Liberty hospital told to mend problems or risk loss of Medicare payments

October 09, 1992|By Douglas Birch | Douglas Birch,Staff Writer

Federal health-care officials say that unless Liberty Medical Center takes significant steps to correct a series of problems with its patient care by Nov. 20, the 282-bed hospital will no longer be eligible for payment under the Medicare and Medicaid programs.

The West Baltimore hospital, which treated 8,000 people last year, was criticized for its surgical, anesthesia and emergency care in a report written in June by the state health department.

David Sayden, a spokesman for the Health Care Finance Administration in Philadelphia, said his office is currently reviewing a plan submitted by hospital officials to fix the problems.

"We have to decide whether it's a credible plan," Mr. Sayden said.

Liberty President Everard O. Rutledge conceded that the hospital may have had some trouble "dotting some 'i's and crossing some 't's," particularly regarding the paperwork on internal reviews of patient care.

"As with any hospital, we will make mistakes from time to time, but they will occur with reasonable margins of human error and not differ significantly from other hospitals," Mr. Rutledge said in a statement. During an interview, he added that "with regard to medical care, we more than meet the community standard. . . . The care is good, I am pleased to note."

Mr. Rutledge said that, despite the state's unflattering evaluation, the not-for-profit Joint Commission on Accreditation of Health Care Organizations gave Liberty a three-year accreditation in June.

He also said the American Medical Legal Foundation, another not-for-profit group, has reviewed some of the specific patient-care cases questioned in the state report.

"They concur with our findings that we have met the community standard," Mr. Rutledge said.

The Liberty president emphasized that the hospital treats many people with severe health problems that are related to poverty.

The 69-page state Department of Health and Mental Hygiene report, done for the federal government, lists numerous problems.

Examples include significant gaps in the medical records of some patients, the fact that salted turkey was fed to some patients on salt-free diets and that some washroom faucets had water more than 20 degrees hotter than recommended.

State inspectors also questioned whether several patients received the proper treatment, based on reviews written by the staff as part of the hospital's quality-assurance program.

The report cites the case of an 80-year-old man who was brought into the hospital last February. His left foot appeared close to turning gangrenous.

Doctors found the next day that the man had a partially blocked artery in the leg. Five days later, the man underwent surgery to graft a new artery into his leg. But the new artery became blocked. He later died.

The report questions, among other things, why the man's leg was not X-rayed immediately and why surgery had not been performed sooner.

An internal review found that the man died of heart problems not related to his leg. "Autopsy findings do not support this supposition," the report says. Hospital officials decided the patient's death was unavoidable. But the report concludes that the "postmortem findings do not support this."

In an interview yesterday, Dr. Reed Winston, vice president for medical affairs at Liberty, explained that the patient suffered from advanced heart disease. "I don't really feel that was an avoidable death," he said.

Dr. Winston acknowledged that some patients were inadvertently given salted foods because of a mislabeled pan, but that new rules were in place in the hospital kitchen to prevent this from happening again. He said there was no problem with the water temperatures. The state inspector, he said, used a faulty thermometer.

"There are some difficulties in record-keeping," he admitted, adding that the hospital has been attempting to improve its handling of an increasing load of paperwork.

"I'm not going to say it's not something that's important, because it is," Dr. Winston said.

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