeon who did meet the requirements, because the doctor had “proficiency in the care of pediatric patients.”

The DHCS said it determined that it needed more information to assess whether that physician meets the standards of the program. “A pediatric neurosurgeon must have the appropriate training, board certification, and experience to provide care to pediatric patients,” it said in an email.

The Santa Barbara hospital is the second facility where the state has taken such action this year: Earlier this year, John Muir Medical Center in Walnut Creek was restricted from admitting new CCS patients to its pediatric intensive care unit until mid-August, when the restrictions were lifted. The state move followed a string of investigations by the San Francisco Chronicle into patient deaths at the Walnut Creek facility.

Cottage Health public relations manager Cristina Cortez said the pediatric intensive care unit at the Santa Barbara hospital “provides exceptional quality care, with zero patient harm events [since January 2022] and 90th percentile patient satisfaction ratings for the past five quarters.” Canfield said the DHCS findings were not based on patient outcomes, and “our outcomes are really, really good.”

Restricting admissions to the unit “has been a terrible hardship for our patients and our families,” who have had to travel outside of Santa Barbara County and miss work to get the care their children need, said Parsa, who is also a pediatric rheumatologist.

“If we didn’t think this program was strong and able to provide the services that we know we can provide — and we are providing — we wouldn’t have a PICU here,” Parsa said.