Sanctioned Hospital Is Fined Again

An Orange County hospital that lost Medi-Cal funding for its pediatric skilled nursing center because of a death last year has been sanctioned again -- this time for transferring three children to distant medical facilities without consulting their parents.

One of the children, a 2 1/2-year-old boy, died 16 days later in a North Hollywood facility before his mother -- who did not have a car -- was able to see him. State health officials did not give the cause of death, but said it was not attributable to the move.

Tustin Hospital and Medical Center officials also failed to provide translated documents to the non-English speaking families or work with them to find facilities near their homes -- both violations of regulations governing patient transfers, according to a citation by the state Health and Human Services Agency.

The hospital was fined $1,000 -- the amount set by law -- for the improper transfers, which followed the loss of Medi-Cal funding. The fine comes after four previous reprimands, levying a cumulative $121,000 in fines, according to a survey of state records compiled by the California Advocates for Nursing Home Reform.

“I can’t imagine that they didn’t know better,” said Rochelle Woolery, ombudsman coordinator for the Orange County Council on Aging, which monitors patients in skilled-nursing facilities. “They just took it upon themselves to move [the patients].”

The problem centers on the Tustin hospital’s 42-bed pediatric subacute care unit, used for children with severe medical problems often requiring ventilators or other life-sustaining equipment. The hospital’s other operations -- an emergency room and 135-bed acute-care facility -- are not affected.

Hospital officials declined to discuss the case and referred calls to attorney Jon Cohn in Los Angeles, who said state regulators ordered the transfers and that hospital officials believed they acted properly.

But state regulators said the hospital admitted the errors to them.

“Tustin readily acknowledged its error in how they transferred these patients out,” said Denise Arend, assistant deputy director of the state health department’s Licensing and Certification Program. Remaining patients were handled correctly, she said.

Eva Casas-Sarmiento, an advocate in the state-funded Office of Clients Rights Advocacy in Garden Grove, said skilled-nursing facilities must follow federal regulations requiring 30-days’ notice before a patient is transferred, to give families time to appeal the decision and help in the planning.

“The goal is to avoid what is called transfer trauma,” said Casas-Sarmiento.

“These are very young kids with severe disabilities, and transferring them far away from their families has the practical effect of causing trauma.”

Casas-Sarmiento represented two other families who last month successfully appealed the Tustin hospital’s plans.

One couple, Manuel and Alma Avila, said this week the proposed transfer of their son Steven, 3, who suffers from debilitating lung problems, to North Hollywood would have ended daily visits from his mother, who doesn’t drive.

“It’s hard on him not to see his parents during the week,” Alma Avila said. “We hug him, clean him up, we spend whole days with him when we can. He gets worse if we don’t see him.”

The Avilas said the appeal means their son will stay at the Tustin hospital while they work with administrators to find a more convenient facility.

“We were not going to leave until they found us a place close to us, and of good quality,” said the father, who works two jobs -- one in a factory shipping dock, the other cleaning offices -- so Steven’s mother can have days free to visit him.

For the Avilas, uncertainty over the transfer has added another layer of pain to an already overwhelming situation.

“I feel a lot of sadness,” Alma Avila said. “You feel like the world is falling down on you. You feel desperate.”

The hospital is one of only nine facilities in California licensed for subacute pediatric patients, and its loss of reimbursement eligibility further crimps an already short supply of the specialized beds -- 278 statewide, according to advocates and state health officials.

The earlier citations were for the June death of a 7-year-old patient; the unrelated death of a 5-year-old who was not properly monitored; burns that four patients suffered from medical equipment, and an incident in which an alarm on a ventilator was turned down too low for nurses to hear.

The death of the 7-year-old occurred when his ventilator became disconnected and was unnoticed by the nursing staff. That led state health officials in September to issue a Class AA citation -- its most severe reprimand -- which, under state law, made the hospital ineligible for Medi-Cal reimbursements for pediatric subacute care.

That meant a drop in rates ranging from $647 to $705 a day per child for pediatric subacute care to about $250 for more routine care, said Lea Brooks, a spokeswoman for the state health department.

The hospital may apply to return to the reimbursement program after it goes 12 months without receiving a serious citation at its subacute pediatric unit, according to regulations.

Meanwhile, under state codes, the facility can continue to receive the higher reimbursements for existing patients as long as it is actively trying to place them at other facilities.

Although it’s unclear when the hospital began moving out patients or how many remain, in January it notified a number of families -- as many as nine, one state official said -- that their children would be transferred in 30 days. However, three were moved only five days later in violation of health codes defining patient rights, according to the March citation.

The reason for the quick transfers wasn’t in the citation, but patient advocates speculated that Tustin officials acted as soon as they found space in an overtaxed system.

“There are only so many beds,” said Woolery.

Tustin Hospital and Medical Center opened in 1997 on the site of a former hospital with a similar name -- Tustin Hospital Medical Center -- that closed after its corporate parent, Healthcare America Inc. of Texas, filed for bankruptcy in 1996.

The hospital is operated by Pacific Healthcare Inc. of Long Beach, a private for-profit company owned by the German-based Asklepios Clinics, which owns five other hospitals in Southern California and one in Atlanta. None of the other California facilities has been cited by state health regulators.