Finding roles for workers at closed hospital

Hundreds of workers at Martin Luther King Jr.-Harbor Hospital are preparing to move to new county jobs as soon as next week, but Los Angeles County officials say they have yet to decide the fate of others who have failed competency tests or been disciplined for recent misconduct.

County officials say they have selected some of the best employees for reassignment to other county hospitals and are ready to execute the first stage of the latest plan to “wipe the slate clean” at troubled King-Harbor, which will be presented to the Board of Supervisors on Tuesday.

Firings and forced resignations have purged the hospital of more than 250 employees since 2004. Yet despite the effort to clean house, 68 workers disciplined during that time for misconduct remain assigned to King-Harbor.

What to do with the medical center’s 1,600 employees has become the most pressing issue facing Los Angeles County’s health system since the Willowbrook hospital closed last month. The county, which is searching for a private contractor to take over the hospital, shut King-Harbor after it failed to pass a critical inspection by federal regulators.

Though King-Harbor’s emergency room and in-patient services are closed, roughly 70 outpatient clinics for specialties such as gastroenterology, neurology and infectious diseases, and a 16-hour-a-day urgent care center, remain open.

The facility will need to retain enough workers to staff those services.

About 750 employees work there. County Chief Executive Officer William T Fujioka said that number probably would shrink.

County officials blame strict civil service rules and the hospital’s history of poor record-keeping for hampering past efforts to remove error-prone employees. But they also say that some workers deserve another chance and that discipline and retraining can sometimes help improve those who have made even egregious errors.

The result is that, in addition to hundreds of problem-free staffers, the county must now find homes for employees who have jeopardized patient care or have a record of misconduct.

Among the most serious cases found in a review of disciplinary appeals are:

* A nursing attendant suspended for 30 days for falling asleep while assigned to watch patients’ cardiac monitors. The April 2005 incident followed a series of cases in which patients at the hospital died after nurses virtually ignored their monitors.

County health officials said the nursing attendant was reassigned and is no longer working with patients. She has performed well since her suspension, they said.

* A nursing attendant suspended for 15 days for failing to keep constant watch of a confused stroke victim who needed a full-time sitter. While alone, the patient fell off a commode and struck her head, causing a brain hemorrhage.

Doctors had to take the patient off anticoagulation medicine to treat the injury -- a decision that left the patient vulnerable to “deep vein thrombosis (blood clots) and possible death,” according to the county’s suspension notification. The nursing attendant is on medical leave.

* A licensed vocational nurse suspended for 10 days for not updating medical records and refusing to follow a supervisor’s order. The nurse’s lengthy disciplinary history dates to 1987, the year she was hired, and includes rebukes for carelessly handling medical documents, failing to follow instructions and incompetence.

County health officials said the nurse has had only positive evaluations since returning to the hospital in February 2006.

John Barbadian, human resources director for the Department of Health Services, said the three employees would not be among the first round of those reassigned from King-Harbor.

Medical employees will be transferred to one of the county’s other four public hospitals: County-USC Medical Center in Los Angeles, Harbor-UCLA Medical Center near Torrance, Rancho Los Amigos National Rehabilitation Center in Downey, and ValleyCare Olive View-UCLA Medical Center in Sylmar.

He pledged that the department would thoroughly vet such employees, taking into account recent evaluations, competency test results and their disciplinary histories before deciding where they can work.

“We don’t want to pass these folks on without clearly looking at their discipline background,” he said.

In their final report on King-Harbor last month, federal regulators determined that the hospital did not meet minimum patient care standards and faulted the performance of nurses who could not find medical equipment or mix medicine properly.

The findings led county Supervisor Gloria Molina to blame King-Harbor employees. She warned that the “poison” at the hospital should not be spread to other county facilities. King-Harbor workers reacted angrily to the criticism, saying it was unfair to blame them all for the shortcomings of a few.

County officials have so far spent weeks going through the personnel files of King-Harbor employees to separate the good from bad. Supervisors expressed impatience last week with their slow pace.

“It’s time for us to really clean house,” Supervisor Zev Yaroslavsky said in a recent interview. “We don’t have the luxury of time.”

Cleaning house will mean working within rigid civil service rules that restrict when and how workers can be disciplined. The rules call on managers to take into account an employee’s length of service and prior discipline record.

Though serious misconduct can still result in an instant dismissal, civil service rules encourage a steady progression in discipline to improve a worker’s performance before resorting to termination.

The rules require managers to thoroughly document misconduct. At King-Harbor, that proved to be a “millstone around everybody’s neck,” Yaroslavsky said, because superiors neglected over the years to keep records on workers’ job performance.

The result was that some problem employees had personnel files that looked spotless.

“How do you fire someone whose personnel file shows that they’re doing a great job?” he asked. “The human resources system of this hospital was, for all intents and purposes, nonexistent. We have started to recreate it now.”

Those fired or suspended for more than five days have the right to ask the county’s Civil Service Commission to determine whether their discipline was fair.

Since 2004, the commission has seen a surge in appeals from King-Harbor employees, coinciding with a crackdown by the department in which nearly 400 workers have been disciplined.

Commission records show that King-Harbor employees have withdrawn nearly half of their appeals, sometimes after settling with the county. Such settlements are not made public.

As of July, 24 cases had been resolved by the commission. In 10 of those instances, commissioners found there was not enough evidence to justify the discipline.

In the case of Margaret Latham, the hospital’s former assistant nursing director, the commission determined that she deserved a demotion rather than a discharge. The department fired Latham after accusing her of telling nurses to falsify medical records to minimize how seriously ill patients were so she would not have to find more nurses to care for them.

A commission hearing officer wrote that the department failed to present any evidence implicating Latham in orders to falsify records and described her testimony before the commission as “credible and not contradicted.” The county Board of Supervisors recently authorized its attorneys to file a lawsuit challenging the commission’s decision.

Latham’s attorney, Howard Z. Rosen, said his client was highly competent and unfairly targeted as department officials reacted to a series of deaths and other patient care lapses by looking to punish employees. He said the case raised questions about the effort to clean house.

“I think it’s all for the press and ultimately for the public,” Rosen said. He faulted county supervisors for failing to take the hospital’s past medical problems seriously. “These people have let the situation occur and they’ve got to blame somebody, and they’re not going to get up and say, ‘It’s us.’ ”

Just how many workers will be transferred from King-Harbor remains unclear. County officials say they hope the transfers will help them avoid layoffs.

Officials at other county hospitals said they were unconcerned about taking in KingHarbor employees. The hospitals need additional medical workers to staff the extra beds they are opening to offset the loss of King-Harbor. Officials said they would test the competency of all arrivals before putting them to work.

“If they clearly can meet those standards, we’re really happy to have them as part of our institution,” said Jorge Orozco, acting chief executive officer of Rancho Los Amigos in Downey.

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jack.leonard@latimes.com

susannah.rosenblatt @latimes.com

Times staff writer Charles Ornstein contributed to this report.