County-USC Faulted for Delays in Care

Government health inspectors faulted Los Angeles County-USC Medical Center for staffing shortages, overcrowding, incomplete medical charts and delays in care, according to the final report of a surprise inspection earlier this month.

The inspectors did not, however, address claims that the delays had led to patient deaths. In interviews, state and county officials said those claims were investigated but not substantiated.

The inspection was conducted a month ago by state inspectors on behalf of the federal Department of Health and Human Services. It was prompted by stories in The Times that County-USC doctors -- including the interim chairman of the emergency department -- attributed at least four patient deaths to long waits.

The inspectors looked at the charts for three of the cases -- a fourth case could not be identified -- but did not believe the deaths were caused by long hospital waits, said Lea Brooks, a spokeswoman for the state health department.

“These people were sick,” Brooks said. “They were very sick.”

The 43-page report confirms much of what county officials released in a preliminary memo after the inspection was completed at the beginning of May.

“I did not find any surprises in it,” said Dr. David Altman, the hospital’s chief medical officer. “There are some issues to address

The report does not discuss problems found in the hospital’s laboratory, according to the memo earlier this month. The Times reported in April that it took several hours to process urgent blood work during a two-day span when new computer systems were introduced at the hospital. County officials said the state would release a separate report on the lab.

Much of the report focuses on nursing shortages throughout the hospital that have led to delays in patient care.

In one case cited by the state, a patient was admitted to the emergency room on April 26 with an abnormal widening of a blood vessel in his heart. His condition grew steadily worse as he waited for a bed in the cardiac intensive care unit.

On April 28, as the patient developed further complications, a physician ordered a potent drug that decreases heart rate and blood pressure. But the drug was not administered for more than 13 hours because there were not enough nurses in the emergency room to monitor the patient.

The lack of nurses also has meant the hospital was unable to use all of its operating rooms, the report said, contributing to the “delay in patients being transferred to inpatient beds.”

“There are some issues in terms of how many nurses are available at any time,” Altman said. “It’s not a surprise. We know there are some times we have to close off beds when there’s not enough nurses.”

Inspectors said shortages in the housekeeping staff forced nurses to change bed linens. They often could not do so quickly, delaying the admission of additional patients.

Altman said the inspectors told him specifically that requiring the nurses to make the beds was not a good use of a “very valuable resource.”

The report also cited problems with incomplete medical charts.

In one case, a patient with “schizophrenia, depression, suicidal ideation, diabetes mellitus out of control, HIV and uncontrolled blood pressure” had been on the streets without medication for two weeks. After six hours in the emergency room, his chart showed a doctor ordered Tylenol. A later order for Tylenol #3 was not dated.

But, inspectors said, the chart contained “no documented evidence that the patient received any medical or nursing care while in the [emergency department]. There were no signatures to reflect that the patient was treated or evaluated.”

Altman acknowledged a problem with charting, particularly in the emergency room. The hospital is devising a new form to make it easier for doctors to sign and date their orders.

Altman said the hospital would submit a written plan of correction for problems cited in the report within 10 days.