Grossmont Hospital board: Should have been notified of problems

Union Tribune (2008-06-30) Anne Krueger

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By Anne Krueger

UNION-TRIBUNE STAFF WRITER

9:17 p.m. July 30, 2008 LA MESA – Board members of the public district that oversees Sharp Grossmont Hospital said Wednesday they should have been notified of serious patient-care and management problems that could lead to the loss of all federal payments for the La Mesa facility.

Jim Stieringer, president of the Grossmont Health Care District's board, said he learned about the problems only after reading a story Wednesday in The San Diego Union-Tribune.

Those deficiencies included the preventable deaths of three patients in March and April, some nurses' improper use of CPR, at least one operating-room mattress that was unsanitary and held together with glue and tape, use of expired medications and incorrect storage and preparation of food.

“I'm not happy,” said Gloria Chadwick, another board member. “The hospital belongs to the public. If there were problems, we certainly should have been apprised.”

The taxpayer-funded district oversees Sharp Health Care's lease to run Sharp Grossmont Hospital, which serves a 750-square-mile area in East County with more than 652,000 residents.

Sharp pays $1 a year to the district and keeps all other revenue from the facility. The district was cash-strapped when it signed the lease in 1991, and some criticized it for turning over the public hospital to a private company.

Over the years, the district has rarely interfered in Sharp's day-to-day operation of the hospital, focusing instead on building and equipment needs. The nitty-gritty management of the hospital belongs to a separate, 20-member corporate board.

The district board's meetings are covered by California's open-meeting laws, while the corporate board's sessions are not.

Stieringer said the district's oversight is supposed to include monitoring health care to ensure hospital patients' needs are being met.

“Our board can be justifiably criticized for not keeping on top of it,” he said. “But Sharp Health Care is supposed to keep the district advised of any untoward events, and we weren't.”

On Tuesday, Sharp executives released to the Union-Tribune a 100-page federal report confirming numerous medical lapses documented during two inspections by state investigators in April and May. They delivered their correction plan to Medicare officials that same day, and regulators will review the response and inspect the hospital again.

Sharp Grossmont could lose reimbursement from Medicare and Medicaid – known as Medi-Cal in California – by Oct. 15 if problems continue. The hospital would essentially have to close if that happens, because half of its net patient revenue comes from Medicare and Medi-Cal. These programs cover care for seniors, the poor and the disabled.

The Grossmont Health Care District is getting about $9.4 million in tax money this year, including $4 million for a construction bond.

Each of its five elected board members can designate someone to sit on the hospital's corporate board. Barry Jantz, CEO of the Grossmont Health Care District, also is invited to attend the corporate board's meetings.

Michele Tarbet, CEO of Sharp Grossmont Hospital, acknowledged that she didn't tell the district board about the problems uncovered during the two inspections. But she said the district has representatives on the corporate board.

“I kept my board completely apprised of what was going on,” Tarbet said.

Jantz said he knew of “serious concerns about some incidents” but not all the details, and that the hospital was working on addressing the deficiencies.

Michael Emerson, who was appointed to the district board in May, had previously served as Stieringer's representative on the hospital corporate board. He said Tarbet told the corporate board about the problems in a closed session.

“She informed the board that the process was moving and they were going rapidly,” he said. “I think she did a wonderful job.”

Emerson said he didn't see a need tell Stieringer about the patient-care investigations.

“It has nothing to do with oversight on the lease,” he said. “It's hospital operations and (the district is) not really involved in that.”

Chadwick said hospital officials should have informed the district board directly because the district's representatives on the corporate board can't share information they hear in closed sessions.

“I feel very strongly that (hospital officials) had an obligation to the elected board,” she said. “In a situation like this, we're held accountable.”

One of the only times in which the district board intervened in hospital operations occurred in 2001, when Sharp officials wanted to close an 11-bed pediatric ward. Facing a public outcry, the district board voted to keep the ward.

Hospital officials provide a brief report to the district board during its monthly meetings, but those presentations are rarely substantive. Stieringer called them “pablum.”

Jantz said he is talking with board members about creating a more formal procedure so district officials are notified about serious issues facing the hospital. The board will discuss the topic at its next meeting Aug. 15.

“It's very evident that that part of the communication needs to be bolstered,” Jantz said.

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Anne Krueger: (619) 593-4962; anne.krueger@uniontrib.com