State regulators have discovered a slew of violations — including incidents involving death and serious injury of suicidal patients — at Santa Clara County’s main hospital in San Jose, jeopardizing critically needed Medicare reimbursements.
Documents obtained by the Bay Area News Group reveal that a state-led investigation last fall of Santa Clara Valley Medical Center — California’s second-largest public health care system — found care deficiencies that could leave the facility in a financially perilous position should they not be corrected to the satisfaction of state and federal regulators.
The hospital serves a significant number of uninsured and underinsured patients, according to the county, including its most “vulnerable and complex” residents.
County Executive Jeff Smith said the state’s probe is being taken “very seriously” and the county will follow through with its 55-page correction plan. He said there is “no chance” reimbursements will stop for the hospital, which has 731 beds and is the flagship facility for the county’s extensive health care system.
The state’s investigation found that last August, a suicidal patient threw a chair through a window, leaped from the hospital’s fourth floor and was killed. In another incident last May, a suicidal patient escaped the hospital’s emergency room and jumped from a third-floor parking garage onto a tree, sustaining injuries so severe they required complex facial repair.
In both instances, investigators found the hospital’s own policies on managing suicidal patients were not followed. In the case of the patient’s death, the hospital was not supposed to have objects inside the person’s room that could be picked up and thrown. In the injury case, the patient was supposed to be observed but was left unattended. The patient, a 19-year-old male, “simply opened the door to his room,” the 136-page investigative report dated Oct. 3 from the California Department of Public Health stated. “Then ran out of the emergency department, left the hospital, ran to an adjacent building, and jumped off a high floor. (He) returned as a trauma patient with critical injuries.”
The hospital’s failures, the report concludes, led to its “inability to ensure patient safety and quality of care.” Other violations include missing or incorrect paperwork that led to serious consequences.
In the case of the suicidal patient who died, state investigators discovered that hospital employees marked the patient as discharged from the hospital. Investigators also found that the patient had been treated at the hospital before — and had shown signs of being a danger to themselves — but this crucial information was not included in the medical record during the later visit.
In addition, the state probe found that the hospital did not adequately maintain its emergency power supply, including evidence there was no regular testing of at least one generator’s batteries. In September, backup generators at the hospital failed during a scorching heatwave, though state regulators did not make a connection between the deficiencies and any specific incident.
According to county officials, a 55-page list of corrective actions has been made to address the violations and has been submitted to state and federal regulators, which include the Centers for Medicare and Medicaid Services, known as CMS.
If regulators do not accept the corrections, Medicare reimbursements will end for patients admitted to the hospital after April 25. For patients admitted before the April deadline, the hospital will get reimbursements for an additional 30 days. CMS did not immediately respond to an inquiry about how many patients would be impacted if Santa Clara Valley Medical Center, known as SCVMC, loses federal reimbursements.
“For CMS to threaten payment is a huge deal,” said Mike Wasserman, former president of the California Association of Long Term Care Medicine. “They don’t do this lightly.”
In a statement, Santa Clara Health and Hospital System CEO Paul Lorenz said the hospital takes “all instances of patient safety very seriously.”
“This survey is an opportunity to reevaluate all of our processes to ensure our health system is providing the highest level of care for each and every patient, even under the most difficult and challenging circumstances,” he said. “We appreciate the opportunity to review and improve our systems, and to provide the best possible patient care. Not only will we be better for this, but our patients and our community will benefit as well.”
Lorenz said he is confident that regulators will accept the county’s corrective actions.
Dr. Stephen Harris, president of the Valley Physicians Group, a union that represents hundreds of the county’s doctors, said health care workers have been raising issues around patient care and operational issues with hospital leadership for two years.
“Now that regulatory authorities have cited SCVMC for a multitude of issues, SCVMC and the county have no choice but to respond. Not with lip service, but with real and meaningful improvements,” Harris said.
In a statement, Santa Clara County Board President Susan Ellenberg said residents “count on the hospitals of Santa Clara County to deliver the highest standard of care.”
“Each recommendation to improve services or programs is actionable, and I’m confident SCVMC leadership and staff will implement the recommendations and will work, as they always do, to ensure patient and employee needs are met,” she said.
Supervisor Otto Lee, who sits on the county’s Health and Hospitals committee, described the state’s findings as “troubling” and “unacceptable.”
“While the regulators review our proposed corrective measures,” he wrote in a statement, “I will remain vigilant in ensuring the fixes are implemented immediately and we stay on top of them moving forward.” Supervisor Joe Simitian echoed Lee’s concerns and said the problems will be discussed in upcoming meetings of the Health and Hospital committee, of which he is also a member.
The county’s medical center system makes up nearly half of its $11 billion budget. Also included are O’Conner Hospital in San Jose, St. Louise Regional Hospital in Gilroy and DePaul Health Center in Morgan Hill, as well as a network of clinics throughout the county.
If you or someone you know is struggling with feelings of depression or suicidal thoughts, the National Suicide Prevention Lifeline offers free, round-the-clock support, information and resources for help. Reach the lifeline at 988 or 800-273-8255, or see the 988lifeline.org website.
