13 Hospitals Fined for Immediate Jeopardy Violations in CA

Cheryl Clark, for HealthLeaders Media , June 4, 2012

3. At Mad River Community Hospital in Arcata, Humboldt County, a surgical team neglected to remove a laparotomy towel from a colon resection patient who had been discharged home, but who returned because of abdominal pain, nausea.

The state report said that hospital policy did not set forth that sponge, instrument, and sharp counts do not include dressings with which a patient may enter the operating room.

"The director of Surgical services said she saw an increased risk of error given the surgical team had worked all day and then were on call for the night of ... when the surgery started at 10:00 P.M."

The incident was Mad River's first penalty and resulted in a $50,000 fine. 

4. At Keck Hospital of USC, Los Angeles County, cardiothoracic surgeons failed to remove a tip from an electrosurgical pencil cautery used for a patient who had undergone an aortic valve repair.  The patient had to undergo a second surgical procedure under general anesthesia.

The incident was Keck's third penalty and resulted in a $75,000 fine. 

5. At Motion Picture & Television Hospital, Woodland Hills, Los Angeles County, surgeons forgot to remove a 10.18 cm by 10.18 cm Raytec sponge that had been used to pack the wound in the knee of a patient who had undergone an ACL reconstruction. 

California officials were alerted to the sponge retention by a "letter" saying that the patient had gone back to the surgeon two months later "with concerns of a lump in the knee area."

When the sponge was identified through imaging, the patient went to another hospital to have it removed. 

The incident was Motion Picture & Television Hospital's first penalty and resulted in a $50,000 fine. 

6. At Chapman Medical Center, Orange, in Orange County, the hospital failed to protect a patient from sexual misconduct and assault by a registered nurse who had injected her with narcotic and/or opiate pain killers and a muscle relaxant.

"A review of the police agency's investigative report by Officer Y, documenting RN 1 admitted to administering the aforementioned medications and kissing Patient A on the mouth using his tongue, fondled her breasts and he stated she touched his erect penis with her hand."

The patient was later asked if she voluntarily participated in the incident "and she stated, no, because she could not move her arms."

The nurse was immediately suspended and arrested by police.

The incident was Chapman's second penalty and resulted in a $75,000 fine. 

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