Posted on September 25, 2006

Hospital Backers Concede Choices Tough

Tracy Weber and Deborah Schoch, Los Angeles Times, September 24, 2006

A day after Martin Luther King Jr./Drew Medical Center resoundingly failed a “make or break” federal inspection, some of the iconic public hospital’s most vocal supporters conceded that it may not be fixable — at least not by the county.

Supervisor Gloria Molina, who long maintained that King/Drew could be revamped, now believes that the county should hand it over to a private firm to run.

“I have no pride of ownership at this point,” she said. “At this point, I’d give it to them, OK? I’d give it to them as long as they would take indigent patients.”

On Friday, federal regulators notified King/Drew that it had failed nine of the government’s 23 conditions for federal funding, falling below minimum standards in such key areas as nursing, surgical services, infection control and the pharmacy.

As a result, the U.S. Centers for Medicare and Medicaid Services said it would cut off annual funding of about $200 million at the end of the year — about half the hospital’s budget.

County supervisors have repeatedly said that should King/Drew lose this funding, they would have to close it, turn it into a clinic or give it to a private firm to run.

Now that this worst-case scenario apparently has come to pass, some city and county leaders said it marks a turning point in how they view the hospital and its future.

Los Angeles City Councilwoman Janice Hahn said her father, former county Supervisor Kenneth Hahn, would be devastated by King/Drew’s failure — and the county board’s inability to fix it.

“Every action the board has taken has not resulted in positive results,” she said. “They clearly need to turn it over to someone who can do the job.”

The elder Hahn fought to build King/Drew after the 1965 Watts riots, and a photograph of him with the Rev. Martin Luther King Jr. appears in at least eight places in the hospital.

Right now, the councilwoman said, “he’s turning over in his grave.”

Even some residents think it might be time for the county to let someone else take the helm at King/Drew.


But other area residents worried that a private firm, however needed, might not be as willing to treat the area’s mostly poor families, the vast majority of which are African American or Latino.

“It’s like stepping on a half-full balloon. You squish one problem, but then you get another one,” said Yves Miller, a Compton math teacher tutoring students at a coffee shop across from the hospital.


The supervisors had been so confident that the hospital was improving, she said, that they had not been focusing on alternatives should it fail the inspection.

“Our contingency plan was prayers and hopes and aspirations that we would pass,” she said.

Federal regulators notified Martin Luther King Jr./Drew Medical Center late Friday that it had failed what was billed as a “make or break” inspection and would lose annual funding of about $200 million — more than half the hospital’s budget — at the end of the year.

The move is likely to force Los Angeles County to close the long-troubled public hospital, give it to someone else to run or turn it into a clinic, as officials have repeatedly acknowledged.

During a lengthy meeting, federal inspectors told King/Drew officials that the hospital still did not meet minimum patient-care standards.

King/Drew has been out of compliance with federal guidelines since January 2004, when it was first cited for serious lapses in care that had injured and killed patients.

During the latest inspection, the hospital failed nine of the government’s 23 conditions for federal funding, according to a letter from the U.S. Centers for Medicare and Medicaid Services that was hand-delivered Friday to King/Drew’s administrator.

Federal regulators identified problems in nursing, pharmacy, infection control, surgical services, rehabilitation services, quality control, patients’ rights and the hospital’s governing body and physical plant.

In fact, inspectors found more problems in the supposedly reformed King/Drew than they had at any time in the last three years. Some of the life-threatening lapses cited were nearly identical to those found in the past.

For instance, the letter said, “there were no appropriately trained and competent staff, on the 3E unit, assigned to watch the heart monitors of seriously ill patients who required cardiorespiratory monitoring. This is especially troublesome, because previously documented cases showed that patients died when nurses at King/Drew failed to heed heart monitor warnings.”

Staff members also admitted to inspectors that they had hit a patient’s morphine pump at least five times to deliver additional sedation, even though the device is intended only to be used by patients. The inspectors called this “a very unsafe practice that can lead to over-sedation, respiratory depression or even death,” the letter says.

“Termination of the Medicare provider agreement is final,” the letter states in underlined text.


The federal government has threatened to pull its funding from King/Drew at least three times before, but it has repeatedly granted reprieves after county officials pledged reforms, including training and disciplinary action for problem employees. In June, the agency said King/Drew would not be given additional chances if it failed a final, top-to-bottom inspection, which was unannounced and took place July 31 to Aug. 10.

The federal action marks a striking failure for the Board of Supervisors, which has spent tens of millions of dollars trying to fix the hospital in the last three years and has been harshly criticized for ignoring King/Drew’s mounting problems.


The 252-bed hospital south of Watts is one of the few sources of acute healthcare for the uninsured in South Los Angeles, most of them African American or Latino. King/Drew has enormous symbolic value as well: It was created to remedy racial inequities in healthcare after the 1965 Watts riots and has long been a source of pride — and jobs — in the community.

King/Drew, the second smallest of the county’s four general hospitals, has 2,238 full-time employees and last year treated 11,000 inpatients and 167,000 outpatients.

The hospital has been beset by patient care lapses and other crises almost since it opened in 1972. But the last three years have been its most challenging. The latest crisis began in August 2003 when The Times reported that two women connected to cardiac monitors died after nurses failed to notice their vital signs deteriorating.

Since then, the newspaper and government inspectors have identified case after case in which patients have been harmed or killed because of serious lapses in care. The Medicare agency’s inspectors now have visited the hospital 15 times.

In December 2004, The Times ran a five-part series detailing how King/Drew was much more dangerous than the public knew. The newspaper found that, by a variety of measures, King/Drew was among the worst hospitals in the state, and even the nation.

The hospital’s failings did not stem from a lack of money, as its supporters long contended. King/Drew spent more per patient than any of the three other general hospitals run by Los Angeles County.


The county has scrambled to fix problems at the hospital, taking some form of disciplinary action against 650 employees since January 2004, more than a quarter of its staff. More than 250 employees, 41 of them doctors, have been fired or resigned under investigation, according to a Sept. 15 memo from the county Department of Human Resources.