September 17, 2008
Discrepancies Found in L.A. County Hospital Audit
By Melissa Evans
Frustrated and angry, county leaders told health department officials Tuesday they want a clearer plan and faster progress in ensuring that nurses are competent at all public hospitals and that employees with criminal backgrounds are weeded out.
The contentious meeting of the Los Angeles County Board of Supervisors focused on an auditor's report released last week that showed nurses are working despite their failure to pass basic skills tests. In some cases, they'd been given four chances to pass.
"Something is wrong with somebody who takes three or four times to pass these basic skills exams," said Supervisor Gloria Molina, who lashed out repeatedly at health officials. "I don't know what's reasonable, but I know what's unreasonable - to keep somebody on board after they failed a test three times. Where are these individuals?"
It's a question county staff, including Nursing Affairs Director Vivian Branchick, couldn't fully answer. Though most of the problems have centered on Martin Luther King Jr.-Harbor Hospital in Willowbrook, there is concern that these employees are being transferred elsewhere, including County Harbor-UCLA Medical Center near Torrance.
The report also showed that nearly 100 employees had been working despite having criminal offenses on their records, and that some of them lied about it. The board pressed officials about why these people hadn't been fired for falsifying their employment applications.
Harbor-UCLA played a significant role in the auditor's report; the hospital tested many of the nurses in question, and has assisted King-Harbor in dealing with some of its personnel issues. King- Harbor closed its inpatient and emergency services a year ago due to severe lapses in care, but still functions as an ambulatory care facility.
Branchick and John Schunhoff, interim director of the Department of Health Services, agreed with all of the auditor's conclusions and recommendations. They presented the board with a list of actions they would take, along with timelines to fix the problems.
Board members, however, were angry that it will take until the end of October to screen all nurses at King-Harbor, and up to a year to develop systemwide standards and the retesting of nurses at all four county hospitals.
"These are kind of obvious questions that should have been asked a year ago," said Supervisor Zev Yaroslavsky, referring to the training and screening of personnel. "None of us are medical professionals, but they are certainly common-sense questions to us."
The auditors found serious discrepancies in the competency of staff among different hospitals. Nurses at King-Harbor had serious problems passing basic-skills tests, while facilities such as Harbor- UCLA had no nurses on staff who hadn't passed.
"There should be a consistent standard and set of expectations for all of the nurses at our facilities," said Supervisor Don Knabe, who represents the coastal South Bay.
Health officials also promised to screen 81 employees with incomplete background checks, assign a team to reassess the employment of 99 workers who have criminal offenses in their background, and evaluate the actions of managers who looked past these infractions or didn't catch them.
Supervisors, unconvinced that staff in the health department can handle these internal tasks alone, also voted to hire an independent watchdog to conduct periodic reviews of personnel issues and the overall management of the department.
Los Angeles County Chief Executive Officer William Fujioka will craft a description of what this person will do, and bring it back to the board for approval in the next few weeks.
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