Patient's death puts Inland hospital under scrutiny10:00 PM PDT on Wednesday, May 27, 2009
By LORA HINES
The Press-Enterprise
A Perris hospital faces a second inspection that could lead to stricter federal oversight and the possible loss of a major source of income because of a 2008 patient death investigation.
Violations at Vista Hospital of Riverside included doctors' delayed response or unresponsiveness to life-threatening emergencies, inadequate infection control and failure to dispense and track medicines, according to a state investigation report.
The hospital filed a correction plan, which state regulators have approved, that includes improved staffing, training, oversight and quality control. It also hired a new chief executive officer, chief nursing officer, nurse manager and clinical educator.
The Centers for Medicare & Medicaid Services, the federal agency that regulates health care facilities, warned Vista Hospital of Riverside in a February letter that it risked losing Medicare funding, the source of most of its money, according to state records.
The 40-bed hospital could soon face a federal follow-up inspection to determine whether the facility complies with federal and state patient care regulations.
Most hospitals heavily rely on Medicare funds to operate. Few lose funding because Medicare & Medicaid doesn't want to put them out of business.
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Mark Zaleski / The Press-Enterprise
Robert Buffa, of Lake Elsinore, holds a picture of his mother, Shirley, who died in May 2008, 11 days after she was sent to Vista Hospital of Riverside, in Perris, to recover from a heart infection. Also shown is Buffa's daughter Madison, 8.
Martin Luther King Jr.-Harbor Hospital in Los Angeles was the most recent hospital in the state to lose funding and close, in 2007. The process took more than four years and culminated with the death of a woman on the floor in the emergency department.
No one from, or representing, Vista Healthcare returned telephone calls for this story.
Ralph Montano, spokesman for the California Department of Public Health, said his agency is not taking action to suspend or revoke Vista Hospital's license.
Vista Healthcare's four hospitals are specialty facilities that treat critically ill patients who need longer-term care than most hospitals can provide. Its facilities accept patients who suffer from chronic illnesses, such as cardiac conditions, organ failure, post-operation complications and gastrointestinal disease. Doctors, case managers, hospital discharge planners and family members refer patients to Vista Healthcare hospitals.
Investigation launched
The investigation was launched after a Lake Elsinore man reported to regulators that his mother, a patient at the hospital, had not received dialysis in five days, which the facility was supposed to provide three times a week. Robert Buffa's 78-year-old mother, Shirley, died 11 days after she was sent to Vista Hospital of Riverside to recover from a heart infection.
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Mark Zaleski / The Press-Enterprise
An investigation report states that Shirley Buffa, who was admitted to Vista Hospital of Riverside on May 16, 2008, suffering from renal disease, hypertension, heart disease and diabetes, didn't get dialysis or prescribed medicine.
The investigation report states that Shirley Buffa, who was admitted to the hospital on May 16, 2008, didn't get dialysis or prescribed medicine. On May 26, 2008, a doctor failed to respond to a call for help when Shirley Buffa's heart rate became dangerously low, the report states.
Robert Buffa has sued Rancho Cucamonga-based Vista Healthcare LLC, which owns Vista Hospital of Riverside, and his mother's doctor for negligence, reckless neglect, willful misconduct, statutory elder neglect and wrongful death. The lawsuit was filed April 15, 2009, in Riverside County Superior Court.
Robert Buffa said his mother, who had renal disease, hypertension, heart disease and diabetes, was transferred to the facility because it offered on-site dialysis, which she had been getting three times a week for at least a year. She was to return to a Corona nursing home, where she had been living, in two weeks, Robert Buffa said.
But Shirley Buffa's health deteriorated days after she arrived at Vista Hospital, her son said. Facility officials first blamed antibiotics for her worsening condition, said Robert Buffa's wife, Brenda, who is a nurse. Hospital administrators said they had erred after he asked about his mother's dialysis schedule almost a week after she was admitted, Robert Buffa said.
"At that point, she couldn't even talk," Robert Buffa said. "I said, 'Mom, I love you. How come you can't open your eyes?' "
Hospital officials then gave Shirley Buffa dialysis three days in a row, which caused more harm and put her in intensive care, Brenda Buffa said. The couple recently received a $350 bill from a doctor at Vista Hospital.
"All of this doesn't seem real," Robert Buffa said as he sobbed. "People tell me that it's not my fault. She didn't deserve that."
Follow-up Inspection
Jack Cheevers, spokesman for Medicare & Medicaid's regional office in San Francisco, said this week that inspectors hadn't yet conducted a follow-up inspection at Vista Hospital of Riverside. Typically, inspectors return to hospitals within 90 days after they have been warned about losing their Medicare funding, he said.
Hospitals that fail to improve then are given a deadline when Medicare funding will end, Cheevers said. Most can't survive without the money, he said.
"For most hospitals, most of the funding is from the government, about 50 percent is just from Medicare," Cheevers said.
Poor-performing hospitals are inspected several times and may have to modify correction plans. It's a lengthy process, in some cases lasting many years, because hospitals almost always close as a result of losing Medicare funding, Cheevers said.
"The goal is not to strip them of that money," he said. "We want to make sure they are taking care of Medicare beneficiaries."
Jim Lott, executive vice president of the Hospital Association of Southern California, said Medicare & Medicaid doesn't threaten to cut funds for frivolous reasons. Patients usually are at risk.
"The question has to be whether any of the violations cited are creating immediate jeopardy to patients," he said.
Hospital violations
According to a 199-page report, state inspectors found violations at Vista Hospital of Riverside, including:
Delayed response or unresponsiveness to life-threatening emergencies
Improper writing of a patient's "do not resuscitate" order
Failure to track medical errors
Failure to dispense and track medicines
Inadequate infection control
An inadequately staffed intensive-care unit
More intensive-care patients than the hospital's license allowed
Use of improperly serviced medical equipment
Conversion of a trailer for medical use without state approval
http://www.pe.com/localnews/inland/stories/PE_News_Local_S_certification28.498dec6.html#
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