On the sultry evening of Aug. 11, 1965, a 21-year-old black man named Marquette Frye was pulled over by the California Highway Patrol at 116th Street and Avalon Boulevard for driving drunk.
A crowd gathered. Frye resisted arrest. A patrolman struck him in the face with a nightstick.
It was as if the blow knocked loose the cornerstone of a dam.
What poured forth was a torrent of rage, propelled through the streets of Watts and South Los Angeles by the conviction that African Americans had lived too long with the contempt of a white-run society — denied respect, along with decent housing, education and medical care.
That flood of anger led directly to the creation of Martin Luther King Jr./Drew Medical Center, which opened in 1972. And the power of that feeling, rooted both in centuries of black struggle and in pride and hope for a better tomorrow, has always been as much a part of the hospital as IV drips and surgical gloves.
From the beginning, King/Drew was to be something special — a hospital that reflected African American achievement and power, a model for urban hospitals nationwide.
But within three years, it had become clear that, for all the aspirations the hospital represented, it was falling far short. At times, instead of healing its patients — almost all of them black and Latino — it was killing and maiming them.
The Los Angeles County Board of Supervisors, which runs the hospital, was left with a political and moral dilemma:
It could take tough, decisive action, which would surely bring protests and pickets. Or it could take the path of least resistance — issue ineffective reprimands, commission studies, fire an administrator or two — and hope the problems would go away.
The political price of inaction was small. Members of the Board of Supervisors rarely face serious electoral challenges, and the people being harmed were not politically powerful or well-connected.
So, given the choice — the distress of racial politics on the one side, the likelihood of more needless deaths on the other — the board chose to risk the latter.
And the problems didn't go away. If anything, they got worse.
In the last year, the county-owned hospital slid into such crisis that the supervisors took the strongest and least popular steps ever to fix King/Drew, closing the trauma unit and hiring an outside consulting firm to manage the hospital for a year.
As they did so, the supervisors were forced to admit that it had taken years of neglect — their neglect — for the hospital to reach such straits.
"We should be embarrassed, all of us collectively," Supervisor Gloria Molina acknowledged at a recent meeting, "because we have failed the community."
It was a remarkable admission from someone who sits on what is, by some measures, the most powerful local political body in the United States.
The 'five little kings' Collectively, the five supervisors — Molina, Michael Antonovich, Yvonne Brathwaite Burke, Don Knabe and Zev Yaroslavsky — represent more constituents than all but eight U.S. governors. They spend twice as much money annually as the combined governments of El Salvador, Nicaragua, Honduras and Costa Rica.
They are both the executive and legislative branches of county government, which gives them broad powers with few checks and balances.
Yet for all their power, the "five little kings," as they have been called, have been unable or unwilling to provide consistently decent healthcare to some of the neediest, least powerful people they represent.
A Times investigation published over the last four days has detailed how King/Drew, by a variety of yardsticks, has become one of the worst hospitals in California and, in some respects, the nation. The record is replete with botched surgeries, misdiagnoses and fatal neglect by nurses.
There is no shortage of people to share the blame.
There have been bureaucrats too timid to tell their superiors the truth. Hospital administrators who downplayed problems. Department heads who tolerated lax discipline. State legislators and members of Congress who stood in the way of change. Regulators and accreditors who balked at sanctions. An affiliated medical school, at the private Charles R. Drew University of Medicine and Science, that failed to provide the expertise and prestige that UCLA and USC offer other county hospitals.
But the county board, more than anyone, had the power to shape King/Drew, for good or ill.
The supervisors have generally responded to the alarm bells at King/Drew weakly or not at all. They have expressed shock at each fresh disclosure of problems, and offered piecemeal reforms that didn't work or didn't last.
"We have not had the information that there were these kinds of problems," Burke said last December, when federal inspectors charged that the hospital was shirking the fundamentals of good patient care.
Why, asked Yaroslavsky, weren't the supervisors told that "the place is going to hell in a handbasket?"
The evidence suggests that they were told — repeatedly.
No major malpractice claim at King/Drew can be settled without the supervisors' approval. Some of the claims at King/Drew, said Molina, were so "astounding" she could "hardly believe it."
They were just one tipoff to the hospital's failings.
Regulators and consultants sent reports. Whistle-blowers complained. Employees sent petitions. Newspapers wrote exposes. Mistreated patients and their families told their stories.
All that information, and more, was available to the supervisors.
But the mistakes continued and, over the years, bodies piled up. Some died in horrifying ways: poisoned by accident, paralyzed by drug overdoses, abandoned in their own vomit.
The reasons for the supervisors' failure are as complex as the county itself. Race has been an issue, but so have incompetent or neglectful workers and bureaucrats — and a rigid Civil Service system that hampers efforts to fire them.
"Most fundamentally," said Assemblyman Mark Ridley-Thomas (D-Los Angeles), whose district includes neighborhoods served by the hospital, "it's a failure of resolve to address the issue creatively and forthrightly."
There's also an issue of turf. By long tradition, the board hands over responsibility for county institutions to the supervisor in whose district they lie.
In the 32-year history of King/Drew, only two supervisors have represented the 2nd District: Kenneth Hahn, a revered powerbroker; and Burke, a committed conciliator.
Both were players in King/Drew's saga from the beginning; both failed to make it the hospital it was meant to be.
Behind riots, deep grievances Months after the Watts riots, Gov. Pat Brown convened a commission chaired by former CIA Director John McCone to investigate the causes. The obvious trigger was the Frye arrest. But the grievances reached much deeper.
The McCone Commission concluded that African Americans in Los Angeles had been denied a fair share of public services, prominently including healthcare. There was no accredited hospital in Watts or surrounding communities; the nearest public hospitals were far away and hard to reach by public transportation.
The McCone report galvanized Kenny Hahn, then in his prime on the Board of Supervisors. First elected in 1952, he was a natural-born politician.
A white man, he cultivated a devoted following, even after his heavily white district turned heavily black. It was a following that would, decades later, help elect his son, James K. Hahn, as mayor, and his daughter, Janice, to the City Council.
Had a lesser politician been supervisor, King/Drew would not have been built. County voters turned down a bond issue to pay for it, many reasoning that it was like rewarding Watts residents for rioting. A majority of his fellow supervisors were skeptical, if not outright opposed.
Hahn's daughter still loves to tell how her father cut short a Hawaiian vacation and herded his family back home when he got wind of a board vote to scuttle the hospital.
"A man," he grumbled, "should be entitled to a legitimate vacation. This is a sneaky way to do business, when a man's back is turned."
Ultimately, Hahn cajoled the state Legislature into funding the hospital. He orchestrated its opening, and watched with pride as young, idealistic African Americans set out to run it.
"It broke down racism like you wouldn't believe," said Dr. Melvin Fleming, an early hospital administrator. Like every other top administrator at the hospital since it opened, he is African American.
Before King/Drew, he said, "we were excluded from any kind of experience at running a hospital in Los Angeles County because of racism."
Until he left office in 1992, Hahn remained King/Drew's patron. He met regularly with hospital officials. King/Drew's community advocates knew they could always reach him by phone.
"Kenny Hahn was our savior; he was our leader," said Dr. Richard Allen Williams, a cardiologist who was involved from the start. Hahn, he added, was "willing to come at any time, any hour, under any circumstances, to make sure that Martin Luther King hospital had what it needed."
What Hahn couldn't do was guarantee that the hospital would succeed.
By 1975, only three years after it opened, The Times was reporting that "horror stories implying neglect and incompetence, especially by nursing personnel, are heard regularly" at King/Drew.
In 1977, a disgruntled nurse wrote Hahn anonymously to complain that the hospital was dirty, patients were "sent around in circles," doctors scheduled to be working were not on the premises and some employees worked drunk or under the influence of drugs, some of them stolen from the hospital pharmacy.
All this, the nurse wrote, had led to the nickname "Killer King," which dogs the hospital to this day.
County officials made few substantial changes until 1989, when a story in The Times described a systemic breakdown of care at King/Drew, where "a disproportionate number of patients are dying."
Hahn demanded an investigation, which led to the dismissal of the medical center's administrator. The hospital hired more nurses and established a team to monitor nursing care.
The fixes didn't hold.
Antonovich, the longest-serving of the current supervisors, spent more than a decade on the board with Hahn. While acknowledging his own role in King/Drew's failures, he said his former colleague, who died in 1997, five years after retiring, left a mixed legacy there.
"Kenny was very protective of the hospital, because of his leadership in getting the hospital built," Antonovich said. "Where he erred was in not demanding the same high-level degree of management and accountability at that hospital as the other county hospitals have had."
A balancing act for Burke By the time Yvonne Brathwaite Burke was elected in 1992, King/Drew seemed to be in perpetual trouble.
The shooting of Sheriff's Deputy Nelson Yamamoto had occurred months before she was sworn in. Yamamoto was saved by King/Drew emergency surgeons, only to die 42 hours later. The coroner said the deputy died of the gunshot wounds. The district attorney faulted doctors, although no charges were filed.
In the face of such challenges, Burke seemed to bring ample talent and experience to the job.
She had been a pathfinder as a black woman in politics, her every job seeming to break new ground. As a young real estate lawyer, she had been a staff attorney to the McCone Commission, drawing attention for her astute handling of politically sensitive matters. In 1976, not long after she became the first sitting member of Congress to have a baby, U.S. News & World Report ran an interview with her under the headline: "A Woman President 'Any Day Now.' "
As supervisor, Burke waded into the politics of King/Drew, initially defending the hospital in the Yamamoto case. A year after her election, she expressed confidence that there was "no intentional maltreatment or gross negligence" in his death.
But as details emerged suggesting that the deputy had been killed by a lethal combination of heart drugs, she reversed herself, saying in July 1995 that the death, along with six other suspicious ones, was "terribly indicting."
The incident foreshadowed the difficulties Burke would face — navigating between a community that demanded protection for the hospital, and outside forces demanding reform.
That December, Burke called for an immediate, sweeping reorganization at King/Drew. Antonovich praised her for "biting the bullet on this very difficult situation."
Burke got her "swift and decisive action," much as Hahn had in 1989: a new nursing director, a team of nursing consultants, a "medical management surveillance team" to keep an eye on doctors, new chiefs for key medical departments — and a new administrator.
Yet a year later, in 1997, Burke called for a new investigation, this time in response to reports that a 3-year-old had received a transfusion of the wrong blood type.
So it went, one problem following another.
"I have to be very honest," Burke said recently. "I have existed from crisis to crisis over this whole 12 years."
As the crises have multiplied in the last year, she has expressed increasing exasperation, but has not proposed any comprehensive plan to fix things.
On a warm Monday in September, she sat alongside her four colleagues in a cramped, dimly lit conference room in the downtown Hall of Administration, facing a bank of cameras and vowing to heed the advice of the county health director, Dr. Thomas Garthwaite, to shut down King/Drew's trauma unit.
Garthwaite said the closure would "decompress" the hospital by sending patients with serious, traumatic injuries to other hospitals. The supervisors had agreed in secret meetings — later deemed violations of the state's open-meetings law — to give it a try.
Now they were announcing their intentions in public.
Burke wasn't happy. But she agreed: "We have to do what we have to do."
The announcement met with an outcry, not only from the usual community activists and political leaders, but from paramedics and police officers who argued that the decision would cost lives by delaying the time it took for some patients to get care. The decision, and the way it was reached, inflamed long-standing suspicions that the board was bent on closing the entire hospital.
Four days later, Burke backed down.
The matter, she said, needed more study.
This time, her fellow supervisors didn't follow her lead. They voted 4 to 0 last month to close the trauma center, with Burke abstaining.
Although she was praised by some for her change of heart, others said it fit an unfortunate pattern.
"That isn't leadership," complained the Wave, a weekly newspaper that circulates in areas served by King/Drew. "It's going in whatever direction the winds of public opinion blow."
Burke is known as an able negotiator and conciliator — qualities that have generally served her well as a supervisor. Larry Aubry, founder of the fledgling Community Oversight Committee, a watchdog group that keeps an eye on political leaders in South-Central Los Angeles, described Burke — not disparagingly — as "an avowed, self-described centrist."
"In other words," he continued, "she's a moderate. And I'm suggesting that no moderate is going to turn this thing around."
Fiercely protective activists Burke's moderation stands in marked contrast to many of the voices heard in the King/Drew debate.
The supervisor herself has said the inflammatory rhetoric from community activists and political leaders has made it hard for her to support reforms at the hospital
Speaking in October 2003 about the hospital's administrators, she said: "Personally, I think I should have pushed for many of these people to be replaced, but any time anything is done, the community has become totally upset."
Since its founding, King/Drew has been fiercely protected by a group of African American activists who have forged close ties to many of the doctors and administrators at the hospital and rallied behind them when county officials demanded change.
Health department chief Garthwaite said he understood why members of the community had reacted as they did.
"I think it's a terribly regrettable statement in our society that no one cared about the healthcare of the citizens of South Los Angeles until there was a riot," he said. "What does that say? The only way to get attention is to be loud and to be political."
The loudest, most political voice on King/Drew in the last year hasn't been Burke's but that of Rep. Maxine Waters (D-Los Angeles), who has rallied community opposition to much of what the supervisors have tried to do at the hospital.
When the supervisors met to discuss the proposed trauma center closure last month, Waters organized a demonstration, roused political leaders, including the Rev. Jesse Jackson, and then virtually hijacked the board's session by grabbing the microphone and staging a one-woman tour de force.
It enhanced her reputation with many in the community, who saw her — unlike Burke — as someone willing to use every weapon in the activist's arsenal to fight for her constituency.
But some have accused Waters — and others — of being knee-jerk King/Drew defenders.
"Why weren't they out in front of the hospital with placards demanding that the hospital serve the community the way Cedars [-Sinai] serves its community?" asked Joe Hicks, a longtime civil rights leader, referring to the prominent medical center on Los Angeles' Westside. "Why are they now standing in the way of reform?"
Fear of being called racist At the heart of the rhetoric surrounding the hospital has been the issue few politicians want to confront: race.
Some in the core group of hospital activists have made race a central element. Members of the Board of Supervisors and other critics have been reluctant to take on problems partly for fear of being branded racists.
"Asking about King/Drew really was like touching the third rail," said Connie Rice, a prominent civil rights lawyer who is African American. "You would get such a voracious and vicious, racially accusatory backlash that no one would touch it."
As a public hospital, King/Drew cannot be a black institution — at least not officially. But in practice, it and its affiliated medical school have been black since their inception.
"It's the most symbolic and substantive institution in the black community," said state Assemblyman Mervyn Dymally, who has been involved with the hospital throughout its history. "It is probably the only major institution in which we have a sense of ownership. King/Drew is ours . It's a product of our sweat and tears."
Most King/Drew employees — including many doctors — are black, as are the vast majority of administrators. Given all that, some community activists consider criticism of the hospital to be racist.
Several county supervisors said they had received racist hate mail over the years whenever they had spoken out about problems at King/Drew.
"They're just really, really, nasty, nasty letters," said Molina, a Latina who has been accused — falsely, she says — of wanting to change the name of the hospital to "Benito Juarez Medical Center," after the 19th century Mexican statesman and national hero.
"There are some political leaders who look at everything through a racial context," Antonovich said. "But when you have political leaders using the race card to prop up inferior medical standards and inferior management, they are doing a disservice to the community."
When supervisors talk about race-based criticism, one voice they cite is that of Ernie Smith, ombudsman for the Black Community Health Task Force, an influential grass-roots organization that is an advocate for African American interests at the hospital.
An engaging man with a PhD in comparative culture from UC Irvine, Smith (no relation to Dr. Ernie Smith, a pediatric cardiologist quoted earlier in this series) is passionate and knowledgeable about the hospital, but couches his arguments in racially bombastic language.
He has warned ominously about a Latino takeover of the hospital. In his lexicon, Garthwaite, the white physician who heads the county health department, is the "grand wizard," an allusion to the Ku Klux Klan. Police are "pigs" and "Rottweilers." King/Drew's African American administrators are establishment pawns, "old hog-maw and sauce-eatin' Negroes."
Many people associated with the hospital insist that race is no longer a significant issue there, or that it is beside the point.
"It's a hospital that's named after Dr. King, but it treats anyone who comes in the door," said former Assemblyman Roderick Wright.
Dr. Xylina Bean, who heads the neonatal division at King/Drew, argues that the hospital and its patients have been the victims of class prejudice as much as racism.
"It's based more in a concept that poor people do not deserve, just because they're poor, the same level of quality of care that the rest of the world requires," Bean said earlier this year at a community meeting. "You can call it racism if you want to, because it does tend to reflect upon specific people who just happen to be African American or just happen to be Hispanic."
Different dynamic for Latinos King/Drew was built at a pivotal time in Los Angeles history, just as African Americans were coming into their own as a powerful political force.
At the same time, the city's Latino population was starting to surge as immigrants flowed north from Mexico and Central America. Latinos now constitute a majority of residents in the area surrounding King/Drew, and a plurality of the hospital's patients.
Despite their greater numbers, Latinos have tended to keep quiet — at least publicly — about King/Drew, even when they believe the hospital has ill served them. They have not agitated for change, in the supervisors' chambers or in the streets.
One likely reason is that many in the community served by King/Drew are illegal immigrants leery of drawing attention to themselves.
"The fear factor is a big barrier to these people getting involved," said Arturo Ybarra, a political organizer who has spent more than 13 years trying to rouse Latinos to take a more assertive role at King/Drew. "They play it low key."
Also, many immigrants come from countries where poor healthcare is a fact of life. King/Drew may be better than any hospital they have known.
"Back in our country, you are used to this," said Jaime Calderon, 42, who grew up in rural El Salvador before immigrating to the U.S. "You go to the hospital there, and they're supposed to operate on your right leg and instead they operate on the left."
Calderon's older brother died at King/Drew in 2002 after a botched liver biopsy.
There may be another dynamic at work. Among Latinos, the hospital does not hold the outsized significance it does for many African Americans. "It's another county hospital to them," said Molina. "It isn't 'their' hospital."
This is true at the most fundamental levels. To begin with, many Latinos say they face a language barrier at King/Drew that makes it seem alien and forbidding.
"I don't communicate well with the staff at the hospital," said Rebecca Hernandez, who emigrated from Mexico 14 years ago and lives in Watts with her husband and four children. She speaks only Spanish.
"They give me written instructions," she said, "but they're all in English. I throw away all the papers because I don't understand them." Although some King/Drew employees do speak both English and Spanish, they aren't always available.
Latinos aren't the only ones who lack a sense of ownership. Many younger black people take the hospital and its conditions for granted, much as someone might accept a long line at the post office.
"A county hospital," said Steven Brown, 36, as he propelled his wheelchair down King/Drew's sidewalk, "is like a county jail. It's always going to be full, but they take care of everybody."
This may be King/Drew's most insidious enemy — the burden of low expectations.
Both grateful and angry Marcia Kpodo's experience with King/Drew is neither the best nor the worst. It speaks to an uneasy ambivalence that many served by King/Drew feel. Kpodo hurried to the hospital one day in January after she learned that her niece, visiting from Philadelphia, had been rushed there with acute appendicitis.
Kpodo arrived to find her 25-year-old niece in agony, still waiting for treatment in the emergency room. She pleaded with the staff to remove the appendix before it burst. She spoke with an administrator and finally begged for help from Rep. Waters, who happened to be touring the hospital. Waters asked the attending physician to treat Kpodo's niece as soon as possible.
Nothing worked. "They told me their hands were tied, because they didn't have an operating room at the time," Kpodo said later.
Not until nearly 12 hours after her niece's arrival did surgeons operate, successfully removing the appendix.
The next day, Kpodo appeared at a community rally led by Waters on behalf of the medical center.
"I'm eternally grateful to King/Drew," Kpodo told the cheering crowd of King/Drew activists.
Later, she acknowledged her anger at the delay her niece endured — but she didn't blame the hospital. Rather, she faulted a medical system that seemed to penalize the less fortunate.
"America," she said, "should be ashamed."
Times staff writers Daren Briscoe, Steve Hymon, Charles Ornstein and Tracy Weber contributed to this report.
On Dec. 23, The Times will publish an article discussing potential solutions to problems raised in its five-part series, "The Troubles at King/Drew." In addition to seeking the opinions of healthcare experts, political leaders and others, the newspaper welcomes ideas from readers. These may be sent to firstname.lastname@example.org.