California hospital fined $43K for error that prompted immediate jeopardy

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In 2025, California fined a hospital about $74,000 for three penalties, including a $42,750 administrative penalty for a medication error that beget an immediate jeopardy, according to The Modesto Bee

In January 2024, CMS placed Modesto, Calif.-based Memorial Medical Center in immediate jeopardy after a medication error, which involved a patient receiving 25 tablets of nitroglycerine while the normal dosage is one 0.4-milligram tablet every five minutes and a maximum of three in 15 minutes, according to the Bee.

The patient was a 75-year-old woman with chest pain. Investigators from the California Department of Public Health reported that her nurse had not administered this medication before. 

The patient soon reported vision changes, nausea and dizziness, and her blood pressure dropped from 137/76 to 74/39 within 15 minutes, the Bee reported. She received activated charcoal from the hospital’s poison-control unit, which helped raise her blood pressure, and IV medication. 

Memorial Medical Center submitted a plan of correction, which CMS approved and resolved the immediate jeopardy. An immediate jeopardy is a rare, serious situation for healthcare facilities, as it requires immediate corrective action and carries the risk of losing a Medicare contract. 

“Memorial Medical Center’s leadership, physicians and staff are deeply committed to compassionate and safe patient care,” Sutter Health, the hospital’s owner, told the Bee. “We value the trust our patients and their families place in us. We are always examining ways we can improve, and our teams continually review and evaluate our processes and procedures to support the ways we care for our patients.”

In addition to the $42,750 administrative penalty for the medication error, the California Department of Public Health also fined the hospital $30,900 in 2025 for a “deliberate breach” of protected health information by a healthcare worker, according to state records.

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