The director of quality assurance at Prince George's General Hospital has resigned, citing a long list of problems with patient care, records keeping and medical staff support at the county's largest public health facility, where 650 workers were fired in September.
Dr. Arthur Kaufman, who held the post for 11 years, said that the firings, which were implemented to save the financially ailing system $3 million a year, have affected virtually every area of operation at the 550-bed hospital and have made it impossible for him to do his job.
"Physicians report unsatisfactory service from almost every department," he wrote in a Nov. 19 memo to the hospital management. "The infection control coordinator advises that the cleanliness and safety of the operating rooms cannot be assured . . . . Conditions prevailing in the hospital now prevent strict conformance with accepted standards . . . . "
About 650 employes, including 60 nurses, were fired around Labor Day. Most were employed by Prince George's General, one of the largest hospitals in the Washington area.
Since then, according to nurses' association head Carol Bragg, an additional 60 to 80 nurses have quit out of frustration over working conditions. "We've been trying to get nurses in and recruit, but who's going to want to come to an institution working short-staffed and that doesn't have the support services other hospitals have?"
Kaufman's criticisms, she said, are "very credible and very true."
After meeting with the hospital's chief administrative officer to discuss the issues raised in the memo, Kaufman resigned.
Hospital officials conceded in interviews yesterday that some of Kaufman's criticisms are valid, but they said many of the problems are longstanding and that they are trying to improve conditions.
After reports of discord last spring, the board of the Community Hospital and Health Care Systems Inc. (CHHCS), the nonprofit corporation that runs the county hospitals, was replaced and an outside firm was hired to make the system more efficient and profitable.
The board overhaul followed disclosures of internal board bickering and allegations of nepotism, conflicts of interest and mismanagement.
"I don't take exception to the fact that there have been many problems there for a long time," said Winfield M. Kelly Jr., a former Prince George's county executive who in July became chairman of the CHHCS board, which oversees operation of the hospital in Cheverly and two other county-owned facilities in Laurel and Bowie.
"I do take exception to the statement that quality care is not being provided; it is," Kelly said. "In the process of cleaning up, we have created a lot of activity. You don't make an omelet without cracking some eggs. He Kaufman got caught up in that process. We're trying to improve all departments, including his."
Corbett A. Price, vice president of Hospital Corporation of America, the private firm hired last summer to manage the hospital, and president of CHHCS, said, "It takes time to correct historical problems. We're making great strides."
He said HCA is conducting its own study of patient care and insisted that there was no correlation between the quality of such care and large numbers of personnel.
Kaufman would not comment on his resignation, which took effect Dec. 1.
Kaufman noted in his memo that his staff was cut in half "so the office cannot handle any new programs or increased workload."
In part because of such reductions, Kaufman said he doubted that the hospital would be accredited again next year "without an extremely coordinated and intense hospital-wide effort."
Kelly, who provided The Washington Post with a copy of the memorandum and resignation letter, referred a reporter for specifics to Dr. Jim Estes, the hospital's medical director and director of medical education.
"We have downsized our nursing corps," Estes said. "I have received complaints from a number of doctors concerned that we don't have an adequate number of nurses. We're in the process of trying to get some back. That is a legitimate complaint."
Estes described Kaufman, who worked part-time at the job while acting also as a self-employed consultant in hospital malpractice cases, as "very qualified; he knows his field and is very cognizant of what goes into a quality assurance program. I think Arthur did a good job and is doing his job when he points out our deficiencies. I'm sorry to see him go."
But Estes cautioned that some of Kaufman's comments are "anecdotal" rather than based on hard data, "and I can't say it's any worse than it has been, that these problems happened in the last day or two."
In his memo, Kaufman also charged that:
*"There is no staff supervision" of the hospital archives. "Records may or may not be returned. Future legal cases dependent on past records -- such as fetal monitoring strips that are not filed -- will be most difficult to defend."
*"Physicians complain of 'insubordinate' (over-extended?) nurses; loss of patient education and specialized nurses (diabetic . . . trauma coordinator, etc.) places burden on staff nurses."
*"Elements of the risk management program are fragmented . . . . Incident reports are not being put into a data base. Investigations are not timely or thorough because of personnel limitations."
*"Physicians . . . reorder tests because they cannot get results; then the reviewers deny payment for 'duplicate' tests . . . . Pharmacy has been pushed to the limit by staff and budget cuts."
"An effective, working hospital is the sum of many interacting parts," Kaufman wrote. "I regret that I must report that our efforts are inadequate and that quality cannot be assured in these circumstances."