Saturday, December 10, 2011

Is there a cover-up of serious errors at Kaiser hospitals?

(< < < Click on image to enlarge.)

"Since 2007, hospitals have been required to report any errors from a list of 28 “adverse events” that put patients in immediate jeopardy of injury or death."

But if the hospitals don't report the events, then they don't get penalized!

The San Diego Union-Tribune reports (see story below) that Scripps La Jolla is "among most penalized."

But the numbers just don't add up. Kaiser Medical Center in San Diego has a much higher death rate than Scripps Memorial Hospital, but Scripps receives more penalites. Scripps, the nationally-ranked UCSF in San Francisco and Southwest Healthcare in Riverside have received the most penalties from the California Department of Public Health.

How could this happen? Probably because Kaiser is covering up mistakes by falsifying medical records. Kaiser mental health workers recently reported that they were forced to falsify medical records. It's time for other Kaiser workers to tell the truth, too. Kaiser patients would be safer if Kaiser received appropriate administrative penalties.

I have personal experience that Kaiser Permanente in San Diego has falsified medical records. On July 7, 2011 I was sent home from the Emergency Room on Zion because I insisted that doctors look at my X-rays taken on June 15, 2011. The doctors refused to do so. My doctor said she didn't want to "tie up" her "resources", and ordered me to be sent home.

As I was leaving, a nurse stopped me and asked me to sign a form, but she had her hand covering the text on the form. I asked to see what the form said. It said I was leaving against medical advice! I was quite surprised.

I asked the nurse, "I can stay if I want to?"

She said, "No."

I took the form with me when I left, and I heard the nurse tell another worker, "She took it with her!"

"Get another one," her friend said.

Sure enough, when I later obtained my medical records, I found that the nurse had indeed acquired another form, and she and the doctor both signed it! The doctor also wrote in the record that I had left of my own volition. I have attached the signed form to this post, but I covered up the doctor's and nurse's names because I believe that most Kaiser doctors would have done exactly the same thing. I believe they understand that they must work as a "team" with the "Kaiser family." The doctors increase their profits by not "tying up resources."

When I filed a complaint with Member Services, my complaint simply disappeared. I filed a complaint about the disappearance, and that complaint disappeared, too! Finally Kaiser processed another complaint. The "resolution letter" stated, the "issue you have raised will be addressed." I suspect it was addressed and delivered to the trash.


State fines Scripps Memorial for surgery error
Janet Lavelle
SDUT
Dec. 9, 2011

Scripps Memorial Hospital La Jolla was among 14 California hospitals issued administrative penalties Thursday for errors that caused or could cause serious injury or death to patients, state health officials said.

This is the sixth penalty Scripps Memorial has received since the California Department of Public Health began issuing them in 2007 — more than any other hospital in the county.

Statewide, UC San Francisco Medical Center is the only other hospital to get six penalties, exceeded only by Southwest Healthcare System in Riverside County, which has been hit with seven since 2007, state records show.

Scripps La Jolla was fined $100,000 after a one-inch pin was mistakenly left inside a patient’s neck during spinal surgery in October 2010.

The pin was found and removed in a second surgery more than 12 hours later, after the patient complained of pain, and trouble swallowing and breathing throughout the day. Three X-rays were done that day, but the problem wasn’t identified until the surgeon returned to the hospital late that night and spotted the pin on the last X-ray.

Scripps La Jolla was the only San Diego County hospital cited among the 14 on Thursday.

In a phone interview with reporters, Pam Dickfoss, acting deputy director of the state health department’s Center for Health Care Quality, said the penalties are part of a larger effort to make hospitals safer.

“Our goal is to improve the quality of health care in all California hospitals,” Dickfoss said.

Since 2007, hospitals have been required to report any errors from a list of 28 “adverse events” that put patients in immediate jeopardy of injury or death. So far, 214 penalties have been issued to 123 hospitals with assessed fines of more than $7.8 million, Dickfoss said...



Here's the list of local hospitals that reported errors. Isn't it a bit suspicious that Kaiser hasn't reported a single error, when it has higher death rates than Scripps, UCSD, and Sharp?

Hospital Administrative Penalties for San Diego County
Penalties Issued in 2011

Scripps Memorial HospitalNew Window
9888 Genesee Avenue, La Jolla, 92037, San Diego County - The hospital failed to ensure the health and safety of a patient when the hospital did not follow its surgical policies and procedures. This resulted in a patient having to undergo a second surgery to remove a retained foreign object. The penalty is $100,000.

Palomar Medical CenterNew Window
555 E. Valley Parkway, Escondido, 92025, San Diego County - The hospital failed to ensure the health and safety of a patient when it did not implement its established policies and procedures for the safe distribution and administration of medication. This is the second administrative penalty issued to the hospital. The penalty is $75,000.

Pomerado HospitalNew Window
15615 Pomerado Road, Poway, 92064, San Diego County - The hospital failed to ensure the health and safety of a patient when it did not follow its policies and procedures for fall prevention. This is the third administrative penalty issued to the hospital. The penalty is $75,000.

Scripps Memorial HospitalNew Window
354 Santa Fe Drive, Encinitas, 92024, San Diego County - The hospital failed to ensure the health and safety of a patient when it did not follow its surgical policies and procedures. This is the first administrative penalty issued to the hospital. The penalty is $50,000.

Scripps Memorial HospitalNew Window
9888 Genesee Avenue, La Jolla, 92037, San Diego County - The hospital failed to ensure the health and safety of a patient when a patient was not adequately supervised during a surgical procedure. This is the second administrative penalty issued to the hospital. The penalty is $75,000.

Sharp Memorial HospitalNew Window
7901 Frost Street, San Diego, 92123, San Diego County - The hospital failed to ensure the health and safety of a patient when it failed to accurately administer a prescribed medication. The penalty is $25,000.
Penalties Issued in 2010

Palomar Medical Center (PDF)New Window
555 E. Valley Parkway, Escondino, CA 820211, San Diego County - The hospital failed to ensure the health and safety of a patient when it did not follow its patient care policies and procedures. This is the first administrative penalty issued to this hospital. The penalty is assessed at $50,000. - Administrative penalty issued based on finding during survey completed on 01/25/2010.

Grossmont Hospital (PDF)New Window
5555 Grossmont Center Dr., La Mesa 91942, San Diego County - The hospital staff failed to follow the policies and procedures for surgical and invasive procedures. Administrative penalty issued based on findings during a survey completed 04/03/2009.

Pomerado Hospital (PDF)New Window
15615 Pomerado Rd., Poway 92064, San Diego County - The hospital failed to ensure the health and safety of a patient when the hospital did not follow its policies and procedures for fall prevention. Administrative penalty issued based on findings during a survey completed 09/02/2009.

Rady Children’s Hospital (PDF)New Window
3020 Children's Way, San Diego 92123, San Diego County - The hospital failed to implement its established policies and procedures for the safe and effective administration of medication. Administrative penalty issued based on findings during a survey completed 05/14/2009.

Scripps Green Hospital (PDF)New Window
10666 North Torrey Pines Rd., La Jolla 92037, San Diego County - The hospital failed to ensure the health and safety of a patient when the hospital did not follow its surgical policies and procedures for equipment cleaning. Administrative penalty issued based on finding during survey completed on 10/15/09.

Scripps Green Hospital (PDF)New Window
10666 North Torrey Pines Rd., La Jolla 92037, San Diego County - The hospital failed to ensure the health and safety of a patient when the hospital did not follow its surgical policies and procedures. Administrative penalty issued based on finding during survey completed on 05/21/09.

Scripps Mercy Hospital (PDF)New Window
4077 Fifth Ave., San Diego 92103, San Diego County - The hospital failed to ensure the health and safety of a patient when the hospital did not follow its surgical policies and procedures. Administrative penalty issued based on finding during survey completed on 07/02/09.

Scripps Memorial Hospital La Jolla (PDF)New Window
9888 Genesee Avenue, La Jolla 92037, San Diego County - The hospital failed to ensure the health and safety of its patients when it failed to follow its surgical policies and procedures. This is the fourth administrative penalty issued to this hospital. The penalty is assessed at $50,000. Administrative Penalty issued based on finding during survey completed on 07/24/2009.

Sharp Memorial Hospital (PDF)New Window
7901 Frost St., San Diego 92123, San Diego County - The hospital failed to ensure the health and safety of a patient when the hospital did not follow its surgical policy and procedure. This resulted in a patient having to undergo a second surgery to remove a retained foreign object. Administrative penalty issued based on findings during a survey completed on 04/06/2009.

Tri-City Medical Center (PDF)New Window
4002 Vista Way, Oceanside 92055, San Diego County - The hospital failed to ensure the health and safety of a patient when the hospital did not follow its surgical policies and procedures. Administrative penalty issued based on finding during survey completed on 10/15/09.

University of California San Diego Medical Center (PDF)New Window
200 West Arbor Dr., San Diego 92109, San Diego County - The hospital failed to ensure the health and safety of a patient when the hospital did not follow its surgical policy and procedure. This resulted in a patient having to undergo a second surgery to remove a retained foreign object. Administrative penalty issued based on findings during a survey completed on 02/24/2009.
Penalties Issued in 2009

Scripps Mercy Hospital (PDF)New Window
4077 Fifth Avenue, San Diego 92103, San Diego County - Administrative penalty issued based on finding during a survey completed on 09/10/2008.

Scripps Mercy Hospital (PDF)New Window
4077 Fifth Avenue, San Diego 92103, San Diego County - The hospital failed to have a safe, effective and timely system for dispensing and administering medications. Administrative penalty issued based on finding during a survey completed on 4/8/2008.

Sharp Chula Vista Medical Center (PDF)New Window
751 Medical Center Ct., Chula Vista 91911, San Diego County - The hospital failed to ensure the health and safety of a patient when the hospital did not follow its surgical policy and procedure. This resulted in a patient having to undergo a second surgery to remove a retained foreign object. Administrative penalty issued based on findings during a survey completed on 01/22/2009.

Sharp Mesa Vista Hospital
7850 Vista Hill Avenue, San Diego 92123, San Diego County - Administrative penalty issued based on findings during survey completed on 12/02/2008. Information specific to the incident resulting in the issuance of this Administrative Penalty can not be released pursuant to Section 5328.15 of the Welfare and Institutions Code.

Tri-City Medical Center (PDF)New Window
4002 Vista Way, Oceanside 92056, San Diego County - The hospital failed to ensure the health and safety of a patient when the hospital did not follow its policies and procedures for fall prevention. Administrative penalty issued based on findings during a survey completed on 03/03/2009.

University of California San Diego Medical Center (PDF)New Window
200 West Arbor Drive, San Diego 92103-8976, San Diego County - Administrative penalty issued based on finding during a survey completed 11/26/2008.
Penalties Issued in 2008

Grossmont Hospital (PDF)New Window
5555 Grossmont Center Drive, La Mesa 91942, San Diego County - The hospital failed to ensure the health and safety of a patient when they failed to activate a stationary ventilator during a transfer of the patient from a transport ventilator resulting in the patient’s death. Administrative penalty issued based on finding during a survey completed on 4/4/2008.

Palomar Pomerado Health System (PDF)New Window
15615 Pomerado Road, Poway 92064, San Diego County - The hospital failed to maintain its anesthesia equipment in proper functioning order. As a result three patients experienced surgical awareness during surgical procedures. Administrative penalty issued based on finding during a survey completed on 4/3/2008.

Promise Hospital of San Diego (PDF)New Window
5550 University Avenue, San Diego 92105, San Diego County - The hospital failed to ensure the health and safety of its patients by allowing an unlicensed staff person to function as a licensed nurse. Administrative penalty issued based on finding during a survey completed on 5/15/2008.

Scripps Green Hospital (PDF)New Window
10666 North Torrey Pines Road, La Jolla 92037, San Diego County - The hospital failed to ensure the patient safety in the surgical department when a patient fell off an operating table during surgery. Administrative penalty issued based on finding during a survey completed on 4/8/2008.

Scripps Green Hospital (PDF)New Window
10666 North Torrey Pines Road, La Jolla 92037, San Diego County - The hospital failed to implement policies and procedures to provide for effective surgical service infection control. Administrative penalty issued based on finding during a survey completed on 11/27/2007.

Scripps Memorial Hospital (PDF)New Window
9888 Genesee Avenue, La Jolla 92037, San Diego County - The hospital failed to implement policies and procedures related to the safe and accurate use of medications in emergent situations. Administrative penalty issued based on finding during a survey completed 11/27/2007.

Scripps Memorial Hospital (PDF)New Window
9888 Genesee Avenue, La Jolla 92037, San Diego County - The hospital failed to develop and implement policies a procedures to protect patient safety related to the use of controlled substances. Administrative penalty issued based on finding during a survey completed 11/27/2007.

Scripps Memorial Hospital (PDF)New Window
9888 Genesee Avenue, La Jolla 92037, San Diego County - The hospital failed to protect a patient's right to considerate and respectful care. Administrative penalty issued based on finding during a survey completed on 8/30/2007.

University of California, San Diego Medical Center (PDF)New Window
200 West Arbor Drive, San Diego 92103-8976, San Diego County - The hospital failed to develop and implement policies and procedures to protect patient safety by failing to ensure the safe administration of medications. Administrative penalty issued based on finding during a survey completed on 9/18/2007.

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