UCI defends dialysis center; cites improvements since inspection found numerous problems
UC Irvine officials defended their dialysis center Monday, saying they made numerous improvements to ensure patient safety after regulators found problems during a surprise fall inspection that put the center’s Medicare funding at risk.
In the 70-page inspection report, state investigators said they observed poor oversight and potentially dangerous mistakes at the center. Among the findings: failures to monitor patients’ dialysis fluid; unsanitary conditions that included dialysis chairs and walls spotted with blood and nurses who did not change gloves or wash their hands; and rusted dialysis equipment and piping held together with tape.
A spokesman for UCI medical center said Monday that after the November inspection, officials retrained and overhauled the center’s staff, appointing a new medical director and nurse manager. In addition, center equipment was repaired or replaced in advance of an extensive upgrade to be completed next year, according to a plan of correction submitted to state regulators Friday.
“We appreciate the seriousness of the issues raised and believe that you will find our response and accomplishments to date to be comprehensive,” Dr. Alpesh Amin, chair of the medical school’s department of medicine, wrote to state regulators Feb. 23. “… By surveying our dialysis unit and giving us guidance about what should and must be improved, you have helped us become better.”
In a letter sent to UCI medical faculty and staff Monday, UCI Chief Executive Terry Belmont and Dr. Ralph V. Clayman, dean of the medical school, noted that the dialysis center had a better track record of providing quality care than other centers in California and nationwide.
“Its annual observed mortality rate is the lowest in Orange County and better than state and the national averages -- 11% at UC Irvine compared to 18% in California and 20% nationally,” they wrote. “In addition, its patient infection rates are among the lowest in Orange County and are below state and county averages. Patient coverage provided by faculty physicians and fellows exceeds Medicare standards.”
At the time of the inspection on Nov. 5, 2010, the center, which opened in the early 1980s, was treating 104 dialysis patients and an additional 20 patients at home, according to the report. They currently treat about the same number of patients, according to John Murray, a UC Irvine Medical Center spokesman.
The center is located on the campus of UC Irvine Medical Center in Orange, but licensed separately and administered by UC Irvine School of Medicine as a physician practice, Murray said.
Prior to the surprise inspection in November the center had last been inspected Jan. 4 2003, according to state regulators.
On Dec. 17, the Southern California Renal Disease Council, which is sponsored by federal regulators, sent a letter to dialysis centers, including UCI, informing them that federal regulators had received “numerous referrals and patient complaints” and that “many facilities” had violated infection control regulations. They recommended “an immediate check of your facilities for cleanliness,” according to the letter.
Federal regulators provide state investigators with a list of dialysis centers with a history of complaints and other problems and require them to inspect 10% of the centers annually, according to Rufus Arther, director of hospital and community care operations for the California regional office of the Centers for Medicaid & Medicare Services. The state has complied with that requirement, according to Ralph Montano, a spokesman for the California Department of Public Health, which conducts the inspections.
Federal regulators also require state investigators to inspect each dialysis center every three years, but Montano said that was “a lower priority" and that state inspectors have not been able to do so, “due to limited resources and competing priorities.”
“By June 2011, all of our district office staff will have trained surveyors to conduct these surveys. As a result,we hope to do more surveys in the future,” Montano said.