Edgemoor Is Told It Must Shape Up or Lose U.S. Funds

The federal government will stop paying the bills for poor patients at San Diego County’s Edgemoor Geriatric Hospital on June 30 unless the county can prove by then that problems at the aging and troubled hospital have been corrected, a U.S. Department of Health and Human Services official said Thursday.

Ronald S. Currie, chief of standards and certification for the department’s San Francisco office, said the department decided to withdraw its support of the facility after inspectors found a spate of problems with patient care and management at the hospital in February and April.

“We don’t expect to pay for people receiving substandard care,” Currie said in an interview. “We found them deficient in the initial survey, and then we went back at a point when we would fully expect things to be corrected, and they weren’t. We have no alternative but to withdraw federal support.”

In a letter to the county dated May 24, Currie said the 323-bed hospital’s many problems pose “a threat to patient health and safety.” He said the department believes there is “little prospect of your facility achieving and maintaining” compliance with federal regulations.

The letter cited five of 18 federal licensing conditions with which the county was not in compliance. They were nursing services, dietetic services, rehabilitative services, medical records, and governing body, a general category involving the county’s administration of the hospital.

If the federal government follows through on its threat to cut Medicare funds for Edgemoor’s patients, the state could not pay the bills under its Medi-Cal program either, Currie said. Because 95% of the hospital’s patients depend on federal and state assistance, the result would be the loss of $8 million of Edgemoor’s $9.7-million budget and the possible closure of the hospital.

But a spokesman for the county said Thursday that the federal government’s action was based on outdated information and that the county has already asked that the move be reconsidered.

Robert Lerner, the county’s public affairs manager, said county health officials will meet with Currie on Thursday to show him what the county has done to improve Edgemoor since the last state inspection in mid-April.

He said the hospital’s nursing staff has been expanded with the hiring of four registered nurses, 10 nurse assistants and a new assistant chief nurse. A dietitian and five food services workers have also been hired, and a new medical records department is in place, Lerner said. He also said another problem cited by the federal government--the inappropriate use of physical restraint--has been corrected.

Comments from county, state and federal officials Thursday made it seem likely that the county’s appeal will be received favorably.

Joan Dowling, regional administrator of the state Department of Health Services, called the federal government’s letter a “procedural thing” and said it did not take into account any changes the county has made since April. The state inspects Edgemoor as an agent for the federal government.

And Currie said the intent of his letter was not to close down the hospital.

“We’re not in the business of trying to throw people out,” Currie said. “What we’d like to see is quality care given to the beneficiaries 365 days a year. To the extent that happens, we don’t push to throw people out of the program. But having identified problems, if they don’t correct them, we just let the clock play out. In most instances, once they get the sharp jolt, they move rather aggressively to do what they need to do to straighten things out.”

County supervisors and the county’s staff have been working to identify and correct the problems at Edgemoor since state inspections and newspaper reports highlighted problems in patient care, maintenance and administration at the hospital earlier this year. The state has fined the county $40,000 for violations at Edgemoor in the past year.

Francoise Euliss, Edgemoor’s administrator for eight years, was transferred from the job in April and Paul Simms, her boss, was dispatched to the site to prepare short-term and long-term plans for the hospital’s improvement. The Board of Supervisors is considering operating the hospital as a separate, nonprofit agency, and will soon consider proposals for razing the hospital’s buildings--some of which are 50 years old--and replacing them with a $16-million structure.