Neonatal Unit at King/Drew May Be Downgraded

Los Angeles County health officials are planning to downgrade the status of the neonatal intensive-care unit at Martin Luther King Jr./Drew Medical Center, restricting its ability to care for the sickest newborns and chipping away at one of the hospital’s most cherished services.

The action is among a raft of changes recommended by the county Department of Health Services to stabilize the troubled public hospital in Willowbrook, just south of Watts.

Health officials also are proposing to renegotiate the county’s $13.8-million agreement with the Charles R. Drew University of Medicine and Science, which runs the 18 doctor training programs at the hospital. They want to change the way faculty members are paid and push Drew’s board of trustees to change its makeup.

Dr. Thomas Garthwaite, director of the county Department of Health Services, said the proposals resulted from a top-to-bottom review of operations at King/Drew following a series of problems with patient care, physician training and financial mismanagement.

The downgrade of the neonatal unit, set for July, could require approval by the county Board of Supervisors. Other problems at King/Drew are scheduled to be discussed at a special session of the board today.

The meeting will include testimony from former U.S. Surgeon General David Satcher, who led a county-appointed task force that examined physician training problems at Drew University and King/Drew.

Downgrading King/Drew’s neonatal ward -- from a regional to an intermediate-care unit -- would mean the hospital would no longer care for newborns in intensive care or babies who require ventilators to breathe for more than four hours. Severely ill patients would be transferred to Harbor-UCLA Medical Center or County-USC Medical Center.

The plan is sure to be contentious because the unit is well regarded by many hospital staff members and patients.

“I have heard a lot of bad things about King/Drew, but they have really been good to me,” said Laquita Hunter, 30, referring to the unit’s staff. “They show me a lot of love.”

Hunter gave birth to two sets of twin daughters at King/Drew; one twin from each set had to spend time in the neonatal unit.

Of the 783 babies born at the hospital in 2002-03, about 135 were in the category proposed for transfer, Garthwaite said.

County health officials say the action is being taken to save money and consolidate services. The neonatal unit at Olive View-UCLA Medical Center also is being downgraded to an intermediate unit. After the downgrades, both hospitals would need fewer doctors and nurses to care for babies, Garthwaite said.

With the number of births at the county’s public hospitals down by more than 85% since 1991, high-level neonatal units are no longer needed at all four full-service public hospitals, county officials said.

The county cited other reasons for the plan as well, related to teaching and patient care. Late last year, a national accrediting group recommended closing King/Drew’s neonatal physician training program because it said the hospital did not treat enough critically ill babies to ensure adequate experience for the trainees. Rotations at other hospitals did not make up for the paucity of cases, the group said.

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 poor pass rates by trainees on board certification exams.

Separately, a division of the California Department of Health Services decided last month to withdraw the state’s recognition of King/Drew as a highly specialized hospital for care of newborns and children. The department cited lapses in care by physician trainees and incomplete nursing assessments, among other things.

Dr. Xylina Bean, director of the neonatology division at King/Drew, has asked the state health department to reconsider its findings, adding that she would be willing to form partnerships with other hospitals to secure more experience for physician trainees.

She said her unit treats more sick babies than Harbor-UCLA and serves a community with higher rates of poverty, lower rates of insurance, less access to medical care and poor transportation to private hospitals.

“You’re telling the people in this community that they don’t matter,” Bean said. “You’re telling the people in this community that you don’t care about their problems. You’re telling the people in this community that you’re on your own.”

Garthwaite said he chose to scale back the neonatal program at King/Drew because he believes that its costs are relatively high and the unit houses babies that don’t require the costly care. He said Harbor-UCLA has performed more like a regional referral center than King/Drew, by accepting more babies from outside hospitals.