King/Drew Medical Center To Lose Medicare, Medi-Cal Funding Without Prescription Drug Administration Changes

CMS will revoke Martin Luther King Jr./Drew Medical Center's certification to participate in Medicare if the facility does not correct "serious flaws in the way it handle[s] prescription drugs" by March 23, according to a letter from the agency sent Wednesday, the Los Angeles Times reports (Weber/Ornstein, Los Angeles Times, 2/12). Last week, Department of Health Services officials told leaders at the hospital that the agency plans to cite the facility for an incident in which the hospital over a period of four days last month mistakenly administered the cancer medication Gleevec to a patient without cancer who was being treated for meningitis. DHS said it would cite King/Drew for delaying care and services, failing to clarify medication errors and lacking "general oversight" of pharmaceutical services. DHS' announcement followed the Board of Pharmacy's prior decision to cite the hospital for the same error. According to the pharmacy board, King/Drew staff mistakenly entered a prescription for Gleevec into an electronic medical record for the patient. Nurses found the error on Feb. 12 and Feb. 13 after they compared pharmacy records and physician orders, but they did not remove the prescription from his medical record for four days. The latest incident at King/Drew follows the release of a CMS report in January that found staff errors led to the deaths of five patients at the hospital in 2003 (California Healthline, 3/5). If CMS certification is revoked, King/Drew would be ineligible to participate in either Medicare or Medi-Cal. King/Drew receives about $200 million per year from the two programs, or about 50% of overall its revenue. Fewer than 10 hospitals in the four-state region that includes California receive "immediate jeopardy" notices of termination each year, according to Steven Chickering, a manager for CMS in San Francisco. The county plans to submit a proposal of correction on Monday, after which time federal inspectors will make a second visit to the facility to "ensure that the hospital ha[s] complied," the Times reports (Los Angeles Times, 3/5). After the pharmacy board citation, the county began requiring two nurses to confirm the accuracy of physician orders for high-risk prescription drugs and began requiring pharmacists to ensure that printouts of patient medication records are reviewed by nurses and returned to the pharmacy with any required revisions. Physicians also must review patient medications daily (California Healthline, 3/5).

Chickering said, "The findings, in our opinion, rose to the level of immediate jeopardy to the health and safety of patients," adding, "They have some serious issues to address ... They need to address them quickly." Dr. Thomas Garthwaite, director of Los Angeles County Department of Health Services, said that he hopes to announce an interim CEO for King/Drew in a few days, adding that he would not be comfortable "until we sustain a period of time when we do not have bad events. ... I won't relax until that happens." Supervisor Zev Yaroslavsky said, "The threat has always been there that the consequence of the hospital not getting its act together could be the loss of federal funding," adding, "Obviously there's a lot of work being done to try to avoid that and to fix the problems." Supervisor Yvonne Burke Brathwaite said that while she thought managers had fixed the prescription problems, she was not sure that county health officials would be able to prevent future problems, adding, "I'm not sure they're managing it OK" (Los Angeles Times, 3/12).