At the center of the debate over the trauma center is the fate of the entire hospital.
Trauma patients often require the attention of more than a dozen doctors, nurses and other medical professionals, placing an enormous burden on the rest of the staff. Once out of trauma care, critically wounded patients continue to require intensive attention in other areas of a hospital.
Closing the trauma unit, county health officials said, would ease the strain on the rest of the hospital, allowing administrators to pay more attention to other problems.
County supervisors acknowledge that closing the trauma unit is a drastic step, but believe that after years of failed attempts to reform King/Drew, only dramatic action has a chance of working.
Yaroslavsky said the supervisors asked Garthwaite to come up with the best medical advice for King/Drew regardless of the political consequences.
"The clock has been ticking," Antonovich said. "We need to make a decision. We need to move forward . There has been too much compromise in the past."
As the county tries to clean up problems at King/Drew, it does so under scrutiny from accrediting agencies and the federal government, whose sanctions could cause the closure of more portions of the hospital or even the entire facility.
The county was required last month to hire an outside management firm to run the hospital as part of an agreement with the federal government to stave off what would be a crippling loss of $200 million in federal funds.
Meanwhile, the Joint Commission on Accreditation of Healthcare Organizations has also recommended pulling its seal of approval. The county is appealing.
If the county loses its appeal, the hospital could lose nearly $15 million in private insurance reimbursements and almost certainly would have to close the trauma unit, regardless of the county supervisors' vote. The national accrediting agency's president, Dennis O'Leary, has said he supports the county's proposal to close the trauma center, though he has said he believes it is not the only way to fix the hospital's problems.
"The hospital has one foot on a banana peel and another out the door," said Jim Lott, executive vice president of the Hospital Assn. of Southern California. "You can't turn it around if you're forever dealing with trauma patients and crises."
Lott said the closure plan is widely supported by the hospital industry across Southern California because officials fear the alternative ultimately would be shutting the entire hospital. That would place a major strain on the rest of the healthcare system.
The county has argued that, because of California Hospital Medical Center's decision to open a new trauma center, trauma care in South Los Angeles would not suffer.
Administrators at California Hospital, about 10 miles to the north of King/Drew, had been considering opening a trauma center for some time but worried about whether it would be financially viable. The number of trauma centers in Los Angeles County has been falling over the last 20 years because of the high cost of treating uninsured patients.
The county and California Hospital agreed on a plan earlier this month under which the county would provide financial incentives to make sure the hospital could cover the cost of treating uninsured patients.
County officials said California Hospital would pick up the majority of the King/Drew trauma patients, roughly 1,200 a year.
The arrangement has added to suspicion among critics that the opening of California Hospital's trauma center requires the closure of King/Drew's, an allegation county health officials deny.
Existing trauma services are so overwhelmed that California Hospital's and King/Drew's units could conceivably operate together, said Carol Meyer, director of the county's Emergency Medical Services Agency.
Critics of the closure remain skeptical. To them, closing the trauma center is the wrong way to fix King/Drew. Rather, they believe the county should make the unit, a critical service in one of the county's poorest areas, a top priority for improvement.
"We're saying mend it, don't end it," Janice Hahn said. "Why haven't they fixed the problems at the hospital?"