Chernof said in June that the hospital was well prepared for the visit. "The staff is really getting to the point where they would welcome the survey," he said at the time. "They've put a lot of energy in this and they're kind of ready to take the final exam."
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.
Since the series ran, problems continued at the hospital, including additional patient deaths and timecard abuse by county-employed physicians and those under contract at King/Drew. The Times discovered that Navigant Consulting, the firm that has been paid more than $17 million to overhaul King/Drew, had inflated its own expenses.
In February 2005, the hospital lost its seal of approval from the Joint Commission on Accreditation of Healthcare Organizations, another vote of no confidence by medical experts in the hospital's quality.
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.
Former county health director Dr. Thomas Garthwaite said Friday that before he left in January, Catholic Healthcare West had expressed interest in taking over King/Drew. The county also discussed turning the hospital into an outpatient clinic under the licensure of Harbor-UCLA Medical Center.
"I think you've got to be able to pass the [Medicare] and the Joint Commission standards to run a hospital," he said. "Virtually every other hospital in the United States does."
County officials have said repeatedly over the last 2 1/2 years that King/Drew has turned a corner. Each time, when inspectors returned to assess the hospital's progress, they found problems.
In September 2004, the agency entered an unusual contract with the county, giving it a year to overhaul King/Drew's operations under the guidance of a hospital turn-around firm. But that deal expired and federal officials did not renew it.
The county had expected a final top-to-bottom evaluation of its reform efforts by January, but the regulators took far longer than expected. In June, after California's top health official accused the federal agency of jeopardizing patients' safety by moving too slowly, the agency said it would conduct a surprise review within 90 days.
At that time, Jeff Flick, the Medicare agency's regional administrator, said, "If they are out of compliance, basically the funding stops."
But he said that if the county turned the operation over to an outside provider or sold it, federal funding might be restored.
Lott said that if King/Drew closes, nearby emergency rooms could be overwhelmed and close.
"This will be the linchpin that brings down emergency medical services in that area," he said. "I have no doubt about it."