The New York Times - November 3, 2006
Bruce Lambert

"Most of the concerns expressed by the Department of Health relate to administrative processes, such as policy development. We take them very seriously. In some cases, the instances date back several years. We have been working, and continue to work, in full cooperation with the D.O.H. to address its concerns."

The state inspection process allows the hospital to respond and requires corrective actions. Fines are also possible.

In May, the Health Department found 19 violations in pediatric surgery at the hospital, citing three patient deaths. One patient was found to have received a drug dose 27 times what is normal, the state said. Another patient had not been properly screened before surgery and a third died while awaiting surgery for days.

In the latest review, several violations cited by the state were procedural, including failing to ensure the privacy of patient records, ignoring credentialing requirements in appointing doctors and authorizing them to practice specialties. In making reappointments, the state said that the hospital also failed to check its records for problems and that one doctor was reappointed without a review of complications in his patients, one of whom died.

In the case of the traffic injury, the state said proper care was delayed about 20 hours, despite worsening symptoms. The patient complained of vomiting and a headache. Later a nurse found the patient restless, agitated and pulling out his intravenous tubes. The patient vomited three times and then was noted as being lethargic and nonresponsive with the left pupil fixed and extremities flaccid.

Still, the plan remained to prepare the patient for discharge and rehabilitation. Sometimes the nurses and doctors skipped checking on the patient or observed only from the doorway.

Eventually the patient's condition deteriorated so much that a brain scan was ordered, the state said. By then both pupils were fixed and dilated. During the scan, the patient lapsed into respiratory distress, requiring a ventilator and intensive care. The scan found a large hemorrhage requiring emergency operation, but it was too late to save the patient. In addition, the report said, the hospital failed to report the case to the state as required.

The report also found the hospital relied on an obsolete AIDS care manual, dating to 1987, which lacked provisions on testing, discrimination, infection control, counseling, confidentiality and coordinated care. Staff members were unaware that the hospital was designated by the state as a specialized AIDS center and were not alert to possible AIDS complications for patients coming in for other problems, the report said.

The state faulted the hospital's quality assurance program, which is supposed to improve care by learning from mistakes. Of nine cases with adverse results reviewed by the state, the hospital had not properly investigated seven of them, the report said.

Drug problems cited included missed medications, a drug overdose of morphine for a child 10 times the normal amount and an overdose of an incorrect medicine for another patient. The review did not report adverse reactions in those cases.

Other violations included failure to track a hepatitis infection resulting from a blood transfusion; having 12 beds in the pediatric intensive-care unit when only 7 were authorized by the state; confusion over the role of dentists in the emergency department; a lack of procedures for the hospital's trustees; and failure to require the chief executive to report to the trustees.

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