L.A. Urban Hospital Censured Yet Again

A national accrediting group has recommended closing the neonatal residency program at Martin Luther King Jr./Drew Medical Center, threatening the public hospital’s ability to treat premature and critically ill babies.

If the decision is upheld, neonatology would become the third of King/Drew’s 18 physician training programs to be shut down. The surgery and radiology programs have been ordered to close in June.

The latest action by the Accreditation Council for Graduate Medical Education is a blow to the heart of the hospital’s mission of serving its mostly poor and minority community. It also raises questions about whether the hospital can survive in its current form, given the barrage of penalties and sanctions being levied against it.

If the neonatal program is lost, two of the services for which King/Drew is best known -- trauma and neonatal -- will not have residents, the backbone of most major urban hospitals.

The proposed closing also demonstrates the vigor with which the national accrediting group is policing hospitals such as King/Drew after drawing criticism for being too lax.

With six of its 18 programs either slated for closing or in peril, King/Drew ranks among the most censured training institutions in the nation.

The hospital plans to challenge the findings of the accreditation council in hopes of keeping the neonatology training program.

“We are getting painted with the same brush as some of the other [training] programs -- and you know some of them deserve it,” said Dr. Xylina Bean, chief of the neonatology division at King/Drew. “But we don’t deserve it. When they throw dirty water, everyone gets splashed.”

Adding to the hospital’s woes, a team of health inspectors acting on behalf of the federal government began a three-day surprise visit Tuesday to look into the deaths of two adult patients at King/Drew this summer. Both women were connected to monitors but for various reasons their failing vital signs were not discovered until it was too late.

Last month, state health inspectors found that nurses had failed to adequately examine the patients and that some had never been taught to use the bedside monitors, which were new. In addition, one nurse lied about having performed crucial tests ordered by a doctor.

Those problems constituted a “serious systematic problem,” enough to warrant a complete federal review, said Lea Brooks, a spokeswoman for the state Department of Health Services.

If the U.S. Centers for Medicare and Medicaid Services concludes that the hospital’s problems are serious enough, it could cut off federal funding to King/Drew.

“It just seems like there’s no ending to this dysfunction,” said Assemblyman Mervyn Dymally (D-Compton), a longtime backer of Charles R. Drew University of Medicine and Science, which runs the residencies at the hospital in Willowbrook, south of Watts. “At some point, those in charge are going to have to take some responsibility for this.”

County health officials said they had assigned a number of different oversight teams and task forces to correct the problems.

But the latest inspection “could very well find additional problems that will require significant correction, which we are committed to do,” said Fred Leaf, chief operating officer for the county Department of Health Services. “We’re not going to allow the hospital to get to a point of being inviable. We’re just not.”

In its latest critical assessment of a King/Drew teaching program, the accreditation council said the hospital did not treat enough critically ill babies to ensure adequate experience for the doctors in training. Rotations at other hospitals did not make up for the paucity of cases, according to a copy of the council’s letter obtained by The Times. The letter states that King/Drew’s neonatal unit treated 43 babies with low birth weights in one recent year.

Neonatologists typically complete a residency in pediatrics and then a three-year fellowship specifically on health problems of very premature babies. King/Drew has three neonatal fellows.

Bean, chief of the neonatal division, said the accrediting group appeared to be penalizing the hospital for not having more babies die. In its letter, the group said King/Drew’s mortality rate is low; that is generally considered one way to measure the seriousness of patients’ conditions.

“How do you treat that?” Bean said. “Do you go off and kill off a few of your patients so your mortality rate will rise?”

The accrediting group, whose approval is required for hospitals to run teaching programs, also cited what it said was a lack of “quality” research by the program’s director and the fellows’ poor pass rates on board certification exams. For instance, two of three fellows failed a recent exam. In addition, the group said, one of the physicians who did not pass the boards herself now is responsible for teaching residents and directing research.

Bean defended her faculty, but said she would be willing to form partnerships with other hospitals to secure more experience for the fellows. She said the neonatal program would be able to continue operating without residents.

King/Drew now has until Jan. 7 to write a letter to the accrediting group in hopes of overturning the findings before they become final. If the hospital fails, it still has one more chance to appeal the decision to the council. The process could take more than a year.

But both Bean and Dr. Roberta Bruni, another King/Drew neonatologist, said they feared the negative focus on the neonatal residency program could make the whole neonatal intensive care unit a target for closure by Los Angeles County, which owns the hospital.

The county wants to close at least one of its four neonatal intensive care units to save money. A recommendation is expected around Dec. 15.

Drawing negative attention now is “like raising your little hand and saying, “I’m here. Kill me. Kill me,” Bruni said.

Dr. Jeffrey Guterman, the county health department’s medical director for clinical resource management, said the accrediting group’s proposed action won’t be a decisive factor in determining which of the county’s four neonatal units to close.

But, he said, “I would be disingenuous if I said that we didn’t look at all components of a facility in our decision-making.”

The county no longer needs to run four neonatal intensive care units, Guterman said, because births have fallen dramatically at public hospitals as the birth rate has declined and private hospitals have aggressively pursued pregnant Medi-Cal patients. In addition, the widespread availability of prenatal care and improved technology have reduced the number of babies who require intensive treatment.

Although Guterman said he couldn’t predict which hospital would lose its neonatal unit, he said that Los Angeles County-USC Medical Center was likely to keep its unit because it is the largest.

For King/Drew’s longtime supporters, the hospital’s newest troubles underscore the need for immediate change.

In October, the accrediting group proposed to give King/Drew a second unfavorable rating for its oversight of all 18 teaching programs. If the problems are not fixed, the hospital risks the closing of all of its residency programs.

The moves against neonatology and surgery indicate “something must be done, and fast, because you can’t allow those two to deteriorate,” said County Supervisor Yvonne Brathwaite Burke, whose district includes the hospital.

Dymally, who heads a special legislative committee on the hospital’s future, said he was so concerned about resident training at King/Drew that he had introduced a resolution in the Assembly calling for the University of California to assist in running the residency programs there.

But, he said, some supporters of the hospital and medical school seem less interested in solving the problems than in keeping outsiders at bay.

“I don’t get the impression that people are terribly concerned about what’s going on,” he said. “They’re more paranoid about UCLA than they are about the crisis that they face. There’s no question that my resolution is more relevant now than ever.”