Kaiser Answers State Complaints
By Richard Halstead, IJ reporter
State inspectors discovered dirty shower rooms and patios fouled by bird droppings when they visited Kaiser Permanente Medical Center in San Rafael last September. These conditions were found on floors of the hospital where patients receive chemotherapy. Such therapy suppresses the immune system and increases patients' susceptibility to infection and disease.The California Department of Health Services issued the hospital two citations for failing to meet general safety and maintenance standards. The hospital received citations for similar violations when the department's inspectors visited the hospital in October 2003.
The hospital submitted a plan to correct the problems that was accepted by the department last month. In a prepared statement, Kaiser officials said they are implementing those changes.
Both inspections were made after a Petaluma resident whose wife was being treated for leukemia at the hospital filed a complaint with the state.
Jim Cooke said he was appalled by conditions at the hospital when his wife, Jean, checked in a year ago. He and other relatives brought in scrub brushes and cleaned his wife's room.
Cooke said there was dirt in the floor's corners; the shower was moldy and musty; and pigeons were nesting and defecating on the floor's patio. Each floor has a small porch room, which is used by patients and their families.
Cooke said he once had to chase a pigeon out of a hospital corridor next to his wife's room. There were no screens on the patios or hospital windows.
"The outside of the hospital was lined with swallows' nests, with swallows' feces dripping down the walls, including over the windows," Cooke said.
A Kaiser spokesman, Carl Campbell, said state law prevents the hospital from removing swallows nests if they are occupied. They can be removed only when the birds leave for the winter, Campbell said.
"We've just finished a three-month project power washing all of the hospital walls, not just where the birds were," Campbell said.
When they visited in 2003, state inspectors examined the fifth-floor room where Cooke's wife stayed. They reported finding waxed-over stains and soiling on the room's floor and a brown residue around the sides of the linoleum in the room's bathroom. The inspectors also checked the fifth-floor patio and discovered bird droppings in a planter box and on the wooden slats above a picnic table.
In response to the citations, Kaiser managers submitted a plan of correction that included an extensive cleaning and refurbishing of the hospital's fifth floor. The hospital pledged to monitor cleanliness every month. It also promised to put screens on patios, clean and refurbish the tables and benches on these porch rooms, and remove their planter boxes.
But Cooke says the hospital was still dirty when his wife returned there for more treatments earlier this year.
"The conditions had deteriorated within one year to exactly what they were the first year," Cooke said.
When inspectors visited in September, managers told them the fifth floor was vacant - except for a pediatric ward - because a major renovation of the floor was planned.
Managers informed inspectors they planned to remove old hallway linoleum, which was rimmed in "black matter." During a tour of the fifth floor, inspectors found a "dark, mold-like matter" in all three showers they checked.
"The stains ran the perimeter of the shower stall, where the walls met the flooring, and into the grout between the tiles," the inspectors reported.
In the showers' floor drains, inspectors found "small particles of white matter and dark stain-covered, Band-Aid shaped debris."
This is the same floor that the hospital promised to clean extensively and refurbish in its 2003 plan of correction.
"We did what we said we would do," Campbell said, referring to the 2003 plan of correction.
The state does not re-inspect hospitals to ensure that plans of corrections are implemented, unless problems are severe enough to involve federal Medicare officials, said Pat DeWan-Duran, a Department of Health Services operations chief.
After their visit in September, inspectors reported that the shower stalls on the fourth floor - where no renovation was planned - were in the same condition as on the fifth. A musty odor was immediately noticeable as soon as the door of one of the fourth floor shower stalls was opened, their report notes.
When the inspectors got to the fifth- and fourth-floor patios, they found them screened but filthy.
"Inside the porch rooms, the overhead rafters were observed littered with feathers, leaves, dust-covered cobwebs and dried bird droppings, which had dripped over the timbers," the inspectors reported. "Coiled pieces of bird droppings littered the base of rectangular wall openings, across from the stairwell doors."
Inspectors noted that patient care equipment, including wheel chairs, were stored uncovered inside both the fourth- and fifth-floor porch areas. The hospital's support services managers provided no explanation for why the porch rooms remained soiled.
"If you have no immune system, there is probably nothing worse you can be around than bird feces," said Cooke, a former nursing home administrator.
The hospital points out that its accreditation was renewed by the Joint Commission on the Accreditation of Healthcare Organizations following an inspection in October. JCAHO is the accreditation organization used by thousands of hospitals nationwide.
Consumer advocates contend that JCAHO, a private agency founded by the hospital industry and the American Medical Association, goes too easy on hospitals.
Cooke said the death of his wife last month had nothing to do with the unsanitary conditions at the hospital. Nevertheless, the conditions added to the stress he and his wife were under at a vulnerable time, he said.
"This won't bring my wife back," Cooke said of his complaints. "But I'm hoping this will save other patients from having to go through this."
Contact Richard Halstead via e-mail at rhalstead@marinij.com
