CENTER CALLED A `LOGISTICAL NIGHTMARE' NEW PAVILION CRITICIZED.

Byline: KAREN MAESHIRO Staff Writer

LANCASTER -- After millions have been spent on converting Antelope Valley Hospital's skilled-nursing facility to a yet-to-open women's health and obstetrics center, a hospital board member is criticizing the problem-plagued building, saying its distance from the main hospital will compromise patient care.

Less demand than expected for skilled-nursing services, coupled with reduced federal reimbursement for that kind of care, convinced hospital officials in 2000 to change the purpose of the building. However, director Berna Mayer now says there's a local shortage of skilled-nursing beds, and patients who need them are taking up acute-care beds at the hospital, leading to emergency room overcrowding.

``I think we could have used the building as a physician office to recruit new doctors instead of putting patients in an acute-care setting so far away from the major building, where it compromises patient care,'' said Mayer, who was elected in 2004 and was not on the board when the decisions were made. ``They are too acute to be over there.''

Hospital officials refuted Mayer's assessment, saying the hospital is fully prepared to deal with emergencies in the Women and Infants Pavilion if they occur, including having in- house physicians on duty at all times and an ambulance available 24 hours a day.

``There is absolutely no way the hospital is going to compromise the standard of care for patients. This was thought through thoroughly and gone through with (Office of Statewide Health Planning and Development),'' hospital spokeswoman Jackie Weder said.

The hospital is spending more than $38million to convert the skilled-nursing facility, which is located south of the main hospital building, to an obstetrics center. The construction cost is $28.6million, and ``soft costs'' for things such as furniture, fees, equipment and a phone system add another $9.5million, Weder said.

The project has experienced delays because of bad weather and other problems, such as an uneven floor, rain damage and a finding that the building was not constructed as designed.

The skilled-nursing facility was a $21million project plagued with three years of delays and cost increases before opening in 2001.

Hospital officials have described it as a white elephant and an albatross, and plans were made to convert it to an obstetrics center before it opened.

Officials attributed the delays and cost increases to factors including poor oversight of construction by a previous hospital administration, changes made because of new government regulations and unrealistically low original cost estimates.

Mayer said there are problems with the pavilion from a medical and safety standpoint in what she called a ``logistic nightmare.''

``As of today, we have no anesthesiologist who will go over there because by the time they call a code, if they need code help, there's no one there to help them,'' Mayer said.

``The emergency staff has to come over. The ER is so far away. We do have an ambulance there 24 hours a day, but how does that help, put a person coding into an ambulance and take them over,'' Mayer said.

As for skilled-nursing patients, Mayer said they either have to stay at the hospital or be placed outside the Valley.

``At the present time, we have all these elderly people, and there aren't any places for them to go. They have to go to L.A., they have to leave the area or stay in the hospital when they are really not acutely ill, and it backs up beds there,'' Mayer said.

Weder said the pavilion will have an obstetrician-gynecologist ``hospitalist'' on duty at all times. A hospitalist works only at the hospital where he does rounds and doesn't see patients by appointment in a private office.

``To help facilitate the standard of care, we have a hospitalist in the Woman and Infants Pavilion on staff at all times, including an anesthesiologist,'' Weder said.

``When a patient codes, should that happen, the procedure is no different than when you're in the hospital.''

``The maternity ward is on the fifth floor. When a patient codes, the emergency room doctors would proceed to that location,'' Weder said.

The Women and Infants Center will feature 39 postpartum beds -- with room to expand to 78 beds -- a 21-bed neonatal intensive care unit, 22 newborn beds, 19 labor and delivery rooms, nine antepartum beds and 12 triage rooms.

The hospital, the only one with a maternity ward in the Antelope Valley, handles about 5,000 births a year.

Weder acknowledged there is a shortage of skilled-nursing beds in the Antelope Valley, but said there is a need for obstetrics services.

``The greater need for the community was a birthing pavilion. No one else does birthing or is providing OB services. Other people are doing skilled nursing,'' Weder said.

The state Department of Health Services needs to make a third and final visit to the pavilion before it can open, Weder said.

[e-mail]

[phone]