Despite community protests, an on-air assault by a popular radio host and the near-unanimous opposition of city political leaders, most of the county supervisors said they remain committed to vote, probably Tuesday, in favor of closing the trauma center at Martin Luther King Jr./Drew Medical Center.
Their stand reflects political reality: The Los Angeles County board faces pressures to close the center that are no less compelling than the public pressures to keep it open. At this point, backing down would be difficult.
County officials contend that closing the trauma center, which treated 2,150 patients with critical wounds last year, is crucial to turning around a troubled hospital where neglect has been tied to the deaths of several patients. Reversing that plan now, they say, would seriously hamper efforts to fix King/Drew.
Interviews over the last few days indicate that four of the five supervisors — Don Knabe, Zev Yaroslavsky, Mike Antonovich and Gloria Molina — are strongly inclined to close the trauma center in Willowbrook, south of Watts.
"These are painful decisions," Knabe said, "but you have to take this dramatic action to try and save the hospital."
Tuesday's scheduled vote comes as officials are trying to convince federal inspectors and national accrediting groups that the county has the resolve to correct the many problems at King/Drew and avoid losing the funding and accreditation vital to keeping the hospital open.
Backing away from the closure would also mean a very public abandonment of the county's top health official, Dr. Thomas L. Garthwaite, the architect of the closure.
Keeping the trauma center open would require supervisors and county health officials to reassess arrangements approved last week to open a new trauma unit at California Hospital Medical Center just south of downtown. The county's financial agreement with California Hospital hinges on the medical center treating hundreds of trauma patients who would otherwise rely on King/Drew.
Moreover, despite the protests, the political costs of closing the King/Drew trauma center are far from clear.
Most opposition has come from the South Los Angeles community served by the hospital, where many believe that closing the trauma center would require victims of gunshots and car accidents to go farther for trauma care.
That area is represented by Supervisor Yvonne Brathwaite Burke, who withdrew her endorsement of the closure after complaints from community activists, local residents and doctors at the facility.
There has been little evidence so far that the passion to save the trauma center extends beyond South Los Angeles.
"Politically, because [supervisors are] elected by district, I think that a lot of them don't have a lot at stake," said Raphael Sonenshein, a professor of political science at Cal State Fullerton.
Except for Burke, other supervisors and their aides said they had received barely any dissent from their constituents.
"We have not received any sort of clamor from our district to keep it open," said Roxane Marquez, Molina's press deputy. A large chunk of Molina's district borders the area served by King/Drew's trauma unit.
"There hasn't been a credible alternative proposed," Yaroslavsky said. "What we've had is a lot of defending of the status quo."
That continued support for the closure has reinforced feelings among opponents that the fate of the trauma unit had already been decided and that last week's public hearing and protest, which drew more than 1,000 people, were simply a formality.
"It does seem that their minds are made up," said Los Angeles City Councilwoman Janice Hahn, whose father, the late Supervisor Kenneth Hahn, helped found the hospital.
Hahn and others critics — including U.S. Rep. Maxine Waters (D-Los Angeles) and radio host Steve Harvey — fear that closing the center will jeopardize victims of gunshot wounds and car accidents because paramedics will have to drive to another trauma center.
"Minutes count in a trauma injury," Hahn said. "People are going to lose their lives in South Los Angeles because people are going to have to travel farther."
At the center of the debate over the trauma center is the fate of the entire hospital.
County health officials contend that the high volume of trauma patients threatens the quality of patient care throughout King/Drew.
Trauma patients often require the attention of more than a dozen doctors, nurses and other medical professionals, placing an enormous burden on the rest of the staff. Once out of trauma care, critically wounded patients continue to require intensive attention in other areas of a hospital.
Closing the trauma unit, county health officials said, would ease the strain on the rest of the hospital, allowing administrators to pay more attention to other problems.
County supervisors acknowledge that closing the trauma unit is a drastic step, but believe that after years of failed attempts to reform King/Drew, only dramatic action has a chance of working.
Yaroslavsky said the supervisors asked Garthwaite to come up with the best medical advice for King/Drew regardless of the political consequences.
"The clock has been ticking," Antonovich said. "We need to make a decision. We need to move forward . There has been too much compromise in the past."
As the county tries to clean up problems at King/Drew, it does so under scrutiny from accrediting agencies and the federal government, whose sanctions could cause the closure of more portions of the hospital or even the entire facility.
The county was required last month to hire an outside management firm to run the hospital as part of an agreement with the federal government to stave off what would be a crippling loss of $200 million in federal funds.
Meanwhile, the Joint Commission on Accreditation of Healthcare Organizations has also recommended pulling its seal of approval. The county is appealing.
If the county loses its appeal, the hospital could lose nearly $15 million in private insurance reimbursements and almost certainly would have to close the trauma unit, regardless of the county supervisors' vote. The national accrediting agency's president, Dennis O'Leary, has said he supports the county's proposal to close the trauma center, though he has said he believes it is not the only way to fix the hospital's problems.
"The hospital has one foot on a banana peel and another out the door," said Jim Lott, executive vice president of the Hospital Assn. of Southern California. "You can't turn it around if you're forever dealing with trauma patients and crises."
Lott said the closure plan is widely supported by the hospital industry across Southern California because officials fear the alternative ultimately would be shutting the entire hospital. That would place a major strain on the rest of the healthcare system.
The county has argued that, because of California Hospital Medical Center's decision to open a new trauma center, trauma care in South Los Angeles would not suffer.
Administrators at California Hospital, about 10 miles to the north of King/Drew, had been considering opening a trauma center for some time but worried about whether it would be financially viable. The number of trauma centers in Los Angeles County has been falling over the last 20 years because of the high cost of treating uninsured patients.
The county and California Hospital agreed on a plan earlier this month under which the county would provide financial incentives to make sure the hospital could cover the cost of treating uninsured patients.
County officials said California Hospital would pick up the majority of the King/Drew trauma patients, roughly 1,200 a year.
The arrangement has added to suspicion among critics that the opening of California Hospital's trauma center requires the closure of King/Drew's, an allegation county health officials deny.
Existing trauma services are so overwhelmed that California Hospital's and King/Drew's units could conceivably operate together, said Carol Meyer, director of the county's Emergency Medical Services Agency.
Critics of the closure remain skeptical. To them, closing the trauma center is the wrong way to fix King/Drew. Rather, they believe the county should make the unit, a critical service in one of the county's poorest areas, a top priority for improvement.
"We're saying mend it, don't end it," Janice Hahn said. "Why haven't they fixed the problems at the hospital?"