Alameda County hospitals, clinics pass Medicare, Medi-Cal muster after year under microsco

Medical center in clear for fed funds
County hospitals, clinics pass Medicare, Medi-Cal muster after a year under the microscope
By Rebecca Vesely, STAFF WRITER

After more than a year of intense scrutiny by state and federal regulators, the Alameda County Medical Center is no longer in danger of losing millions of dollars in public funding, hospital officials confirmed Tuesday.

The medical center passed a Feb. 15 inspection by the federal Centers for Medicare and Medicaid Services and the state Department of Health Services. CMS has the power to suspend reimbursements to hospitals that care for patients insured through Medicare or Medi-Cal.

In a letter dated Thursday, CMS officials notified medical center officials they were in the clear.

"Effective the date of this letter we are restoring your facility's deemed status," wrote Deborah Romero, acting manager for hospital and community care at CMS's Division of Survey and Certification.

The letter is the culmination of more than a year of surprise
inspections. In that time, the medical center came close to losing CMS funding, which would have shuttered the county's public hospital system, including three inpatient hospitals and outpatient clinics in Oakland, Hayward and Newark.

The inquiry began in late 2003 after the slaying of Dr. Erlinda Ursua, a longtime physician at John George Psychiatric Pavilion in San Leandro, the county's locked inpatient psychiatric hospital. A female patient who suffers from bipolar disorder, Rene Pavon, has been charged with the crime and is awaiting trial.

In December 2003, several weeks after Ursua's death, a patient at John George committed suicide at the facility, also prompting the state and federal investigation.

During an unannounced inspection in February 2004, federal and state surveyors found numerous problems at John George, including not properly
monitoring, documenting or treating patients, failing to repair security systems and neglecting to implement previous plans of correction required by regulators.

The surveyors also concluded that the hospital was negligent in its care ofPavon and the patient who committed suicide, and failed to create a safe environment for staff, including Ursua.

Those deficiencies led CMS to widen its investigation to all Alameda County Medical Center facilities, which operate under one license.

An inspection in August revealed fewer problems at John George but serious deficiencies at Highland Hospital in Oakland and Fairmont Hospital in San Leandro. The problems were in medical records, the pharmacy, the physical environment and food and dietary. The citations ranged from improper medication of patients to mold in refrigerators.

Shortly
after that inspection, CMS informed the medical center that it would terminate funding in November unless it saw improvements.

On a return inspection in November, the surveyors found continued problems, mostly centered at Highland Hospital, which runs north county's only trauma center.

But CMS gave the medical center another chance.

The latest inspection Feb. 15 found improvements in all areas previously cited.

Claude Watts, interim CEO of the medical center, said the key to achieving compliance was to perform continuous audits of patient charts to make sure every detail was in place.

"We looked at all the plans of care for patients and did 100 percent chart reviews every day to look for deficiencies and reeducate staff," Watts said.

He added that extensive chart reviews were ongoing. "The goal
is to get everyone in the mind-set that we need to meet conditions of certification at all times," he said.

Meeting federal standards has required a cultural shift within the hospital system, which has been plagued with inefficiencies, Watts said.

"The key word is accountability," he said. "I don't think we did a good job of that in the past. It's sinking in. Everyone understands what needs to be done."

CMS and state surveyors won't return to the medical center unless prompted by another complaint or serious incident.

Meanwhile, the medical center's next inspection will occur in about 18 months with an independent regulatory agency, the Joint Commission on Accreditation of Healthcare Organizations.

The medical center's Board of Trustees hired Cambio Health Solutions, a turnaround consulting firm, in February 2004
to improve financial problems at the medical center — including a $70 million deficit — and achieve compliance with regulatory agencies.

Cambio was retained on an 18-month,

$3.2 million contract approved by the county Board of Supervisors. Cambio consultants plan to leave in the fall and are searching for a permanent CEO.

Contact Rebecca Vesely at rvesely [at] angnewspapers.com.