Professional Documents
Culture Documents
Initial Questions 1. Does the LA County DHS conduct its own investigations of immediate jeopardies at countyrun facilities, such as the death of Patient A and the surgical complications involving Patient B, as detailed in the Sept. 13, 2011, CMS 2567 inspection report? Each facility conducts its own internal patient safety investigations, which are shared with DHS leadership. 2. If so, are those investigations complete, and can I get copies? These investigation reports, which are part of Harbor-UCLAs internal patient safety process, are not public documents. The protections provided to these reports encourage providers to communicate openly so that issues can be identified in a nonjudgmental manner and improvements can be made. At Harbor-UCLA we understand the importance of open communication and transparency. Positive changes have been observed by hospitals that have adopted a culture of open, honest and professional communication after unanticipated outcomes occur. If we dont know about things that are going on -- not only adverse events, but also near-misses and unsafe conditions -- we cant solve them. 3. Does the department have guidelines on the care of a psychiatric patient who declines liquid and food, as per the account of Patient A in the Sept. 13, 2011, report? Each DHS hospital that cares for psychiatric patients has a policy for patients that refuse food and fluids. 4. Finally, has the departments Chief Medical Officer been meeting monthly or more with Harbor-UCLA officials to review and discuss issues including patient safety, quality improvement, and other issues, as stated in Harbor-UCLAs plan of correction issued in response to the Sept. 13, 2011, inspection? (This involvement of the CMO is mentioned on p. 15 and elsewhere in the correction plan.) Yes. General Questions 1. How many Harbor-UCLA beds are now licensed, and how many of those are now in use? The hospital is licensed for 538 beds, and is budgeted for 373 beds. 2. How many beds were in use in the psychiatric unit in July 2011? Harbor has 2 inpatient psychiatric units -- 8-West has 24 Beds, 1-South has 14 beds. 3. Is the psychiatric unit contained in the existing Harbor-UCLA building, or is it a satellite facility on the campus? Harbor has 2 inpatient psychiatric units -- 8 West is in the main hospital; 1-South is in a building immediately adjacent to the main hospital. 4. Has medical and nursing staff been reduced at Harbor-UCLA in general and in the psych unit specifically in the past five years? Or have staffing levels remained even or risen? Generally speaking, medical and nursing staffing has increased.
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By April 2007, Harbor-UCLAs census had dropped to 328 and reverted to previous levels. 7. What is the current status of CMO Dr. Gail V. Anderson Jr., who, according to news reports, was placed on leave in August 2011 during an investigation? Is he still on staff? This is a personnel issue, which precludes comment. Has the investigation been completed? This is a personnel issue, which precludes comment. Does the hospital have a new, permanent, CMO, and, if so, whom? Dr. Hal F. Yee, Jr., MD, PhD, is the Acting Chief Medical Officer. Patient A 1. The 2567 report says that Patient A came to Harbor-UCLA via the psychiatric ER on 7/9/11. Was Patient A admitted to the psychiatric unit, and, if so, did the patient remain there until being transferred to the ICU on 7/25/2011? Yes. 2. If so, did the psychiatric unit at the time have a policy specifically addressing how to treat a patient refusing food or drink, lab work and vital signs? Yes, the hospital had policies in place. As a result of our patient safety review of this incident, Harbor-UCLA has strengthened several existing policies, and developed and implemented an additional policy. The net result of these improvements has been establishment of a standardized process for clinicians to take specific patient safety actions at specific timeframes. Under this standardized process, if a patient refuses to eat for more than 5 days without other means of nutrition support or refuses to drink for more than 2 days without receiving IV or enteral fluids, the following actions will occur: A Registered Dietitian will perform a nutrition assessment/consultation. Page 2
3. If so, did that policy make clear the point in time at which steps would be taken to provide food or drink? Or was that dealt with on a case-by-case basis? The existing policies dealt with such situations on a case-by-case basis. As a result of our robust patient safety review of this case, the hospital has now implemented a standardized process for clinicians to take specific actions at specific timeframes. As noted above, under this standardized process, if a patient refuses to eat for more than 5 days without other means of nutrition support or refuses to drink for more than 2 days without receiving IV or enteral fluids, the following actions will occur: A Registered Dietitian will perform a nutrition assessment/consultation. Internal Medicine will perform an assessment/consultation. Based on the results of this assessment/consultation, If the patients medical status is potentially life threatening and the patient lacks capacity to give informed consent for treatment, appropriate medical action will be taken to prevent harm to the patient. If the patients medical status is not life threatening, an examination for capacity to give informed consent for treatment will take place and appropriate actions will be taken. 4. Why was Patient A not assessed by an internal medicine physician? At the time, were Harbor-UCLA psychiatric patients normally get assessed by internists? All Psychiatric patients who are admitted undergo an initial physical evaluation as part of their initial evaluation, unless they refuse it, which is a patients right. If a psychiatric patient refuses the physical exam, repeated attempts are made to obtain the patients consent. As noted above, based on our now-standardized process, if a patient refuses to eat for more than 5 days without other means of nutrition support or refuses to drink for more than 2 days without receiving IV or enteral fluids, the following actions will occur: A Registered Dietitian will perform a nutrition assessment/consultation. Internal Medicine will perform an assessment/consultation. Based on the results of this assessment/consultation, If the patients medical status is potentially life threatening and the patient lacks capacity to give informed consent for treatment, appropriate medical action will be taken to prevent harm to the patient. If the patients medical status is not life threatening, an examination for capacity to give informed consent for treatment will take place and appropriate actions will be taken.
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