Review of Nursing Homes Called Lax : Health care: State inspectors late to respond to complaints one-third of the time, failed to apply maximum penalties against serious violators, report says.

ANAHEIM — State health inspectors have been lax in their oversight of Orange County nursing homes and other health facilities, often responding to complaints late and failing to sufficiently penalize serious offenders, according to a sharply critical report issued Thursday by the state auditor.

The district licensing office “has not adequately used the preventive and reactive procedures available to ensure that long-term health care facilities provide the best care possible,” State Auditor Kurt R. Sjoberg said in his agency’s report.

The district office responded late more than one-third of the time to complaints made between July, 1992, and March, 1995, according to a review of 60 cases sampled by state auditors. It responded late to complaints in all three fiscal years reviewed.

During the same period, the district office did not follow through with certain required inspections, performed others late, incorrectly prioritized complaints and failed to apply maximum penalties against facilities with serious violations, the report said.

“There were several areas where we believed the health and safety of patients were in jeopardy,” Sjoberg said in an interview. He said the audit “found that many times the priority given to a complaint or correction of a problem was not always high enough.”

“This was sometimes very traumatic to a patient or client. . . . Many times patients were submitted to treatment that was not appropriate.”

In one case, the district office assigned the lowest possible priority to a complaint in which a patient experienced “substantial weight loss and multiple falls during a short period of time,” according to the report. In another case, a patient was badly bruised in an accident after inspectors failed to apply the maximum penalty to a facility that provided inadequate supervision, the report states.

An official with the state Department of Health Services said her department agreed with the auditor’s findings, but insisted that the Orange County office has made steady progress since 1992.

“I think overall it shows an office that has made a significant improvement in their management and their responsiveness to their various responsibilities,” said Brenda Klutz, assistant deputy director of the department’s licensing and certification program.

In fact, statistics compiled by state auditors show that the district office’s response rate to complaints has improved significantly in recent months. In addition, the office went from having the lowest citation rate in the state in 1992 to well above average in 1993, statistics in the report show.

Klutz said that 1992 was a low point for the Orange County office because it had a tremendous backlog of cases and, rather than relying on citations, it was issuing deficiency notices and the threat of removing the certification that allows facilities to bill for Medi-Cal and Medicare. But after a management review determined only three citations were issued in 1992, she said, citations and other enforcement actions were stepped up.

Citations are considered more serious than deficiency notices and carry monetary penalties. “The district office staff have responded admirably, and I think the report demonstrates that,” Klutz said.

Sjoberg acknowledged that improvements have been madez: “There are positive signs. Not all deadlines are being met on a timely basis, but they are working to improve and change the system.”

However, the audit report noted that the Orange County office “is still not effectively using its enforcement authority to the maximum” in regulating local health care facilities. According to the report, local officials often downgrade disciplinary action taken against nursing homes found guilty of serious breaches of state and federal laws.

The report described one case in which a facility was issued two Class B citations--the second most serious kind--when a patient’s life was jeopardized. The patient, a diabetic, had lost 34 pounds, suffered dehydration and developed bedsores. The facility failed to properly administer insulin and coordinate his diet, further imperiling the patient, the report states.

Only after the Class B citations were appealed by the complaining party as too lenient were they upgraded to Class A, carrying a stiff monetary penalty, according to the report. It is extremely rare for a complainant to appeal a penalty.

Even when citations were issued to the facilities, local regulators “did not ensure that facilities promptly submitted plans of correction,” the report states. Plans of correction were late in 65% of the cases reviewed, according to the report.

The report comes in response to a request from a fact-finding panel chaired by former Assemblyman Gil Ferguson (R-Newport Beach), which in June, 1994, held a hearing to air public concerns about whether nursing home regulators were doing an adequate job. Advocates for nursing home patients contended during the five-hour session that the Orange County office had fallen behind the rest of the state in enforcement.

At the time, Jacqueline Lincer, chief of the local office, argued that she decided to cope with an overwhelming workload in 1992 by instructing her staff to write fewer citations, but that the office had increased its issuance of citations since October, 1993.

Lincer declined to comment on the state auditor’s report Thursday, referring all questions to Klutz.

The majority of the district office’s work involves oversight of about 80 nursing homes in Orange County and a small portion of Los Angeles County. Inspectors also oversee acute-care hospitals, psychiatric hospitals, developmentally disabled facilities and other health care facilities.