Kaiser cited for use of unlicensed help

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Kaiser Permanente Hospital in Santa Rosa has been cited by the state Department of Health Services for allowing a technician to perform medical procedures during orthopedic operations.

The Santa Rosa hospital is the third Kaiser facility to be cited by the state for using an unlicensed assistant during operations. Kaiser hospitals in Sacramento and in San Jose were also cited by the agency, which licenses and regulates the state's hospitals.

The investigation of Kaiser in Santa Rosa, conducted in June and completed Aug. 7, revealed that the hospital's four orthopedic surgeons were using an orthopedic assistant, who is a technician, to perform such procedures as suturing deep tissue wounds, placing pins in bones and cauterizing veins.

The orthopedic assistant acted under the supervision of the surgeon, but those procedures are normally performed by a physician or a registered nurse.

Orthopedic assistants are usually used in clinics for such things as applying clamps to minor veins, preparing the cast for a broken limb or holding a limb still for the physician, said Mary Becker, who investigated Kaiser for the State Department of Health Services.

The orthopedic assistant at Kaiser, whose name was not disclosed, had no formal training beyond a 26-week course from an orthopedic device company. He was not licensed as a nurse or even as an operating room technician, Becker said.

"These were clear violations of state regulations and the regulations are there for a reason,'' said John Daly, the North Bay district administrator for the Department of Health Services and the person who oversaw the investigation and preparation of the report.

Daly said Monday he had never seen a case such as this, of a technician clearly exceeding his scope of training, in 11 years as a health services regulator.

Kaiser, however, said the assistant was an unusually talented technician and was capable of the tasks he performed.

He worked full-time in the operating room assisting surgeons and has performed procedures on thousands of patients since he was hired in 1991, said Bob Schultz, chief physician at Kaiser.

Suturing, placing pins, and the like "exceeded technically what he was supposed to do, but there is no evidence that this compromised patient care in any way,'' Schultz said. "He does an excellent job.''

Schultz said surgeons did not realize state law prohibited using an orthopedic assistant for those procedures and promptly agreed to stop the practice when alerted by the report by the Department of Health Services.

Kaiser policies, however, also prohibit unlicensed personnel from suturing wounds or placing pins in bones. In addition, the orthopedic assistant signed an agreement in 1997 that he would not perform such procedures, a year before the state investigation, according to the state report on the violation.

The department's investigation was triggered by a complaint by the California Nurses Association, the union that represents Kaiser nurses. The union has often raised concerns about Kaiser's use of technicians rather than registered nurses.

Mary McVay, vice president of the nurses' association, said assisting a surgeon during an operation calls for advanced training, even for a registered nurse.

"We're upset that this person is suturing tissue when they don't have that expertise. They're putting pins in bones when they have no idea where the nerves are, or the tendons,'' McVay said. "You could harm a patient to the point they would not be able to use that appendage.''

Kaiser's Schultz said surgeons will continue to use the orthopedic assistant during operations, but the technician will only perform technical tasks allowed by state regulations.