Kaiser Permanente has submitted a plan to HCFA to correct deficiencies found in a survey of its Walnut Creek and Martinez, Calif., hospitals.
Unlike HCFA's previous survey of Kaiser facilities in Oakland and Richmond, Calif., the latest survey does not cite safety concerns nor threaten Kaiser with loss of Medicare funding, said Judson Lively, M.D., associate physician-in-chief at the hospitals, which operate under one license.
Investigators inspected the two hospitals in June following a large number of complaints to the California Department of Health Services (June 23, p. 17). Kaiser was given 10 days to submit a corrective plan and 45 days to implement it.
The survey cited five areas of concern, Lively said. They are: oversight of Kaiser patients in other hospitals; quality assurance; documentation in nursing services; medical records; and how quickly patients receive care in the emergency room.
Kaiser was working on several of those areas before the surveyors arrived, Lively said.
"We have working agreements with other hospitals, but we aren't doing what Oakland and Richmond are doing-shifting patients to other hospitals," Lively said. Kaiser is building an addition at Walnut Creek, he said.
The hospitals, with 230 licensed beds, care for 170 inpatients and 3,500 outpatients a day. "We provide healthcare to an enormous chunk of Northern California," he said.
"These are not Kaiser problems. They are present throughout the (nation's) healthcare system," Lively said. "Healthcare in general is becoming more complicated than it has been. The issues are tougher to resolve. Patients are more complex. We've got to re-evaluate how to do things and do them better."
The California Nurses Association charged that the violations in Walnut Creek and Martinez are directly related to service cuts made by Kaiser in Richmond and Oakland.
But Lively said, "I don't believe staffing is the primary issue. We've hired more ER staff and will be hiring more."
Meanwhile, HCFA accepted a state Department of Health Services' survey finding Kaiser in compliance with HCFA conditions at the Oakland and Richmond hospitals.
Kaiser has implemented a plan to correct the deficiencies relating to transport, staffing levels, training and a lack of documentation.
David Lawrence, M.D., Kaiser chairman and chief executive officer, said in an interview that it was difficult to keep Oakland staffed with adequately trained personnel because many nurses transferred to other facilities when Kaiser announced it would close the hospital. An unusually severe flu season last winter compounded the problem, he said.
Oakland will be closed because it needs extensive upgrading to meet seismic requirements and there is excess bed capacity in the region.
Richmond ran into difficulty because its low patient census can't sustain a high-quality critical-care program and Kaiser had not made adequate arrangements with other hospitals for critical-care beds.
A spokesman said reports were inaccurate that HCFA concluded that patient deaths at Oakland and Richmond were due to prolonged stays in the emergency room and delays in being placed in critical-care beds. The HCFA report did not draw any correlations between the delays and the patient deaths, he said.