CA hospital closed by state

  1. Anybody know what sort of surgeries this place did? I'd never heard of it.

    State shuts Inland hospital

    HEALTH: "I've never seen anything quite this dysfunctional," a regulator says.

    11:35 PM PDT on Monday, May 24, 2004

    By DOUGLAS E. BEEMAN / The Press-Enterprise
    Angels hospital

    The medical center in

    Rancho Cucamonga


    elective surgeries

    no emergency room

    At least 4 patients died from March 12 to April 24.

    In a rare move, state regulators shut down a Rancho Cucamonga hospital, claiming staff deprived patients of nourishment, failed to change respiratory equipment until it was visibly filthy and relied on paramedics to resuscitate heart patients.

    "I've never seen anything quite this dysfunctional," said Brenda Klutz, deputy director of the state Department of Health Services, which regulates hospitals.

    State regulators typically give hospitals time to correct problems and rarely even come close to shutting down a facility. Klutz said this is the first time in her 12 years as deputy director that she has signed a temporary hospital suspension order to close a facility.

    State health department regulators responded earlier this month to a series of complaints from current and former staff and patients' families and found patient care at Angels Hospital in such disarray that within 12 hours they ordered the hospital to transfer its six patients elsewhere. The hospital is licensed for 55 beds.

    Doctor faces probe

    In addition, state officials have referred one physician to the state medical board for possible disciplinary action, and several more referrals may follow, Klutz said. Several nurses also may be referred for disciplinary review to the Board of Registered Nursing, she said.

    Stan Lim / The Press-Enterprise
    State health department have shut down Angels Hospital in Rancho Cucamonga, accusing the hospital of failing to provide adequate care.

    Hospital representatives could not be reached for comment. An attorney representing the hospital, Jodi Berlin, declined to comment.

    Angels Hospital, at 10841 White Oak Ave., opened about a year ago in a facility once occupied by bankrupt Heritage Hospital. Angels Hospital had no emergency room. Most of its patients were there for elective surgeries performed by surgeons with privileges at the hospital, Klutz said.

    After the May 7 inspection, state inspectors returned the next day and prohibited the hospital from accepting any more patients or performing surgeries until regulators could complete their investigation, Klutz said. Although the state investigation continues, regulators are now pressing to revoke the hospital's license.

    At least four patients died between March 12 and April 24, although state officials declined to say whether the deaths were directly related to neglect or to other causes.

    According to the state's administrative accusation against Angels Hospital and its officers:

    A notice of the closing is posted on the door of Angels Hospital. State officials referred one physician to the state medical board for possible discipline, and several more referrals may follow, a regulator said.

    On at least three occasions hospital staff called in paramedics to handle medical emergencies because no doctor was available. In one case, hospital staff called upon paramedics to place a breathing tube in a patient when they couldn't do it themselves. Two of the patients died.

    The hospital ran short of the amino acid liquid nutrition at least two patients needed to help their bodies repair damaged tissue. One patient was given too little or none of the liquid nutrition, resulting in "severely low" serum and blood proteins that put the patient at risk for infections, starvation, further illness or death, according to the state's accusation.

    The other patient also had low serum and blood protein levels. But instead of increasing the patient's liquid amino acid nutrition, a pharmacist on March 11 ordered a decrease in nutrition. About two weeks later, the patient died.

    The hospital was supposed to change ventilator tubing every two days to minimize the risk of bacterial infections in patients. Due to budget constraints in March, the hospital changed ventilator tubes only when they were visibly soiled, according to the state's accusation. One patient whose tubing was changed only twice in one month died at the hospital March 26 of heart and lung arrest, widespread bleeding and infection and pneumonia, according to the state report.

    Cardiac telemetry machines designed to monitor for potentially fatal heart disruptions were left unmonitored for three hours on March 21. In addition, the sound alarms on the machines were turned down so low they could not be heard throughout the unit, according to the accusation.

    One medical record said a patient died at 2 p.m. April 24, but a different record said the patient was still alive and being given heart drugs nearly two hours later.

    The hospital also shorted patients' medicines and failed to follow doctors' orders for consultations with other specialty physicians.

    Basic safety problems

    "There were clear cases of incompetency," Klutz said. "You don't turn off the alarm on a telemetry monitor while you are away from the unit for two to three hours."

    Inspectors also found basic safety problems, such as staff spread too thin or unqualified to perform their assigned duties. One nurse, for example, was assigned to the telemetry unit, the operating room and the post-operative unit all at the same time, Klutz said. "That's not safe."

    The hospital is owned by Angels Medical Center Inc., whose primary owner is Marylou Fernando of Rancho Palos Verde, according to state hospital licensing records. She could not be reached for comment.

    Klutz said she didn't know whether any of the actions by the hospital's staff or owners amounted to criminal actions.

    "Once we have all the paperwork together, we will be turning it over to the people who can make that determination," she said.

    Reach Douglas E. Beeman at (909) 368-9549 or
  2. 6 Comments

  3. by   traumaRUs
    That seems like a bizarre story. Which hospital was closed: Cucamonga or Angels, what is "liquid nitrogen amino accids"? This story has a lot of wholes in it. Whats the source?
  4. by   SmilingBluEyes
    I somehow think there is more to the story. or perhaps some sort of urban legend. it just does not make sense.
  5. by   jemb
    nope, not an urban legend. it was angels hospital in rancho cucamonga (locally called cucamonga). there was a follow up in today's press enterprise, also, which is where the original article was printed.

    as far as the liquid nitrogen amino acids--things like that i just chalk up to the reporter, or the person he spoke who gave hime the info, not completely understanding what they are trying to say. that happens a lot in news reports.

    this occurred earlier this month. from the story as printed:

    angels hospital, at 10841 white oak ave., opened about a year ago in a facility once occupied by bankrupt heritage hospital. angels hospital had no emergency room. most of its patients were there for elective surgeries performed by surgeons with privileges at the hospital, klutz said.

    after the may 7 inspection, state inspectors returned the next day and prohibited the hospital from accepting any more patients or performing surgeries until regulators could complete their investigation, klutz said. although the state investigation continues, regulators are now pressing to revoke the hospital's license.
  6. by   Gomer
    Article about the closure in the "LA TIMES" today.

    Also, I heard on our local news last night that a hospital in Monrova (sorry, didn't get the name) just northeast of LA is closing. Staff haven't been paid in weeks.
  7. by   SmilingBluEyes
    just sickening.
  8. by   jemb
    Here's the LA Times article. It has better details about some of the outrageous incidents. I'm wondering what nurse would have been willing to work there. It will be interesting to see if the BRN takes any disciplionary action with any of the nurses involved.

    Hospital Called Faulty, Shut Down
    In a rare move, the state immediately closes Angels Hospital in Rancho Cucamonga, alleging undue patient deaths and inept care.
    By Janet Wilson
    Times Staff Writer

    May 26, 2004

    State regulators shut down a Rancho Cucamonga hospital this month, where at least three patients died after they allegedly received inept and inadequate medical care, including use of contaminated equipment to cut costs and failure to provide life-sustaining nutrition to a seriously ill patient.

    At least twice, Angels Hospital — a small, acute-care facility — failed to have a doctor available for emergencies, and hospital staffers were forced to summon paramedics by calling 911, according to the California Department of Health Services. In each of the two cases, the patient died.

    "The systems of care, the nursing services, infection control, pharmacy services … I can't speculate as to the reason, but the net effect is the systems were not functioning," said Brenda Klutz, deputy director of the state health agency. "I mean here's an acute-care hospital that's calling 911."

    Only in extremely rare occasions has the state ordered the immediate closure of a hospital.

    Angels Hospital opened just last year after new owners bought out the vacant, bankrupt Heritage Hospital, a 55-bed facility. The hospital has no emergency room and when closed this month had only six inpatients.

    On May 7, after state inspectors toured the hospital and reviewed records, Klutz ordered the inpatients to be moved elsewhere within hours and ordered administrators to halt all surgeries.

    State inspectors also found that, at least once, hospital staffers turned down sound alarms on cardiac telemetry machines — "so low they could not be heard throughout the unit" — and staffers were not monitoring the machines, designed to detect "potentially fatal" cardiac arrests.

    "It's just an extremely dangerous practice," said Klutz. "It's not safe. It's not sound medical practice. It's just dangerous."

    The investigation into the deaths and other missteps could lead to criminal charges, Klutz said. Regulators also referred one doctor at the hospital to the Medical Board of California for possible disciplinary action.

    The licensed owner of Angels Hospital, Marylou Fernando of Rancho Palos Verdes, could not be reached for comment.

    A former chief executive officer of Angels Hospital, Larry R. McFarland, said Tuesday that he quit in March — before the patient deaths — because of some "fundamental disagreements with the owner" and said he had no authority over the hospital's finances.

    "It was just a situation where we decided to part," McFarland said, declining to elaborate. "We had a difference in philosophy."

    On May 12, Klutz signed a temporary suspension order to close the facility and ordered it to stop submitting claims for Medicare and Medi-Cal payments.

    Klutz said that, in her 12 years with the department, she had never issued an order to immediately close a hospital. Regulators often give hospitals time to correct problems, and rarely is a facility shut down.

    "It's an extreme situation," Klutz said. She said her staff responded after receiving complaints from current and former hospital staffers, and a family member of a patient who died. "We decided we needed to act very quickly."

    Officials with a national hospital healthcare group agreed that the action was unusual.

    "I've never heard of it happening," said Jonathan Small, spokesman with the Institute for Healthcare Improvement, a Boston-based organization that has worked with hundreds of hospitals nationally to improve medical care.

    Angels Hospital provided surgeries and other procedures that required acute, overnight hospital care, Klutz said.

    Inspectors said they found numerous unsafe practices, which in some cases preceded a patient's death:

    • On March 12, a patient suffered a "code blue" serious medical emergency at 7:05 a.m. No doctor was on duty, and no effort was made to contact one. Staffers called 911, but paramedics could not revive the patient, who was declared dead 40 minutes later.

    • On March 21, a second patient went into "code blue" emergency status at 11:30 p.m., not breathing and with low blood pressure. An unqualified "respiratory care practitioner" tried unsuccessfully to insert a breathing tube in the patient. An hour later, paramedics arrived and inserted the tube. Fifteen minutes later, the patient was pronounced dead.

    • Another patient died March 26 of heart and lung arrest, infection, bleeding and pneumonia. Klutz said hospital records showed that although hospital policy was to change ventilator tubing every 48 hours for sanitary reasons, the hospital changed tubing that month only when it was visibly soiled, because of budget constraints. In a period of more than a month, the patient's tubing was changed just twice.

    Laboratory tests for the same patient showed reduced serum and blood protein levels on March 11, but a "pharmacist wrote an order to decrease the amount or percentage of amino acids … to correct the condition. There was no documented rationale for the decrease," according to the hospital license suspension order.

    • On April 24, hospital records indicated, another patient had been pronounced dead at 2 p.m. But another notation, at 3:45 p.m., stated that the patient had become nonresponsive, and that drugs were being administered.

    Klutz's report stated that the hospital had no registered pharmacist and that medications ordered by doctors were not always obtained and administered to patients.

    Regulators expect to finish a formal investigation this week, which also will be forwarded to federal Medicare and Medicaid regulators.

    Klutz said a state hearing would be scheduled before an administrative law judge, who will determine whether the hospital should be permanently closed. The findings may also be forwarded to local law enforcement or the state attorney general for possible criminal prosecution.

    McFarland said that after Fernando bought the hospital, her husband, Rolando Fernando, helped with administrative duties. He was named in published reports as a co-owner of the hospital with his wife but is not officially listed as an owner and was not listed in the state regulatory accusation.

    Rolando Fernando surrendered his physician and surgeon license Sept. 1 after the Medical Board of California formally accused him of negligent care of cosmetic surgery patients, insurance fraud and falsely stating that a patient needed tumors removed.

    Neither Rolando Fernando nor his attorney in the proceedings, Donald B. Marks, could be reached Tuesday for comment.


    Times staff writers Wendy Thermos and Hugo Martín contributed to this report.