The Los Angeles County Board of Supervisors ordered the public health department this week to provide an update on the nursing home inspection process, responding to a Kaiser Health News report that draft penalties in three patient deaths had been reduced without explanation.
The supervisors unanimously approved the motion to have the acting public health director report back with a “detailed description” of procedures for reviewing nursing home penalties recommended by on-site inspectors. The vote followed an article published Saturday in the Los Angeles News Group newspapers, which described three fatal cases in which sources said inspectors’ draft citations had been downgraded.
“It is vital that the Department of Public Health take the appropriate steps to reassure the public that they are upholding the integrity of the investigation and citation process,” Supervisor Mike Antonovich, who put forth the motion, said in a written statement.
The motion also instructed the department to report the percentage of inspectors’ recommended citations that had been changed by their bosses, without specifying the time period, and asked for information on staff training.
The article detailed three deaths that occurred at two Los Angeles County nursing homes. In one home in Montrose, a 30-year-old man bled to death in 2010. At a Sun Valley facility in 2012, two young children died seven months apart after they pulled out their breathing tubes. In all three cases, the facilities were faulted for poor monitoring of the patients, who were known to be at risk.
In each of the three, a county inspector planned to issue the highest level citation but their bosses downgraded the severity level, meaning fines were tens of thousands of dollars lower, according to interviews and documents. The downgrading also allowed the facilities to avoid potential action against their licenses.
Public health department officials said the level of the citations in the three deaths was appropriate. But department officials acknowledged that there was no documentation about “how, or if, any changes were communicated” to the inspectors.
The department said it is now using a form to ensure that managers are conferring with inspectors to assure the citations are issued appropriately. Those completed forms are internal documents, not available to the public.
The news report was among a series of stories published by Kaiser Health News about problems with oversight of nursing homes in California’s largest county. The stories led to several audits, including one in August, which found officials in the department were regularly downgrading citations without explanation. The audit did not cite specific examples, however.