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Monday, February 02, 2004A report compiled by federal officials said nurses at Martin Luther King Jr.-Drew Medical Center left critically ill patients unattended for hours at a time and were ordered to lie about patients' conditions. Some of those left alone died, according to the Centers for Medicare and Medicaid Services report. County officials said the findings could lead to a criminal investigation into the hospital's practices. The Los Angeles hospital, owned by the county, is in danger of losing its federal funding because of severe lapses in care: If the problems are not immediately corrected, the hospital could lose all federal funding, which accounts for about half its $430 million annual budget. The Los Angeles County hospital, established as a response to the 1965 Watts riots, is the only public hospital in the South Los Angeles area and serves a largely poor population. It receives $13.8 million a year from the county. An accrediting group last year stripped the hospital of its ability to train aspiring surgeons and radiologists and recommended closing the neonatology training program. Chances are they have trouble collecting enough to cover their budget, even with full federal funding. And when budgets are tight, unfortunately one of the first things to get cut is staffing. And according to the LA Times version, it's staffing that appears to be the problem: A federal health official familiar with King/Drew, who declined to be identified, said the problems found and the number of questionable deaths were highly unusual. Nurses told inspectors, for instance, that their supervisors had ordered them to downplay the conditions of critically ill patients to subvert rules requiring that the sickest patients get more nursing care. ...As a result, inspectors said, nurses sometimes struggled to care for four times as many patients as the state allowed. Crucial medications and treatments were often delayed for hours. Nurses also did little to help patients who were in severe pain, according to the findings. On one shift reviewed by inspectors, nine of the 16 patients should have been classified at the sickest level, which would have required one nurse for every two patients. One patient was bleeding and required multiple transfusions, five required ventilators to aid their breathing and one of those patients had a temperature as high as 104 degrees, inspectors found. Four more patients were waiting to be admitted from the emergency room. Yet there were only two registered nurses assigned to the unit — one for every eight patients, according to the report. One less skilled licensed vocational nurse, though not qualified for the task, was left to watch the cardiac monitors. When nursing administrators were asked for help, they told the nurses on duty that no help was available, the report said. How unqualified was that person to watch the monitors? Very unqualified: When nurses went to his room, they found a "flat line" on the cardiac monitor and no heart rate, the report said. He died within hours. The employee assigned to watch the monitors "had not notified the nurse prior to being alerted by the patient's family" that the man's heart had stopped, according to the report. ...When inspectors visited King/Drew on Dec. 23, the nurse assigned to watch the cardiac monitors told them she "did not feel comfortable" with use of the devices. Her employee file also lacked proof that she had been trained to operate them or spot abnormal heart rhythms, the report said. While inspectors spoke to the nurse, the monitors for all six patients in 4B showed a red X next to the "pulse" read-out. None of the three nurses in 4B at the time knew the X meant that the alarm, designed to alert them to dangerous dips in patients' heart rates, was off. This story confirms the staff shortage angle: Martin and another nurse, Alan Noel, acknowledged that patient care at the hospital had slipped to unacceptable levels, but blamed the decline on severe staffing shortages. Noel said a single nurse might be left in charge of as many as 14 patients, more than double a normal load. Under such conditions, he said, patients were often neglected and it became impossible to administer decent care. 'You have 14 patients and one patient crashes, you have to spend all your time with that patient,' Noel said. Since the change in nursing management, he said, more nurses have been on duty, although there are still too few nurses working the night shift." An adequate and well-trained nursing staff is the cornerstone of good hospital care. That's what's so worrying about the call for mandated computer systems to "reduce hospital errors." The money to pay for those systems has to come from somewhere. Chances are, it will come from staff reductions. And a good nurse can never be replaced by a computer. posted by Sydney on 2/02/2004 08:04:00 AM 0 comments 0 Comments: |
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