Much maligned Olive View-UCLA Medical Center simply can't seem to keep itself out of trouble. The hospital--which previously had made headlines for nurses and doctors running a makeshift beauty salon in the NICU, as well as for running said NICU without enough staff--is once again in the spotlight, this time for allowing an admitted ER patient to go without being assigned a doctor for two days, reports the Los Angeles Times.
A memo written to the hospital's staff by Dr. Mark Richman, Olive View's patient safety and clinical information technology officer, in early October outlines how a medical student wrote a doctor's name on the patient's paperwork, but then never contacted that doctor about the assignment. Richman admits he was the attending physician who helped the student with that paperwork.
While the patient, who has not been identified, did receive medical care over the two-day span, it was not administered under a team, the Times reports, and no proper documentation was taken.
"The circumstances leading to this reflect what is known in the patient safety field as a 'Swiss cheese' event, in which a series of events occurs, each of which bypasses an expected blockade of an error," Richman wrote in the memo.
Richman added that this might not be the first time such an incident has occurred. He was concerned that "students, interns and fellows in other departments...might be unaware that admission is often a two-step process," the Times wrote.
Both the California Department of Public Health and Los Angeles County Department of Health Services are investigating the matter.
To learn more:
- read this Los Angeles Times article