Did State Examiners Look the Other Way at Edgemoor Hospital?

Private nursing home administrators and other critics have charged that for years the state Department of Health Services virtually ignored widespread abuses at Edgemoor Geriatric Hospital.

From 1982 to 1984, Edgemoor sailed through state licensing inspections with only two serious code violations and no fines, records show.

But during the first four months of this year the state slapped the San Diego County-run nursing facility in Santee with four Class A citations and $13,000 in penalties. Among the problems uncovered at Edgemoor this year were two patient deaths due to negligent care and the use of strong-arm tactics by staff members on one patient.

“The problems at Edgemoor didn’t happen overnight,” said Michael Ellentuck, vice president of the San Diego Health Assn. “The same problems that were there five years ago are still there now. The state wasn’t doing its job . . . The conditions were horrid. I don’t understand why (Edgemoor) was allowed to continue to operate.”

Linda Higgins, chief executive officer of Sharp Knollwood Convalescent Hospital in San Diego and a member of the Edgemoor Professional Review Committee, said, “I know they just weren’t treating Edgemoor the same way they were other private nursing homes. We would have been shut down a long time ago.”

Edgemoor’s acting administrator, Paul B. Simms, defended the state’s monitoring efforts, saying that annual inspections focus on minor deficiencies, not major citations.

“Whoever thinks the grass is greener on the public side of licensing got here last night,” Simms said. “(The state) has been doing their job the last five years. No question. They’re just doing more of it now.”

Last year, the state’s annual licensing inspection found 134 minor deficiencies at Edgemoor, including improper handling and storage of drugs, failure to notify physicians of sudden changes in the condition of patients and kitchen areas infested with rodents, cockroaches and flies.

But only two of the problems were written up as minor Class B citations and resulted in one $250 fine.

Assemblyman Larry Stirling (R-San Diego), who earlier this year called for a state investigation into the use of state money by Edgemoor administrators, said he recently confronted officials at the state health department’s licensing office in San Diego County about Edgemoor’s past.

“I asked them, ‘How in the hell did you allow (Edgemoor) to get into this mess?’ ” Stirling recalled. “They explained that they were new and they were as appalled as I was.”

State investigators have spent the last week conducting an inspection at Edgemoor. The 323-bed Santee hospital, which cares for the elderly, disabled and mentally disturbed, could lose its $8 million in Medi-Cal and MediCare funding by the end of the month if the state determines that the hospital has not improved conditions there.

Ernest Trujillo, head of the state licensing division in San Diego, was unwilling to comment on the enforcement effort at Edgemoor before this year. Trujillo was transferred to the San Deigo district from Sacramento in January.

“I can’t explain what happened before,” Trujillo said. “I presume they took what actions they felt were necessary.”

Trujillo’s predecessor, P.A. Alvarez, who now supervises the state’s Sacramento district office, agreed that Edgemoor has long been beset with problems.

“I always thought that (Edgemoor) was a marginal facility in the sense it was so big and it was county-operated and it was continually having problems with staffing,” Alvarez said. “We had problems before there, but never in the magnitude of closing the facility.”

Alvarez said he could not pinpoint the reasons for the hefty increase in Class A, or serious, citations issued against Edgemoor this year compared to past years.

“I don’t have an answer,” Alvarez said. “I don’t feel it was because of the fact that we were not actively enforcing the regulations. It’s just that things change from day to day.”

One of those changes has been in the attitude of state health officials whose inspectors, armed with reform legislation, a new breed of aggressive investigators and surprise inspections, have written nearly twice as many major citations this year against California nursing homes than the number issued in all of 1984.

Inspectors at the San Diego district issued 7 Class A citations and 31 Class B citations between January and May, compared to 4 Class A and 16 Class B citations during the same period last year.

While those statistics match similar increases that have been recorded statewide, they do not come close to the startling turnaround at Edgemoor.

Since Jan. 1, Edgemoor has received four Class A citations for a total of $11,500 in fines. The hospital was cited for:

- Failing to diagnose the deteriorating condition of an 82-year-old man who had both legs amputated below the knee. Even though the patient had become “disoriented, lethargic and confused,” according to hospital records, nurses failed to use bed rails and other devices ordered by a physician. The man was found on the floor next to his bed and died two days later.

- Leaving a 66-year-old woman who legs were paralyzed unattended in a tub of water, in which she drowned.

- Giving penicillin to a patient whose health records indicated he was allergic to it. Pharmaceutical consultant William Murray wrote in his report that there was “substantial probability that death or serious physical harm would result” from the dosage.

- Roughing up a patient who fell asleep and began snoring during a group session. Two staff members grabbed and shook the man, causing him to suffer a dislocated left shoulder and fractured upper arm.

In the past three years, Edgemoor was handed two Class A violations--for not treating a patient with a gangrenous foot, and failing to care for a man who choked to death on a mouthful of food. One citation was dismissed and the other has not yet been filed in Superior Court.

Edgemoor was issued four minor Class B citations in 1982, none in 1983, five last year and six through the first four months of this year.

In the past, state officials have been reluctant to crack down on nursing homes run by county officials for fear of creating friction between two government agencies, critics charged.

“The way they treat the private entrepreneurs and the public agencies are worlds apart,” Stirling said.

The administrator of one private nursing home in San Diego said that state inspectors cited his facility two years ago for mishandling patient trust funds. Investigators last year found the same violation at Edgemoor but did not issue a citation, said the administrator, who asked not to be identified.

In addition, state officials in the health department’s legal office dismissed a $5,000 Class A citation against Edgemoor in 1982 because they “did not wish to pursue the citation for a county facility,” said Alvarez, the former chief of the San Diego licensing office.

Trujillo flatly denied that state licensing officials are tougher on private nursing homes than on county facilities such as Edgemoor.

“I take exception to that,” Trujillo said. “I’d like to have them come forward with those allegations.”

The outcome of last week’s survey by state inspectors is expected to determine whether Edgemoor will keep an estimated $8 million of its $9.8-million annual budget. If Edgemoor does not pass the inspection and loses its money, county officials have indicated that they plan to close the facility.

The inspection is expected to be completed later this week, Trujillo said.

James Forde, director of the county Department of Health Services, recently sent a letter to 75 area nursing homes asking them to take Edgemoor’s patients if the facility loses its funds.

The letter angered private nursing home administrators, who said they have tried to provide suggestions to help turn Edgemoor around, but have been ignored. Now, the administrators are being informed that they may have to take Edgemoor’s patients.

San Diego County’s elderly patients will suffer if Edgemoor’s doors are closed, said Ed Maguire, a hospital administrator and chairman of the Edgemoor Professional Review Committee.

“I’m pleased at what’s happening at Edgemoor,” Maguire said. “Things have improved dramatically. Edgemoor is on its way to becoming a good institution, and it’s going to get even better.”

HISTORY OF EDGEMOOR CITATIONS Chart shows rise in serious citations issued to Edgemoor in ’85

YEAR CLASS A (SERIOUS) CITATIONS OUTCOME 1982 Patient died choking on food Dismissed 1983 None 1984 Failed to treat patient’s gangrenous foot Complaint not yet filed 1985 Gave penicillin to allergic patient $5,000 fine Legless patient fell on floor and died $3,000 fine Paralyzed patient left unattended in bathtub and died $1,000 fine