By Tom Kisken, VENTURA COUNTY STAR
State regulators received more complaints, found more violations and assessed more fines at Los Robles Regional Medical Center in Thousand Oaks than any other hospital in Ventura County last year.
California Department of Public Health records show the for-profit hospital operated by HCA Healthcare violated state regulations 32 times in incidents investigated in 2023. The deficiencies include at least 11 violations of state-mandated staffing ratios for nurses.
Los Robles was fined $25,000 last year for not staffing enough nurses in summer 2022. It faced more than $30,000 in additional fines for two incidents involving surgical materials left inside patients during a cesarean section procedure and exploratory bladder surgery.
The Thousand Oaks facility was the only hospital in the county to be fined by the state public health department last year, according to the records.
The state data show the area’s eight hospitals were targeted in 239 complaints or incident reports filed with the California Department of Public Health by family members of patients, employees and others. Many of the incidents were self-reported by hospitals.
Common issues included lack of care that complaints allege led to dangerous bed sores, record keeping that didn’t follow hospital policies, patients not treated with respect and medication not administered on time.
Less common incidents included massive sewage flooding, employees not following policy in disposing unused fentanyl and an elderly hospital visitor injured by a restroom door that closed too quickly.
Many of the accusations were unfounded, according to state records. But investigators substantiated 80 violations in investigations performed in 2023 though some of the incidents occurred in 2022.
Los Robles, the largest hospital in the county with 325 beds, was the most frequent offender. State public health workers investigated 86 complaints or facility-reported incidents and found 32 deficiencies, compared to 19 violations at Adventist Health Simi Valley and 11 at Community Memorial Hospital – Ventura.
Seven deficiencies were found at St. John’s Regional Medical Center in Oxnard, and the same number was found at Ventura County Medical Center in Ventura.
Violations of state regulations dictating how many patients can be cared for by one nurse were the most common transgression at Los Robles. Staffing shortages in five different units of the hospital contributed to several patients receiving medications as much as two hours late in June. A lack of nurses also factored into complaints about bed sores and a patient being given an incorrect dosage, according to state records.
Other hospitals struggled with staffing, too. Community Memorial Hospital in Ventura fell out of nursing staffing ratios on a shift in January 2023. St. John’s Regional Medical Center didn’t staff enough respiratory therapists on multiple occasions in December 2022.
The state records show workforce shortage problems emerged more often at Los Robles. Investigators said the hospital didn’t have enough nurses for much of June and July in 2022 in shortages that impacted 11 different hospital units. The violations resulted in a $25,000 administrative penalty on the hospital in March 2023.
The accusations are not new. Complaints about staffing violations, insufficient hiring and retention pushed nurses in SEIU Local 121RN to strike for five days over Thanksgiving in a contract dispute. John Dobbert’s family members alleged inadequate staffing contributed to the 79-year-old Simi Valley man’s death at the hospital in 2018. The hospital paid $30.5 million last year to settle a lawsuit filed by the family.
‘Coming out of the ashes’
Hospital officials denied the staffing allegations in the lawsuit and in the contract battle with the nurses union. In a February phone interview, Los Robles Chief Nursing Officer Debora Silva acknowledged the hospital regularly fell out of staffing ratios in the summer of 2022, triggering the state fine. She said factors such as a then high turnover rate of nurses and rising COVID-19 admissions that taxed Los Robles and other hospitals across the county led to staffing issues.
“We do have staffing challenges over the past year. We are not going to deny that,” she said.
But workforce levels have improved dramatically over the last two months as 181 nurses hired last year have finished training and joined the workforce, Silva said. Turnover rate for nurses has dropped to 17% a year and the pipeline of newly trained nurses coming to the hospital out of college is improving.
“We’re coming out of the ashes,” Silva said. She asserted workforce issues have not impacted patient safety.
“We haven’t been able to see a direct relationship between the staffing challenges and harm to our patients,” she said.
Corey Clark, a former Los Robles nurse who now represents the nurses union, SEIU Local 121RN, said in a phone interview the staffing levels contribute to patients getting bed sores because they’re not repositioned often enough, medication mistakes and inattentive care. She said patients sit in their own urine because of the lack of nurses and other caregivers.
“I think you can definitely look at the data and show a routine pattern of behavior,” she said. “It’s unsafe on a day-to-day basis and when a winter surge happens, it gets really, really unsafe.”
A law passed in 2019 mandates the California Department of Public Health fine hospitals that violate the state’s staff ratios from $15,000 to $30,000. Enforcement was relaxed during the COVID-19 pandemic, but state regulators warned hospitals in September they face fines for violations.
The fines haven’t materialized often in Ventura County despite frequent complaints. Only one penalty was levied throughout 2023 for staffing violations in the action that resulted in the fine on Los Robles. Silva said she was surprised only one hospital faced enforcement actions when all were short-handed partly because of the COVID-19 surge.
“It was a struggle that every hospital and every emergency room was going to have,” she said.
State officials declined repeated requests for a phone interview about staffing and other violations recorded by their Center for Health Care Quality on a Cal Health Find website. Instead, in a written response to questions, they noted hospitals are exempt from fines if nursing shortages are uncontrollable and hospitals make immediate efforts to meet requirements even if the efforts fail.
Staffing shortages are not unique to Los Robles or to Ventura County, said Jan Emerson-Shea, spokesperson for the California Hospital Association. Hospitals and other health facilities across the nation struggle with the shortage of workers.
Nurses contend part of the answer to the shortage is enforcing existing law. They say fining hospitals for violations would push them to add more nurses and find ways to keep them.
“I think there are certain for-profit hospitals that only follow the law when their pocketbooks are hit,” Clark said, referring to Los Robles. “What you listen to is losing money.”
Some experts contend $15,000 to $30,000 fines are not nearly high enough to force hospitals to change hiring practices.
Dr. Kevin Kavanagh, board chair of the Health Watch USA patient advocacy program, supports fine systems that reduce the amount of revenue to hospitals, particularly a federal program linked to money from Medicare. He also said public sites that allow consumers to see which hospitals commit violations can help bring change.
“I really think they’re more concerned about the adverse publicity than the actual fine itself,” Kavanagh said.
Hospitals accuse union nurses of using staffing levels as a bargaining chip. Silva said staffing complaints filed by nurses typically increase at the height of contract impasses.
“It’s well known that the nurses’ unions often urge their members to file complaints with CDPH when they are in the midst of contract negotiations with hospitals/systems. That’s one of their tactics,” Emerson-Shea said in an email.
Fentanyl protocols broken at Community Memorial Hospital in Ventura
Several Ventura County hospitals struggled with medication issues last year, according to state records. A patient at Adventist Health Simi Valleywas given two doses of the blood thinner Lovenox two hours apart instead of 12 hours apart in March 2023. The 81-year-old patient died 18 hours after the mistake.
Regulators initially ruled the hospital’s actions placed the patient in “immediate jeopardy” in a penalty that usually carries a fine of at least $25,000. The penalty was rescinded because the hospital reported the error and took immediate corrective action, according to Adventist Health Simi Valley leaders.
Community Memorial in Ventura was found deficient in seven incidents involving medication investigated during 2023. In one case, nurses broke protocols in using a fentanyl medication dispenser, regulators said. In another incident, dosages of the opioid oxycodone were left at a patient’s bedside in a drawer. In a third instance, pharmacy staff broke protocols by not conducting a manual count of fentanyl vials but instead used post-it notes as a calculating tool.
Regulators said the lapses increase the potential of the drugs being used by people other than patients.
Community Memorials officials didn’t respond directly to repeated questions about the medication deficiencies but said every violation is thoroughly investigated by the hospital. Changes are made so mistakes are not repeated.
“We have developed a pro-active culture to identify potential problems and implement sustainable changes to address the root causes,” spokesperson Jamie Maites said in a written statement.
Watchdog agencies said medication incidents emerge often at hospitals nationwide. Kavanagh said the mistakes were caused by on human error, inadequate training and staffing levels.
“There’s enough nurses to work in hospitals,” he said. “There are not enough nurses that want to work in (hospitals).”
State records show 43 complaints or incident reports investigated during 2023 at Community Memorial Hospital. Maites said hospital records show only 25 complaints and noted that many of the incidents were reported to regulators by the hospital.
Like other hospitals, Community Memorial also responded to questions about state violations by citing high marks received in other assessments. The hospital received the highest ranking possible — five out of five stars ― from the Centers for Medicare & Medicaid Services. The rating includes patient safety, repeated admissions and care for conditions like heart attacks and pneumonia.
Plugged sewage pipes at Los Robles Regional Medical Center
Some of the hospital deficiencies across Ventura County revolve around mechanical issues. In March 2023, regulators said a restroom was clogged in a patient’s room on the third floor at Los Robles. Efforts to unplug it caused toilets to overflow in the main lobby, flooding the gift shop, an area behind the information desk and a space near the elevators.
A spouse of a patient reported the flooding and said the water was up to her ankles and darkened by feces.
“I have been doing this job for 15 to 16 years and have never seen this happen before,” a hospital environmental services employee said in the state’s investigative report.
Hospital officials emphasized the flooding happened in the lobby area and not on patient care floors.
“Our team responded as quickly as possible to the incident, following proper sanitization protocols,” spokesperson Megan Merino said. “There was no patient harm.”
Investigators said the hospital violated state regulations by not reporting the incident. State records state Adventist Health Simi Valley also didn’t report two separate sewage floods in the hospital’s kitchen in April 2023. Inspectors said the sewage exposure could have contaminated food.
“This was not a reflection of quality of care,” spokeswoman Meena Ahmadzai said of the incident. “Our patients are our families and friends, and we take our commitment to them very seriously.”
Los Robles was fined twice last year over allegations of lapses in which surgical objects were left in patients during surgery. State reports show a small wire used to monitor a fetus’s health was left inside a woman during a C-section in January 2023. The incision was reopened and the coil was removed. The hospital was fined $18,020.
The second fine, came several months after a surgical sponge was left in a patient during a July 2022 surgery. The patient went through a second surgery so the object could be removed. The hospital was fined $12,000.
Silva said she couldn’t discuss the two cases because of patient confidentiality laws. In such cases, hospitals are required to take corrective actions to reduce the chances of such incidents happening again.
Los Robles praised in assessments
Hospital leaders said their facilities shouldn’t be judged based solely on California Department of Public Health reports. Silva of Los Robles said the number of complaints is impacted by the size of the hospital, the number of patients receiving care and the status of union negotiations.
She cited the hospital’s streak of 11 “A” grades from the nonprofit patient safety organization, the Leapfrog Group. The hospital has also been named one of the nation’s best 250 hospitals by the Healthgrades rating system.
“I think it’s excellent,” she said of the quality of the care, noting she has been a patient at the hospital herself. “I would be very, very comfortable having any of my family members receive care here at Los Robles.”
Shea-Emerson voiced similar concerns about the state data.
“You cannot make any assumptions about the quality of care based solely on enforcement actions by the (California Department of Public Health),” she said. “Again, an enforcement action may be for something as minor as a paperwork error.“
Watchdogs said the records serve as a warning flag. Michelle Monserratt-Ramos is a patient safety advocate for the nonprofit Consumer Watchdog organization. She advises patients to investigate hospital violations found by the California Department of Public Health as a way to protect themselves.
Ask her if she would go to a hospital with more complaints, deficiencies and enforcement actions than other hospitals and her answer is immediate.
“Absolutely not,” she said.
Tom Kisken covers health care and other news for the Ventura County Star. Reach him at [email protected].
