On August 27, 2014, the Los Angeles County Auditor-Controller released his latest findings on nursing home complaint investigations by the Los Angeles County Department of Public Health.
His office found very serious problems with the quality of investigations. For example, in 40 percent of the complaint cases examined – including five cases involving the deaths of nursing home residents – DPH managers downgraded or deleted the surveyors’ recommended deficiencies and citations, usually without any documentation.
No one who has had dealings with the Los Angeles County Department of Public Health can be surprised that its managers are systematically protecting nursing home operators at the expense of abused or neglected residents. However, the extraordinarily high percentage of deficiencies and citations being downgraded or deleted is alarming. Conscientious surveyors have been fleeing the Department for years and many of those who remain do not seem inclined to challenge their managers by seeking citations or deficiencies that could trigger enforcement actions.
The auditor also faulted Los Angeles County DPH for not prioritizing complaints appropriately, closing complaint investigations without conducting or completing investigations, failing to notify complainants of findings, losing case files and not reassigning complaint investigations when a surveyor retired.
The Los Angeles County Board of Supervisors ordered the audit in March after a series of articles by Kaiser Health News reporter Anna Gorman exposed a “clean up” project to clear out a huge backlog of nursing home complaints without any investigation. The auditor issued an earlier report on April 4, 2014 on the first phase of his investigation. That report cited a backlog of nearly one thousand complaints that had been open for more than two years, no deadlines for completing complaint investigations and no central management systems for complaint investigations.
The County’s August 22, 2014 response by its now retired director, Jonathan Fielding, is hardly reassuring. Dr. Fielding’s response is filled with excuses, led by an incredible claim that the County needs an additional 183 positions to carry out this work, while also stating that it has already fixed almost all of the problems with existing staff. The County seems intent on using the evidence of its extreme mismanagement to cash in by demanding that California and the federal government pay to more than double its staff. If the State and federal governments do not come up with the cash, Dr. Fielding says “DPH will be forced to recommend termination of the contract to the Board.”
Under a contract with the California Department of Public Health, the Los Angeles County Department of Public Health is charged with inspecting nursing homes and protecting the rights of nursing home residents. According to the auditor, the County has returned millions of dollars in unspent funds in recent years, raising serious questions about its claim that it is underfunded.
The troubling findings affirm the urgent need for top-level leadership changes at the Los Angeles County and California Departments of Public Health.