Troubles at King-Harbor

Columba Avena wipes away a tear during a special meeting of the Los Angeles County Board of Supervisors on Monday. Avena's sister Edith Isabel Rodriguez died in May after writhing in pain on the floor of King-Harbor's emergency room lobby for 45 minutes, while staffers did nothing to help. (Brian VanderBrug / LAT)

Los Angeles County supervisors put their seal on the closure of Martin Luther King Jr.-Harbor Hospital on Monday, voting unanimously to shut inpatient services and promising to pay up to $16.3 million to nearby private hospitals and doctors bracing for a deluge of patients.

At a specially convened board meeting, supervisors also released a 124-page report by federal inspectors that detailed dozens of errors and failures by the hospital during a make-or-break review last month. In the last four years, the hospital has been cited more than a dozen times for patient care lapses and blamed for a series of patient deaths.

One patient complained of severe chest pain but was not given pain medication for 4 1/2 hours, the report said. Medical equipment was not sterilized properly, potentially exposing patients to infections. Under the scrutiny of inspectors, three nurses took more than three minutes to find a vial of medicine. Another didn't know how to mix medication during an emergency drill.

"I don't know how you'd be able to tell how stupid some of these people are," said Supervisor Yvonne B. Burke, whose district includes the hospital and who has previously raised strong opposition to closure. "I mean when I read this, I can't see how a nurse couldn't mix medicine. I can't see how she says, 'I don't know where to find this instrument.' That is incomprehensible."

On a broader level, the federal report faulted the public hospital and its governing body -- the Board of Supervisors -- for failing to execute an adequate plan for improving performance.

Inspectors concluded that there was no functioning quality improvement plan at the hospital. They noted that two key managers who were supposed to oversee the plan had been on the job a matter of weeks and had assessed only 40% of the hospital's inpatient services and none of its outpatient services.

"When it failed, it failed at the bottom level, but it filters all the way to us, and we're the ones that failed," said Supervisor Gloria Molina, who asked her colleagues to make the report public. It is posted on the Internet at bos.co.la.ca.us/Categories/Agenda/cms1_071137.htm.

Officials from several local hospitals told supervisors that the closure threatens the county's fragile emergency room network, which has seen 10 hospitals shut their departments in the last six years.

The county abruptly closed King-Harbor's emergency room to new patients Friday evening, citing a shortage of nursing staff. Inpatient units will be closed within the next 10 days as patients are discharged or transferred to other hospitals.

Surrounding hospitals reported a surge in critically ill patients Sunday and Monday mornings. And officials from several hospitals told supervisors that the county's reimbursement plan for people without medical insurance fails to cover losses expected from serving the King-Harbor population. Last year, the emergency room logged roughly 47,000 visits.



"We are at the breaking point," Rob Fuller, chief operating officer of Downey Regional Medical Center, told supervisors.

On Monday morning, Downey's emergency room was holding seven seriously ill patients because the hospital's intensive care unit was full. Four of those patients were from the King-Harbor area, Fuller said.

The county's plan would pay nearby private hospitals for treating indigent patients taken by ambulance from the King-Harbor coverage area. But officials from those hospitals noted that walk-in visitors made up the vast majority of King-Harbor's emergency room visits last year.

County Chief Executive William T Fujioka acknowledged that the reimbursement won't satisfy everyone but described it as "very, very fair." He said the county would find it difficult to link walk-in patients to the closure of King-Harbor, formerly known as King-Drew.

As part of the county plan approved Monday, health officials are in the process of opening an additional 52 beds at Rancho Los Amigos National Rehabilitation Center in Downey and 20 beds at Harbor-UCLA Medical Center in Torrance.

Outpatient clinics at King-Harbor will remain open, as will an urgent care center that will operate 16 hours a day. Supervisors pressed county Director of Health Services Dr. Bruce Chernof to reopen the facility within a year.

Chernof told supervisors that some medical employees at the hospital who were no longer needed would be reassigned to other facilities. It is unclear what will happen to the rest.

While Burke urged colleagues not to blame all hospital employees for the inspection results, Molina said everyone at King-Harbor should be tested for competency.

"We can't allow what has happened and the kind of poison that we've had at Martin Luther King Hospital poison the rest of our healthcare system," she said.

At the four-hour meeting, dozens of people spoke of the critical health needs in the area served by the Willowbrook hospital and urged the board to reopen it as soon as possible.

"Many lives have been saved in that emergency room, and we do not disparage all of the workers," said Rep. Maxine Waters (D-Los Angeles). "We do not support incompetence. We want qualified personnel. We want comprehensive medical services, and we too demand that we have the best."

jack.leonard@latimes.com

Times staff writer Charles Ornstein contributed to this report.